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. 2020 Jun 3;15(6):e0230452.
doi: 10.1371/journal.pone.0230452. eCollection 2020.

Acute malnutrition recovery energy requirements based on mid-upper arm circumference: Secondary analysis of feeding program data from 5 countries, Combined Protocol for Acute Malnutrition Study (ComPAS) Stage 1

Rachel P Chase  1 , Marko Kerac  2 , Angeline Grant  3 , Mark Manary  4 , André Briend  5   6 , Charles Opondo  7 , Jeanette Bailey  2   8
Affiliations

Acute malnutrition recovery energy requirements based on mid-upper arm circumference: Secondary analysis of feeding program data from 5 countries, Combined Protocol for Acute Malnutrition Study (ComPAS) Stage 1

Rachel P Chase et al. PLoS One. .

Abstract

Background: Severe and moderate acute malnutrition (SAM and MAM) are currently treated with different food products in separate treatment programs. The development of a unified and simplified treatment protocol using a single food product aims to increase treatment program efficiency and effectiveness. This study, the first stage of the ComPAS trial, sought to assess rate of growth and energy requirements among children recovering from acute malnutrition in order to design a simplified, MUAC-based dosage protocol.

Methods: We obtained secondary data from patient cards of children aged 6-59 months recovering from SAM in outpatient therapeutic feeding programs (TFPs) and from MAM in supplementary feeding programs (SFPs) in five countries in Africa and Asia. We used local polynomial smoothing to assess changes in MUAC and proportional weight gain between clinic visits and assessed their normalized differences for a non-zero linear trend. We estimated energy needs to meet or exceed the growth observed in 95% of visits.

Results: This analysis used data from 5518 patients representing 33942 visits. Growth trends in MUAC and proportional weight gain were not significantly different, each lower at higher MUAC values: MUAC growth averaged 2mm/week at lower MUACs (100 to <110mm) and 1mm/week at higher MUACs (120mm to <125mm); and proportional weight gain declined from 3.9g/kg/day to 2.4g/kg/day across the same MUAC values. In 95% of visits by children with a MUAC 100mm to <125mm who were successfully treated, energy needs could be met or exceeded with 1,000 kilocalories a day.

Conclusion: Two 92g sachets of Ready-to-Use Therapeutic Food (RUTF) (1,000kcal total) is proposed to meet the estimated total energy requirements of children with a MUAC 100mm to <115mm, and one 92g sachet of RUTF (500kcal) is proposed to meet half the energy requirements of children with a MUAC of 115 to <125mm. A simplified, combined protocol may enable a more holistic continuum of care, potentially contributing to increased coverage for children suffering from acute malnutrition.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow chart.
Fig 2
Fig 2. Average daily proportional weight change (solid line) and weekly MUAC change (dashed line) vs MUAC at prior visit.
Fig 3
Fig 3. Estimated daily energy (kcal) that would provide 95% of patient visits in the specified MUAC category with energy needs for observed growth.
Comparisons are made by: (A) MUAC category at admission, (B) continent, (C) and age group of 6–23 months (<24m) or 24–59 months (≥24m).
Fig 4
Fig 4. Comparison of mean energy provided by each of five protocols: The protocol proposed herein, Golden’s minimum, intermediate, and standard protocols, the Sierra Leone protocol, and the Kenya protocol.
See this image and copyright information in PMC

References

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