Vitamin A and iron status of children before and after treatment of uncomplicated severe acute malnutrition

Kangas, Suvi T.; Salpéteur, Cécile; Nikièma, Victor; Talley, Leisel; Briend, André; Ritz, Christian; Friis, Henrik; Kæstel, Pernille

doi:10.1016/j.clnu.2020.03.016

Cited by 27 publications

(26 citation statements)

References 47 publications

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“…While improvement was observed, the vitamin a and iron status remained sub-optimal among children treated successfully for SAM with rutf. 1 One more interesting finding in our study was that children receiving home based TF also had rate increase of serum iron more than the children receiving WHO-RUTF although there was no significant difference was noted in rate of increase in serum retinol (Table 3). There are no such studies done till date to support findings of our study.…”

Section: Discussionmentioning

confidence: 49%

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Serum iron and serum retinol level of severe acute malnourished children on therapeutic intervention with WHO/UNICEF recommended therapeutic food and home based therapeutic food

Bhandari¹,

Mehta

2021

Int J Contemp Pediatr

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Background: The prevalence of anaemia and vitamin A deficiency among children with severe acute malnutrition (SAM) and their correction during nutritional rehabilitation are not well documented. This study assessed serum iron and serum retinol levels, effect of ready-to-use therapeutic foods (RUTF) and home based treatment on levels of serum iron and serum retinol level in SAM children.Methods: This was a simple randomised controlled trial in 6-59 months old children with SAM. Two groups of 70 each were divided, one was given RUTF and other home based food comparable to RUTF. Serum retinol and serum iron were measured on day 1 and 6 weeks of therapy.Results: Home based food was found better in terms of increase in serum iron than RUTF while there was no difference in rise of serum retinol in both the groups. There was no significant difference between day 1 value of serum iron in both the groups as p value was 0.82 but the level of serum iron at 6 weeks has shown significant difference in both the groups as p value was 0.0014 so there was significant increase in serum iron in group B in comparison to group A; the serum retinol value in both the groups has not shown any significant improvement.Conclusions: It was concluded home based food is better in correcting iron deficiency in SAM children as it is cheap, easily available, palatable, and acceptable than RUTF.

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Section: Discussionmentioning

confidence: 49%

“…Severe acute malnutrition (SAM), though the least prevalent form of malnutrition is associated with high mortality risk. 1 These children are undernourished and susceptible to disease.…”

Section: Introductionmentioning

confidence: 99%

Serum iron and serum retinol level of severe acute malnourished children on therapeutic intervention with WHO/UNICEF recommended therapeutic food and home based therapeutic food

Bhandari¹,

Mehta

2021

Int J Contemp Pediatr

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“…This corroborates our previous findings. We previously reported a high rate of anemia (55%), iron deficiency (35%), and vitamin A deficiency (9%) at the end of treatment in both groups ( 36 ). This shows that deficiencies persist and remain unresolved during treatment and suggests that there is potentially a need to revise the level of fortification of RUTF for certain micronutrients including vitamin A, iron, and zinc or to test complementary approaches to ensure that children recover a normal micronutrient status.…”

Section: Discussionmentioning

confidence: 92%

“…The coverage of recommended energy intake combined with a similar overall micronutrient adequacy could partly explain the similar programmatic results (weight and MUAC gain velocity, recovery proportion, and length of stay in treatment) previously found in the MANGO study ( 11 ). Nevertheless, the significant differences between arms for intake and probability of adequate intake of iron, vitamins C and B-6, folate, and vitamin B-12 could explain the previous observation of a lower hemoglobin concentration at discharge among children in the reduced dose arm ( 36 ).…”

Section: Discussionmentioning

confidence: 95%

Adequacy of Nutrient Intakes of Severely and Acutely Malnourished Children Treated with Different Doses of Ready-To-Use Therapeutic Food in Burkina Faso

