Ready-to-use therapeutic food for home-based treatment of severe acute malnutrition in children from six months to five years of age.

Systematic review of randomized trials in children aged 6 months to 5 years with severe acute malnutrition treated in home-based settings in Malawi. Four trials were included, mostly in HIV-uninfected children, with one trial including HIV-infected children.

Home-based ready-to-use therapeutic food (RUTF) was given to children with severe acute malnutrition, either to meet full daily requirements or as a supplement to their usual recovery diet. Regimens included locally produced peanut-based RUTF and standard commercial RUTF, with one trial testing a lower-milk-powder formulation versus standard RUTF; comparators were standard flour porridge or maize/soy flour, or full daily RUTF.

Evidence was limited and did not support a definitive overall conclusion across RUTF strategies. RUTF meeting full daily requirements improved recovery versus standard diet, with RR 1.32 (1.16 to 1.50) and weight gain MD 1.47 g/kg/day (95% CI 0.49 to 2.45), while mortality was similar, RR 0.97 (0.46 to 2.05). By contrast, RUTF used only as a supplement to the diet reduced recovery versus full daily RUTF, RR 0.71 (0.60 to 0.84), and the lower-milk-powder RUTF formulation did not clearly change recovery versus standard RUTF, RR 0.97 (0.93 to 1.01), though relapse was higher, RR 1.33 (1.03 to 1.72).

The evidence base was small and limited to Malawi, reducing generalizability. Comparisons were heterogeneous across RUTF formulations and dosing strategies, and several outcomes were based on small effective sample sizes. Adverse outcomes were sparsely reported, and the review could not draw definitive conclusions for several clinically important endpoints.