Soya, maize and sorghum ready-to-use therapeutic foods are more effective in correcting anaemia and iron deficiency than the standard ready-to-use therapeutic food: randomized controlled trial

Abstract

Background: The prevalence of anaemia and iron deficiency (ID) among children with severe acute malnutrition (SAM) and their correction during nutritional rehabilitation are not well documented. This study assessed anaemia and ID prevalence and their predictors at start of SAM treatment, and the efficacy of their treatment and effect on gut health of two novel Ready-To-Use Therapeutic foods (RUTF) prepared from soybean, maize and sorghum (SMS) with (MSMS-RUTF) or without added milk (FSMS-RUTF) compared to those of the standard formulation prepared from peanut and milk (PM-RUTF).

Methods: This was a 3-arms parallel groups, simple randomised, controlled non-inferiority trial in 6-59 months old Central Malawian children with SAM. Anaemia was defined using altitude- and ethnicity-adjusted haemoglobin. Iron status was defined using soluble transferrin receptor (sTfR) and body iron stores (BIS). We used Pearson's chi-square test, t-test for paired or unpaired data, Kruskal-Wallis test for between-arm differences as appropriate and logistic regression to identify independent predictors of anaemia or iron deficiency anaemia (IDA).

Results: The sample size was 389. At admission, the prevalence [%(95%CI)] of anaemia was 48.9(41.4-56.5)% while that of ID and IDA were 55.7(48.6-62.5)% and 34.3(28.2-41.0)% when using sTfR criterion and 29.1(24.4-34.4)% and 28.9(23.7-34.9)% when using BIS criterion, respectively. At discharge, nutrition rehabilitation with SMS-RUTF was associated with the lowest prevalence of anaemia [12.0(6.9-20.3)% for FSMS-RUTF, 18.2(11.9-26.8)% for MSMS-RUTF and 24.5(15.8-35.9)% for PM-RUTF; p = 0.023] and IDA [7.9(3.4-17.3)% for FSMS-RUTF, 10.9(4.8-22.6)% for MSMS-RUTF and 20.5(10.7-35.5)% for PM-RUTF; p = 0.028]. SMS-RUTF was also associated with the highest increase in BIS [Change in BIS (95%CI)] among the iron deplete at admission [6.2 (3.7; 8.6), 3.2 (0.8; 5.6), 2.2 (0.2; 4.3) for the same study arms; Anova p = 0.045]. Compared to P-RUTF, FSMS-RUTF had the highest adjusted recovery rate [OR (95%CI = 0.3 (0.2-0.5) with p < 0.001 for FSMS-RUTF and 0.6 (0.3-1.0) with p = 0.068 for MSMS-RUTF]. No effect of iron content on risk of iron overload or gut inflammation was observed.

Conclusions: Anaemia and ID are common among children with SAM. FSMS-RUTF is more efficacious in treating anaemia and correcting BIS among this group than PM-RUTF.

Trial registration: This study was registered on 15 April 2015 ( PACTR201505001101224 ).

Keywords: Anaemia; Iron; Iron deficiency; Milk; Ready-to-use therapeutic food; Severe acute malnutrition.

Fig. 1

Body iron stores at admission (TA) and discharge (TD) according to study arm and body iron status category of admission. Study arms: FSMS-RUTF = Milk Free Soya-Maize-Sorghum Based Ready-To-Use Therapeutic Food, MSMS-RUTF = Milk Soya-Maize-Sorghum Based Ready-To-Use Therapeutic Food and PM-RUTF = Peanut milk based Ready-To-Use Therapeutic Food; Body iron stores categories: NBIS=Normal body iron stores/no iron deficiency, LBIS = Low body iron stores, DBIS = Depleted Iron stores; Assessment time: TA = at admission and TD = at discharge

Fig. 2

Gut inflammation at admission and discharge according to study arm. Study arms: FSMS-RUTF = Milk Free Soya-Maize-Sorghum Based Ready-To-Use Therapeutic Food, MSMS-RUTF = Milk Soya-Maize-Sorghum Based Ready-To-Use Therapeutic Food and PM-RUTF = Peanut milk based Ready-To-Use Therapeutic Food