High-Oleic Ready-to-Use Therapeutic Food Maintains Docosahexaenoic Acid Status in Severe Malnutrition

Abstract

Objectives: Ready-to-use therapeutic food (RUTF) is the preferred treatment for uncomplicated severe acute malnutrition. It contains large amounts of linoleic acid and little α-linolenic acid, which may reduce the availability of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) to the recovering child. A novel high-oleic RUTF (HO-RUTF) was developed with less linoleic acid to determine its effect on DHA and EPA status.

Methods: We conducted a prospective, randomized, double-blind clinical effectiveness trial treating rural Malawian children with severe acute malnutrition. Children were treated with either HO-RUTF or standard RUTF. Plasma phospholipid fatty acid status was measured on enrollment and after 4 weeks and compared between the 2 intervention groups.

Results: Among the 141 children enrolled, 48 of 71 receiving HO-RUTF and 50 of 70 receiving RUTF recovered. Plasma phospholipid samples were analyzed from 43 children consuming HO-RUTF and 35 children consuming RUTF. The change in DHA content during the first 4 weeks was +4% and -25% in the HO-RUTF and RUTF groups, respectively (P = 0.04). For EPA, the change in content was 63% and -24% in the HO-RUTF and RUTF groups, respectively (P < 0.001). For arachidonic acid, the change in content was -3% and 13% in the HO-RUTF and RUTF groups, respectively (P < 0.009).

Conclusions: The changes in DHA and EPA seen in the children treated with HO-RUTF warrant further investigation because they suggest that HO-RUTF support improved polyunsaturated fatty acid status, necessary for neural development and recovery.

Figure 1

Changes in plasma fatty acids after receiving 4 wk of HO-RUTF or RUTF. (A) Change expressed in percent by weight of fatty acid, showing HO-RUTF induces a slight reduction in DPAn-6 and increases in the ω3 long chain PUFAs EPA and DHA. In contrast, treatment with conventional RUTF led to an increase in DPAn-6 and a decrease in DHA. (B) Changes expressed as percent of the pooled means demonstrate the most significant percent change was in EPA. * indicates the difference beween the RUTFs was P < 0.05 (using Excel 2003, build 11.5612.5606). Means ± 95%CI. EPA, DPAn-3, and DHA changes are normally distributed by Shapiro-Wilks test (P > 0.1); DPAn-6 evaluated by t test (P =0.0002).