Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Feb 21;15(5):1076.
doi: 10.3390/nu15051076.

Effectiveness of Dietary Management for Moderate Wasting among Children > 6 Months of Age-A Systematic Review and Meta-Analysis Exploring Different Types, Quantities, and Durations

Bernardette Cichon  1 , Jai K Das  2   3 , Rehana A Salam  4 , Zahra A Padhani  2 , Heather C Stobaugh  5   6 , Muzna Mughal  1 , Patrizia Pajak  1 , Alexandra Rutishauser-Perera  1 , Zulfiqar A Bhutta  2   3   7 , Robert E Black  8
Affiliations
Meta-Analysis

Effectiveness of Dietary Management for Moderate Wasting among Children > 6 Months of Age-A Systematic Review and Meta-Analysis Exploring Different Types, Quantities, and Durations

Bernardette Cichon et al. Nutrients. .

Abstract

Currently, no World Health Organization guidelines exist for the management of approximately 31.8 million moderately wasted children globally. The objective of this review was to synthesise evidence on the optimal type, quantity, and duration of dietary treatment for moderate wasting. Ten electronic databases were searched until the 23rd of August 2021. Experimental studies comparing interventions for the dietary management of moderate wasting were included. Meta-analyses were conducted and results were presented as risk ratios or mean differences with 95% confidence intervals. Seventeen studies comparing specially formulated foods were included involving 23,005 participants. Findings suggest little or no difference in recovery between Fortified Blended Foods (FBFs) with improved micronutrient and/or milk content (enhanced FBFs) and lipid-based nutrient supplements (LNS), whereas children treated with non-enhanced FBFs (locally produced FBFs or standard corn-soy blend) may have lower recovery rates than those treated with LNS. There was no difference in recovery when ready-to-use therapeutic and ready-to-use supplementary food were compared. Other outcomes mostly aligned with results for recovery. In conclusion, LNSs improve recovery compared to non-enhanced FBFs, but are comparable to enhanced FBFs. Programmatic choice of supplement should consider factors such as cost, cost-effectiveness, and acceptability. Further research is required to determine optimal dosing and duration of supplementation.

Keywords: corn–soy blend; fortified blended foods; moderate acute malnutrition; ready-to-use supplementary foods; ready-to-use therapeutic foods; supercereal; wasting.

PubMed Disclaimer

Conflict of interest statement

B.C. and H.S. were co-authors of some of the studies included in this review. As stated in the acknowledgements, the PICO question was developed by the WHO Organization and the Guideline Development Group for the revision of the guidelines on the prevention and treatment of wasting.

