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.

Community-based cluster-randomized trial in the Dioila Health District of rural Mali. Children aged 6 to 35 months with moderate acute malnutrition were enrolled through community health centers and surrounding villages and assigned to one of four active supplement arms.

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 kcal/day; or locally milled flour about 129 g/day from 1-kg weekly bags, providing 500 kcal/day, with 5 Mixme micronutrient powder sachets per week.

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 setting, with cost and availability still important program considerations.

This was a single-district community trial with no placebo or no-treatment control, so the comparison is limited to active products. The provided extraction does not include detailed effect sizes or complete follow-up/completion data, and programmatic cost and availability may limit generalizability. Seasonal and local food-security conditions may also influence applicability outside this setting.