Nikièma

Kangas

Salpéteur

et al. 2021

The Journal of Nutrition

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Background Ready-to-use therapeutic foods (RUTF) are designed to cover the daily nutrient requirements of children with severe acute malnutrition (SAM). However, with the transfer of uncomplicated SAM care from the hospital environment to the community level, children will be able to consume complementary and family foods (CFF) in addition to RUTF, and this might decrease the quantity of RUTF needed for recovery. Objectives Using an individually randomized clinical trial, we investigated the effects of a reduced RUTF dose on the daily energy and macronutrient intakes, the proportion of energy coming from CFF, and the mean probability of adequacy (MPA) of intake in 11 micronutrients of 516 children aged 6–59 mo who were treated for SAM in Burkina Faso. Methods The data were collected using a single 24-h multipass dietary recall, 1 mo after starting treatment, from December 2016 to August 2018, repeated on a subsample of 66 children. Differences between children receiving the reduced RUTF (intervention arm) and those receiving standard RUTF (control arm) were assessed by linear mixed models. Results Daily energy intake was lower (P < 0.01) in the intervention arm (mean ± SD 1321 ± 339 kcal) than in the control arm (1467 ± 319 kcal). CFF contributed to 40% of the daily energy intake in the intervention and 35% in the control arm. The MPA for 11 micronutrients was 0.89 ± 0.1 in the intervention arm and 0.95 ± 0.07 in the control arm (P = 0.06). Conclusions Reducing the dose of RUTF during SAM treatment had a negative impact on daily energy intake of the children. Despite this, children covered their recommended energy intake. The energy intake coming from CFF was similar between arms, suggesting that children's feeding practices did not change due to the reduction in RUTF in this context. This trial was registered at the IRSCTN registry as ISRCTN50039021.

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“…The recurrence of AM after recovery has been the focus of several publications recently [ 9 , 16 , 27 ]. Thus, there is now sufficient evidence to suggest that post-SAM children need special attention, including sustained follow-up and correction of persisting deficits even when they have recovered based on anthropometry [ 13 , 28 , 29 ]. This study has shown that this special attention is required throughout the 12 months after recovery as vulnerability to AM and infection persisted throughout the 12 months follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Nutrition status and morbidity of Ethiopian children after recovery from severe acute malnutrition: Prospective matched cohort study

et al. 2022

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After recovery, children with severe acute malnutrition (SAM) remain vulnerable to sub-optimal growth and malnutrition relapse. Although there is an increased interest in understanding these problems, data are scarce, and contextual factors can cause variability. We prospectively followed a cohort of Ethiopian children (215 post-SAM cases and 215 non-wasted controls), monthly for one year. The post-SAM cases were: age 6–59 months at admission into the community management of acute malnutrition (CMAM) program and being successfully discharged from CMAM (MUAC>11.0cm, weight gain of 20%, absence of oedema and clinically stable for two consecutive weeks). The controls were apparently healthy children from same village who had no history of an episode of AM and were matched 1:1 to a post-SAM child by age and sex. The primary outcomes were: cumulative incidence of acute malnutrition; growth trajectory; cumulative incidence of reported common morbidities, and cumulative proportion and incidence of deaths. The burden of common morbidities was higher among post-SAM than controls; post-SAM children had more frequent illness episodes (Incidence Rate Ratio of any illness 1.39, 95% CI: 1.14, 1.71; p<0.001). The prevalence of SAM was consistently higher among post-SAM cases than the control group, having a 14 times higher risk of developing SAM (Incidence Rate Ratio: 14.1; 95% CI: 3.5, 122.5; p<0.001). The divergence in weight and growth trajectory remained the same during the study period. Our results advocate for the design of post-discharge interventions that aim to prevent the reoccurrence of acute malnutrition, reduce morbidity and promote catch-up growth. Research is needed to define the appropriate package of post-discharge interventions.

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Vitamin A and iron status of children before and after treatment of uncomplicated severe acute malnutrition

Cited by 27 publications

References 47 publications

Serum iron and serum retinol level of severe acute malnourished children on therapeutic intervention with WHO/UNICEF recommended therapeutic food and home based therapeutic food

Serum iron and serum retinol level of severe acute malnourished children on therapeutic intervention with WHO/UNICEF recommended therapeutic food and home based therapeutic food

Adequacy of Nutrient Intakes of Severely and Acutely Malnourished Children Treated with Different Doses of Ready-To-Use Therapeutic Food in Burkina Faso

Nutrition status and morbidity of Ethiopian children after recovery from severe acute malnutrition: Prospective matched cohort study

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