Effect of Locally Produced Ready-to-Use Therapeutic Food on Children under Five Years with Severe Acute Malnutrition: A Systematic Review
Abstract
This review assessed the effect of Ready-to-Use Therapeutic Food (RUTF) on children under five years with Severe Acute Malnutrition (SAM). The reviewed studies were obtained from six databases. Using the search strategy, 3,521 studies were selected. After title and abstract screening, 75 studies were obtained for further full article screening. The inclusion criteria were types of study (RCT, quasi-RCT, or crossover), participants (SAM children aged 6−60 months with no complications), interventions (locally produced RUTF and standard RUTF), and outcome measures (recovery rate, mortality rate, weight gain rate, height gain rate, length of stay, weight-for-age z score, height-for-age z score, weight-for-length z score, anemia status, blood iron status, serum albumin, plasma amino acid level, adverse effects and acceptability of RUTF). A total of 33 studies were included in this review. Nine out of twenty-two studies that used standard RUTF had positive effects on recovery outcomes in children with SAM. The alternative RUTF produced from local protein sources showed slightly lower positive effects on SAM treatment than those of standard RUTF. Since the studies used different methods to assess the outcome, no formula could be selected as the best formula and selection should be made based on individual research objectives. In conclusion, both standard and the alternative locally produced RUTF can be applied for treatment of SAM by considering the local preferences, ingredients availability, production sustainability and product safety.
References
Ali E, Zachariah R, Dahmane A, Van den Boogaard W, Shams Z, Akter T, Alders P, Allaouna M, Draguez B, Delchevalerie P, Harries AD. 2013. Peanut-based ready-to-use therapeutic food: acceptability among malnourished children and community workers in Bangladesh. Public Health Action. 3(2):128-135. https://doi.org/10.5588/pha.12.0077
Bahwere P, Banda T, Sadler K, Nyirenda G, Owino V, Shaba B, Dibari F, Collins S. 2014. Effectiveness of milk whey protein-based ready-to-use therapeutic food in the treatment of severe acute malnutrition in Malawian under-5 children: a randomized, double-blind, controlled non-inferiority clinical trial. Maternal & Child Nutr. 10: 436-451. https://doi.org/10.1111/mcn.12112
Bahwere P, Akomo P, Mwale M, Murakami H, Banda C, Kathummba S, Banda C, Jere S, Sadler K, Collins S. 2017. Soya, maize, and sorghum-based ready-to-use therapeutic food with amino acid is as efficacious as the standard milk and peanut paste-based formulation for the treatment of severe acute malnutrition in children: a non-inferiority individually randomized controlled efficacy clinical trial in malawi. Am J Clin Nutr. 106: 1100-1112. https://doi.org/10.3945/ajcn.117.156653
Bahwere P, Balaluka B, Wells JCK, Mbiribindi CN, Sadler K, Akomo P, Dramaix-Wilmet M, Collins S. 2016. Cereals and pulse-based ready-to-use therapeutic food as an alternative to the standard milk- and peanut paste-based formulation for treating severe acute malnutrition: a non-inferiority, individually randomized controlled efficacy clinical trial. Am J Clin Nutr. 103: 1145-1161. https://doi.org/10.3945/ajcn.115.119537
Bailey J, Lelijveld N, Marron B, Onyoo P, Ho LS, Manary M, Briend A, Opondo C, Kerac M. 2018. Combined protocol for acute malnutrition study (compas) in rural south sudan and urban kenya: study protocol for a randomized controlled trial. 19: 251. https://doi.org/10.1186/s13063-018-2643-2
Bhandari N, Mohan SB, Bose Am Iyengar SD, Taneja Sm Mazynder Sm Oricilla RA, Iyengar K, Sachdev HS, Mohan VR, Suhalka V, Yoshida S, Martines J et al. 2016. Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition: a randomized trial in India. BMJ Global Health. 1(2016): e000144. http://dx.doi.org/10.1136/bmjgh-2016-000144
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE. 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?. Lancet. 382:452-477. https://doi.org/10.1016/S0140-6736(13)60996-4
Cercamondi Cl, Egli IM, Mitchikpe E, Tossou F, Hessou J, Zeder C, Hounghouigan JD, Hurrek RF. 2013. Iron bioavailability from a lipid-based complementary food fortificant mixed with millet porridge can be optimized by adding phytase and ascorbic acid but not using a mixture of ferrous sulfate and sodium iron edta. J Nutr. 143(8):1233-1239
Choudhury N, Ahmed T, Hossain MI, Islam MM, Sarker SA, Zeilani M, Clemens JD. 2018. Ready-to-use therapeutic food made from locally available food ingredients is well accepted by children having severe acute malnutrition in Bangladesh. Food and Nutrition Bulletin. 39(1):116-126. https://doi.org/10.1177/0379572117743929
Ciliberto M, Sandige H, Ndekha MDJ, Ashorn P, Briend A, Cilliberto HM, Manary MJ. 2005. Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished malawian children: a controlled, clinical effectiveness trial. Am J Clin Nutr. 81: 864-870. https://doi.org/10.1093/ajcn/81.4.864
Codex Alimentarius Commission. 2019. Joint FAO/WHO Foods Standards Programme, Codex Committe on Nutrition and Foods for Special Dietary Uses, Proposed Draft Guideline for Ready-to-use Therapeutic Foods. Rome : Food and Agriculture Organization.
