Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis

Abstract

Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between -3 and -2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn-soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I² = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I² = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.

Keywords: Children; Moderate acute malnutrition; RUSF; Ready-to-Use Supplementary Food; School-age children; Wasting.

Fig. 1.

PRISMA flow diagram of the study selection. N, number.

Fig. 2.

Summary of the pooled effect sizes (standardised mean differences and risk differences) of anthropometric measures and the recovery rate of RUSF compared to other interventions.

Fig. 3.

A random-effects meta-analysis comparing the mean difference of anthropometric measurements improved in children with MAM treated with a RUSF and other dietary supplementation types. Positive effect sizes indicate improvements in favour of the RUSF group, and negative effect sizes in favour of comparison.

Fig. 4.

Subgroup meta-analysis comparing the mean difference of anthropometric measurements improved in children with MAM treated with a RUSF versus CSB++. Positive effect sizes indicate improvements in favour of the RUSF group, and negative effect sizes in favour of comparison.

Fig. 5.

A random-effects meta-analysis of studies comparing the risk difference of children who recovered from MAM who were treated with a RUSF and other dietary supplementation types. Positive effect sizes indicate improvements in favour of the RUSF group, and negative effect sizes in favour of comparison.

Fig. 6.

Subgroup meta-analysis of studies comparing the risk difference of children who recovered from MAM who were treated with a RUSF and other dietary supplementation types. Positive effect sizes indicate improvements in favour of the RUSF group, and negative effect sizes in favour of comparison.