Figures

Figure 1
Figure 1
Flowchart showing the number of studies per comparison group.
Figure 2
Figure 2
Flowchart of intervention categories.
Figure 3
Figure 3
PRISMA flow diagram.
Figure 4
Figure 4
Forest plot of enhanced FBF compared to LNS—Outcome: Recovery rate (1) CSB++ Supplementary Plumpy/Nutriset; Recovery defined as WLZ > −2.0 and MUAC >12.5 cm for >= 2 follow-up visits; (2) Enhanced FBF vs. LNS, factorial trial including 12 different products; Recovery at 12 weeks (WHZ >= −2 and MUAC >= 125 mm); Supercereal Plus with amylase (SC + A) vs. RUSF; Recovery defined as achieving MUAC ≥12.5 cm by the seventh visit and no bipedal oedema; (3) Corn–soy–whey blend (CSWB) w/oil vs. RUSF; Recovery defined as achieving MUAC ≥12.5 cm by the seventh visit (12 weeks) and no bipedal oedema; (4) CSB+ w/oil vs. RUSF; Recovery defined as achieving MUAC ≥12.5 cm by the seventh visit (12 weeks) and no bipedal oedema; (5) CSB++ vs. soy RUSF; Recovery defined as reaching a WHZ >= −2; (6) CSB++ vs. soy/whey RUSF; Recovery defined as reaching a WHZ >= −2; (7) CSB+ with soy oil vs. RUSF; Recovery defined as reaching a WHZ >= −2; (8) CSB++ vs. locally produced RUSF; Recovery defined as reaching a WHZ >= −2.
Figure 5
Figure 5
Forest plot of CSB compared to LNS—Outcome: Recovery rate (1) CSB vs. Supplementary Plumpy/Nutriset; Recovery was defined as WFH ≥ 85% on 2 consecutive visits within 16 weeks; (2) CSB vs. milk/peanut fortified spread; defined as having a WHZ > −2 within 8 weeks; (3) CSB vs. soy/peanut fortified spread; defined as having a WHZ > −2 within 8 weeks; (4) CSB vs. standard RUTF; Recovery defined as reaching a WHM% >/= 85% for 2 consecutive weeks within 16 weeks.
Figure 6
Figure 6
Forest plot of locally produced FBF compared to LNS—Outcome: Recovery rate (1) Locally milled flours (LMF) compared to RUSF; Recovery defined as WLZ > −2.0 and MUAC >12.5 cm for >= 2 follow-up visits; (2) Misola compared to RUSF; Recovery defined as WLZ > −2.0 and MUAC >12.5 cm for >= 2 follow-up visits.
Figure 7
Figure 7
Forest plot of enhanced FBF compared to locally produced FBFs—Outcome: Recovery (1) CSB++ compared to Misola; Recovery defined as WLZ > −2.0 and MUAC > 12.5 cm for >= 2 follow-up visits; (2) CSB++ compared to locally milled flours (LMF); Recovery defined as WLZ > −2.0 and MUAC > 12.5 cm for >= 2 follow-up visits; (3) CSB+ compared to locally produced soy peanut blend (SBP); Recovery defined as WHZ > −2 and attaining 10% of their admission weight for two consecutive visits; (4) CSB+ compared to malted-sorghum-based porridge (MSBP); Recovery defined as WHZ > −2; (5) CSB+ vs. local ingredients based supplements (LIBS); Recovery was defined as MUAC > 12.5 cm and/or WHZ > −2 without bipedal oedema at the end of 12 weeks.
See this image and copyright information in PMC

References

    1. United Nations Children’s Fund (UNICEF) World Health Organization. International Bank for Reconstruction and Development/The World Bank . Levels and Trends in Child Malnutrition: Key Findings of the 2021 Edition of the Joint Child Malnutrition Estimates. World Health Organization; Geneva, Switzerland: 2021.
    1. Roberton T., Carter E.D., Chou V.B., Stegmuller A.R., Jackson B.D., Tam Y., Sawadogo-Lewis T., Walker N. Early Estimates of the Indirect Effects of the COVID-19 Pandemic on Maternal and Child Mortality in Low-Income and Middle-Income Countries: A Modelling Study. Lancet Glob. Health. 2020;8:e901–e908. doi: 10.1016/S2214-109X(20)30229-1. - DOI - PMC - PubMed
    1. Black R., Victora C., Walker S., Bhutta Z., Christian P., de Onis M., Ezzati M., Grantham-McGregor S., Katz J., Martorell R., et al. Maternal and Child Undernutrition and Overweight in Low and Middle Income Countries. Lancet. 2013;382:427–451. doi: 10.1016/S0140-6736(13)60937-X. - DOI - PubMed
    1. World Health Organization. World Food Programme. United Nations System Standing Committee on Nutrition. United Nations Children’s Fund . Community-Based Management of Severe Acute Malnutrition: A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund. World Health Organization; Geneva, Switzerland: 2007.
    1. World Health Organization . WHO Guideline on the Dairy Protein Content in Ready-to-Use Therapeutic Foods for Treatment of Uncomplicated Severe Acute Malnutrition. World Health Organization; Geneva, Switzerland: 2021. - PubMed