De Pee S, Bloem MW. 2009. Current potential role of specially formulated foods and food supplements for preventing malnutrition among 6-23 months old children and treating moderate malnutrition among 6-59 months old children. Food Nutr Bull. 30(3):1-40.
Gera T., 2010. Efficacy and safety of therapeutic nutrition products for home-based therapeutic nutrition for severe acute malnutrition: A systematic review. Indian Pediatr. 47:709-718. https://doi.org/10.1007/s13312-010-0095-1
Goossens A, Bekel Y, Yun O, Harczi G, Ouannes M, Shepherd S. 2012. Mid-Upper Arm Circumference based nutrition progrmming: Evidence for a new approach in regions with high burden of acute malnutrition. PLoS One. 7(11):e49320. https://doi.org/10.1371/journal.pone.0049320
Hendrixson DT, Godbout C, Los A, Callaghan-Gillespie M, Mui M, Wegner Dm Bryant T, Koroma A, Manary MJ. 2020. Treatment of severe acute malnutrition with oat or standard ready-to-use therapeutic food:a triple-blind, randomized controlled clinical trial. Gut.0(2020):1-7. https://doi.org/10.1136/gutjnl-2020-320769
Hossain MI, Huq S, Islam MM, Ahmed T. 2020. Acceptability and efficacy of ready-to-use therapeutic food using soy protein isolate in under-5 children suffering from severe acute malnutrition in Bangladesh: a double-blind randomized non-inferiority trial. Eur J of Nutr. 59: 1149-1161. https://doi.org/10.1007/s00394-019-01975-w
Hsieh JC, Liu L, Zeilani M, Ickes S, Trehan I, Maleta K, Craig C, Thakwalakwa C, Singh L, Brenna JT et al. 2016. High-oleic ready-to-use therapeutic food maintains docosahexaenoic acid status in severe malnutrition. J Pediatr Gastroenterol Nutr. 61(1): 138-143. https://doi.org/10.1097/MPG.0000000000000741
Hsu JW, Badaloo A, Wilson L, Taylor-Bryan C, Chambers B, Reid M, Forrester T, Jahoor F. 2014. Dietary supplementation with aromatic amino acids increases protein synthesis in children with severe acute malnutrition. J Nutr. 144(5):660-666. Doi: https://doi.org/10.3945/jn.113.184523
Irena AH, Bahwere P, Owini VO, Diop EHI, Bachmann MO, Mbwili-Muleya C, Dibari F, Sadler K, Collins S. 2015. Comparison of the effectiveness of a milk-free soy-maize-sorghum-based ready-to-use therapeutic food to standard ready-to-use therapeutic food with 25% milk in nutrition management of severely acutely malnourished Zambian children: an equivalence non-blinded cluster randomized controlled trial. Maternal and Child Nutr. 11(4): 105-119. https://doi.org/10.1111/mcn.12054
Jadhav AR, Karnik P, Fernandes L, Fernandes Sm Shah Nm Manglani M. 2017. Indigenously prepared ready-to-use therapeutic food (rutf) in children with severe acute malnutrition. Indian Pediatrics. 56(4): 287-293 .
