Malian children with moderate acute malnutrition who are treated with lipid-based dietary supplements have greater weight gains and recovery rates than those treated with locally produced cereal-legume products: a community-based, cluster-randomized trial.
What this study found
RUSF produced the best overall clinical response, with greater weight gain and sustained recovery than the other supplements, although it was more costly. CSB++ had intermediate results, while Misola and locally milled flour were less effective. Four children developed severe acute malnutrition with complications and were hospitalized during the study: 2 in the Misola group, 1 in the CSB++ group, 1 in the locally milled flour group, and 0 in the RUSF group. Overall, the findings support lipid-based supplements as the most effective option for treating moderate acute malnutrition in this…
- Study & population
- Community-based cluster-randomized trial in the Dioila Health District of rural Mali.
- Intervention
- Children with moderate acute malnutrition received one of four oral 12-week dietary supplements in the community: RUSF (Supplementary Plumpy) 92-g sachets daily, providing 500 kcal/day; CSB++ about 127 g/day from 1-kg weekly bags, providing 501 kcal/day; Misola about 125 g/day from 1-kg weekly bags, providing 500…
- Key limitation
- This was a single-district community trial with no placebo or no-treatment control, so the comparison is limited to active products.
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Open PDFOriginal abstract
BACKGROUND Moderate acute malnutrition (MAM), defined as weight-for-length z score between -3 and -2 or midupper arm circumference between 11.5 and 12.5 cm, affects ∼33 million children aged <5 y worldwide. OBJECTIVE The objective was to compare the effects of 4 dietary supplements for the treatment of MAM. DESIGN Twelve community health centers in rural Mali were randomly assigned to provide to 1264 MAM children aged 6-35 mo one of 4 dietary supplements containing ∼500 kcal/d for 12 wk: 1) ready-to-use, lipid-based supplementary food (RUSF); 2) special corn-soy blend (CSB++); 3) locally processed, fortified flour (Misola); or 4) locally milled flours plus oil, sugar, and micronutrient powder (LMF). RESULTS In total, 1178 children (93.2%) completed the study. The adjusted mean (95% CI) change in weight (kg) from baseline was greater with RUSF than with the locally processed blends and was intermediate with CSB++ [1.16 (1.08, 1.24) for RUSF, 1.04 (0.96, 1.13) for CSB++, 0.91 (0.82, 0.99) for Misola, and 0.83 (0.74, 0.92) for LMF; P < 0.001]. For length change, RUSF and CSB++ differed significantly from LMF. Sustained recovery rates were higher with RUSF (73%) than with Misola (61%) and LMF (58%), P < 0.0001; CSB++ recovery rates (68%) did not differ from any of the other groups. CONCLUSIONS RUSF was more effective, but more costly, than other dietary supplements for the treatment of MAM; CSB++ yielded intermediate results. The benefits of treatment should be considered in relation to product costs and availability.