Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries.

Systematic review and meta-analysis of 8 randomized controlled trials enrolling 10,037 children aged 6 to 60 months with moderate acute malnutrition in low- and middle-income countries. Most studies were conducted in rural African settings, with one urban Bangladesh trial, and compared LNS or blended foods at full or complementary doses against standard care or against each other.

The review evaluated externally provided foods for outpatient treatment of moderate acute malnutrition in children, mainly lipid-based nutrient supplements (LNS) and blended foods such as corn/soy blends (CSB, CSB++) and a few complementary-food formulations. Regimens were given orally as full-dose or complementary-dose supplements alongside standard care, with LNS typically around 500 kcal/day in several trials and blended foods often at roughly 750 to 1227 kcal/day depending on the formulation and comparison.

Both LNS and blended foods were effective for treating moderate acute malnutrition, with LNS producing a higher recovery proportion than blended foods. LNS did not reduce mortality, default, or progression to severe acute malnutrition, and it caused more vomiting in at least one pooled comparison (RR 1.43, 95% CI 1.11 to 1.85; 2712 children). Weight gain favored LNS modestly across comparisons, with mean differences of 0.18 to 0.69 g/kg/day. Overall, the evidence suggests blended foods such as CSB++ may be similarly effective and cheaper than LNS, but the assessed foods did not fully meet WHO nutritional specifications.

The evidence base was heterogeneous, with multiple LNS and blended-food formulations, varying doses, and different comparison groups across trials. Several outcomes were reported in pooled form or from unpublished/personal-communication data, limiting arm-level interpretability. Long-term outcomes, cost-effectiveness, and interventions to improve the home diet were not addressed, and the evidence is concentrated in African settings with limited generalizability outside that context.