Jones KDJ, Ali R, Khasira MA, Odera D, West AL, Koster G, Akomo P, Talbert WA, Goss VM, Ngari M et al. 2015. Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trial. BMC Medi.13:93. https://doi.org/10.1186/s12916-015-0315-6
Kaleem R, Aziz N, Zaman S, Salimi MA. 2014. Nutritional rehabilitation of severely malnourished children by high density diet in comparison to ready to use therapeutic food. Pak Pediatr J. 38(4): 235-243.
Kangas ST, Salpeteur C, Nikiema V, Talley L, Ritz C, Friis H, Briend A, Kaestel P. 2019. Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomized non-inferiority trial in Burkina Faso. Plos Med. 16(8). https://doi.org/10.1371/journal.pmed.1002887
Kangas ST, Kaestel P, Salpeteur C, Nikiema V, Talley L, Briend A, Ritz C, Friis H, Wells JC. 2020. Body composition during outpatient treatment of severe acute malnutrition: Results from a randomized trial testing different doses of ready-to-use therapeutic foods. Clinical Nutr. https://doi.org/10.1016/j.clnu.2020.02.038
Kerac M, Bunn J, Seal A, Thindwa M, Tomkins A, Sadler K, Bahwere P, Collins S. 2009. Probiotics and prebiotics for severe acute malnutrition (pronut study): a double-blind efficacy randomized controlled trial in Malawi. Lancet. 373: 136-144. https://doi.org/10.1016/s0140-6736(09)60884-9
Khanum S, Ashworth A, Huttly SR. 1998. Growth, morbidity, and mortality of children in Dhaka after treatment for severe acute malnutrition: a prospective study. Am J Clin Nutr. 67:940-945. https://doi.org/10.1093/ajcn/67.5.940
Kohlmann K, Callaghan-Gillespie M, Gauglitz JM, Steiner-Asiedu M, Saalia K, Edwards C, Manary MJ. 2019. Alternative ready-to-use therapeutic food yields less recovery than the standard for treating acute malnutrition in children from ghana. Global Health Sci and Prac. 7(2). https://doi.org/10.9745/GHSP-D-19-00004
MacLean WC, Graham GG. 1980. The effect of energy intake on nitrogen content of weight gain by recovering malnourished infants. Am J Clin Nutr. 33(4):903-909.
Manary MJ, Ndekha MJ, Ashorn P, Maleta K, Briend A. 2003. Home based therapy for severe malnutrition with ready-to use food. Arch Dis child. 89: 557-561. https://doi.org/ 10.1136/adc.2003.034306
Maust A, Koroma AS, Abla C, Molokwu N, Ryan KN, Singh L, Manary MJ. 2015. Severe and Moderate Acute Malnutrition Can Be Successfully Managed With an Integrated Protocol in Sierra Leone. American Society of Nutr. https://doi.org/10.3945/jn.115.214957
Nga TT, Nguyen M, Mathisen R, Hoa DB, Minh NH, Berger J, Wieringa FT. 2013. Acceptability and impact on anthropometry of a locally developed ready-to-use therapeutic food in pre-school children in vietnam. Nutr J. 12(120). https://doi.org/ 10.1186/1475-2891-12-120
Oakley E, Reinking J, Sandige H, Trehan I, Kennedy G, Maleta K, Manary M. 2010. A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children. J Nutr. 140:2248-2252. https://doi.org/10.3945/jn.110.123828
Ozkale M, Sipahi T. 2014. Hematologic and bone marrow changes in children with protein-energy malnutrition. Pediatr Hematol Oncol. 31(4):349–58.
Potani I, Spiegel-Feld C, Brixi G, Bendabenda J, Siegfried N, Bandsma RHJ, Briend A, Daniel AI. 2021. Ready-to-use therapeutic food (RUTF) containing low or no dairy compared to standard RUTF for children with severe acute malnutrition: A systematic review and meta-analysis. Adv Nutr. 12(5):1930-1943. doi: 10.1093/advances/nmab027.
