Lipid based nutrient supplements (LNS) for treatment of children (6 months to 59 months) with moderate acute malnutrition (MAM): A systematic review

Abstract

Background: Moderate acute malnutrition is a major public health problem affecting children from low- and middle-income countries. Lipid nutrient supplements have been proposed as a nutritional intervention for its treatment.

Objectives: To evaluate the effectiveness and safety of LNS for the treatment of MAM in infants and children 6 to 59 months of age.

Study design: Systematic review of randomized-controlled trials and controlled before-after studies.

Results: Data from nine trials showed that use of LNS, in comparison to specially formulated foods, improved the recovery rate (RR 1.08; 95% CI 1.02-1.14, 8 RCTs, 8934 participants, low quality evidence); decreased the chances of no recovery (RR 0.70; 95% CI 0.58-0.85, 7 RCTs, 8364 participants, low quality evidence) and the risk of deterioration into severe acute malnutrition (RR 0.87; 95% CI 0.73-1.03, 6 RCTs, 6788 participants, low quality evidence). There was little impact on mortality (RR 0.94, 95% CI 0.54-1.52, 8 RCTs, 8364 participants, very-low- quality evidence) or default rate (RR 1.32; 95% CI 0.73-2.4, 7 studies, 7570 participants, low quality evidence). There was improvement in weight gain, weight-for-height z-scores, height-for-age z-scores and mid-upper arm circumference. Subset analyses suggested higher recovery rates with greater amount of calories provided and with ready-to-use therapeutic foods, in comparison to ready-to-use supplementary foods. One study comparing LNS with nutritional counselling (very low quality evidence) showed higher chance of recovery, lower risk of deteriorating into severe acute malnutrition and lower default rate, with no impact on mortality, and no recovery.

Conclusions: Evidence restricted to the African regions suggests that LNS may be slightly more effective than specially formulated fortified foods or nutritional counselling in recovery from MAM, lowering the risk of deterioration into SAM, and improving weight gain with little impact on mortality or default rate.

Fig 1. Study flow diagram.

Fig 2. Risk of bias graph.

Review authors' judgements about each risk of bias item presented as percentages across all included studies.

Fig 3. Risk of bias summary.

Review authors' judgements about each risk of bias item for each included study.

Fig 4. Forest plot Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods Outcome: 1.5 Recovery from moderate acute malnutrition (ALL).

Fig 5. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.3 Recovery from moderate acute malnutrition (SUBGROUP: by type of supplement).

Fig 6. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.6 Recovery from moderate acute malnutrition (SUBGROUP: Calories provided).

Fig 7. Forest plot: Lipid-based nutrient supplement versus specially formulated micronutrient fortified foods, outcome: 1.2 No recovery.

Fig 8. Forest plot: Lipid-based nutrient supplement versus specially formulated micronutrient fortified foods, outcome: 1.6 Mortality.

Fig 9. Forest plot: Lipid-based nutrient supplement versus specially formulated micronutrient fortified foods, outcome: 1.7 Post Discharge Mortality.

Fig 10. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.10 Deterioration to severe acute malnutrition.

Fig 11. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.11 transferred to Inpatient.

Fig 12. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.23 Relapse after discharge.

Fig 13. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.14 Weight Gain (g/kg/d) [g/kg/day].

Fig 14. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.15 Weight Gain Total [kg].

Fig 15. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.16 weight-for-height z-score End.

Fig 16. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.17 Weight-for-length z-score Gain.

Fig 17. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.18 Length Gain.

Fig 18. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.19 Length Gain (mm/d).

Fig 19. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.20 height-for-age z-score End.

Fig 20. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.21 mid-upper arm circumference Gain [cm].

Fig 21. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.22 Mid-upper arm circumference Gain (mm/day) [mm/day].

Fig 22. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.24 Default Rate.

Fig 23. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.25 Hemoglobin (Final).

Fig 24. Forest plot: Lipid-based nutrient supplement versus Specially formulated micronutrient fortified foods, outcome: 1.26 Change in Hemoglobin [gm/dL].