Radhakrishna KV, Kulkarni B, Balakrishna N, Rajkumar H, Omkar C, Shatrugna V. 2010. Composition of weight gain during nutrition rehabilitation of severly under nourished children in a hospital based study from India. Asia Pac J Clin Nutr. 19(1):8-13.
Ramdath DD, Golden MH. Non-haematological aspects of iron nutrition.Nutr Res Rev. 1989;2(1):29–49.
Ravichandra KR, Bahera N. 2017. Locally prepared ready to use therapeutic food for the treatment of children with severe acute malnutrition: a randomized controlled trial. Int J Contemp Pediatr. 4(4): 1491-1495. http://dx.doi.org/10.18203/2349-3291.ijcp20172692
Sato W, Furuta C, Matsunaga K, Bahwere P, Collins S, Sadler K, Akomo P, Banda C, Manganga E, Kathumba S et al. 2018. Amino-acid-enriched cereals ready-to-use therapeutic foods (RUTF) are as effective as milk-based RUTF in recovering essential amino acid during the treatment of severe acute malnutrition in children: An individually randomized control trial in Malawi. PloS ONE. 13(8):e201686. https://doi.org/10.1371/journal.pone.0201686
Schoonees A, Lombard MJ, Musekiwa A, Nel E, Volmink J. 2019. Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age. Cochrane Database of Systematic Reviews. 5: 1-178. https://doi.org/10.1002/14651858.CD009000.pub3.
Shewade HD, Patro BK, Bharti B, Soundappan K, Kaur A, Taneja N. 2013. Effectiveness of indigenous ready-to-use therapeutic food in community-based management of uncomplicated severe acute malnutrition: a randomized controlled trial from India. J Tropical Pediatrics. 90(5). https://doi.org/10.1093/tropej/fmt039
Sigh S, Roos N, Chamnan C, Laillou A, Prak S, Wieringa FT. 2018. Effectiveness of a locally produced, fish-based food product on weight gain among cambodian children in the treatment of acute malnutrition: a randomized controlled trial. Nutrients. 10(909). https://doi.org/10.3390/nu10070909
Sigh S, Roos N, Sok D, Borg B, Chamnan C, Laillou Am Dijkhuizen MA, Wieringa FT. 2018. Development and acceptability of locally made fish-based for the ready-to-use therapeutic products for the prevention and treatment of malnutrition in cambodia. Food and Nutrition Bulletin. 39(3): 420-434. https://doi.org/10.1177%2F0379572118788266
Singh AS, Kang G, Ramachandran A, Sarkar R, Peter P, Nose A. 2010. Locally made ready-to-used therapeutic food for treatment of malnutrition: A randomized controlled trial. Indian Pediatrics. 47(8):679-686. https://doi.org/10.1007/s13312-010-0100-8
Thakur GS, Singh HP, Patel C. 2012. Locally-prepared ready-to-use therapeutic food for children with severe acute malnutrition: a controlled trial. Indian Pediatrics. 50. https://doi.org/10.1007/s13312-013-0097-x
Thapa BR, Goyal P, Menon J, Sharma A. 2017. Acceptability and efficacy of locally produced ready-to-use therapeutic food nutreal in the management of severe acute malnutrition in comparison with defined food: a randomized control trial. Food and Nutrition Bulletin. 38(1):18-26. https://doi.org/10.1177/0379572116689743
The Ministry of Health of Republic of Indonesia. 2018. The primary outcome of basic health research 2018. Jakarta: The Ministry of Health of Republic of Indonesia.
Versloot CJ, Voskuijil W, Van Vliet SJ, van den Heuvel M, Carter JC, Phiri A, Kerac M, Heikens GT, Rheenen PF, Bandsma HJ. 2017. Effectiveness of three commonly used transition phase diets in the inpatient management of children with severe acute malnutrition: a pilot randomized controlled trial in Malawi. BMC Pediatrics. 17(2017): 112. https://doi.org/10.1186/s12887-017-0860-6
Victoria CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. 2008. Maternal and child undernutrition:consequences for adult health and human capital. Lancet 371(9609): 340–357.
[WHO] World Health Organization. 2006. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization.
[WHO] World Health Organization. 2013. Guideline update on the management of severe acute malnutrition in infants and children.. Geneva: World Health Organization.
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