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Updated: Jun 18, 2025
Author Spotlight: Developing a Safer and More Efficient Treatment Protocol for Wasting Marmoset Syndrome (WMS)
Published on: July 12, 2024
The relationship between energy provided and growth during severe wasting treatment
Isabel Potani1,2, Zachary Tausanovitch1, Christian Ritz3
1Airbel Impact Lab, International Rescue Committee, New York, New York, USA.
Insights
Higher energy intake at the start of treatment for severe acute malnutrition in children with low mid-upper arm circumference (MUAC) significantly boosts catch-up growth. This finding supports optimizing energy provision for better treatment outcomes in malnourished children.
Area of Science:
- Pediatrics
- Nutritional Science
- Global Health
Background:
- Severe acute malnutrition (SAM) treatment aims to rapidly improve growth and reduce mortality.
- The precise impact of initial energy provision on catch-up growth in SAM is not fully understood.
- Children with mid-upper arm circumference (MUAC) < 115 mm represent a critical group requiring effective nutritional intervention.
Purpose of the Study:
- To investigate the association between energy intake at admission and catch-up ponderal growth in children with SAM.
- To quantify the impact of initial energy provision on weight gain velocity and anthropometric z-scores.
- To inform optimized feeding protocols for children with SAM.
Main Methods:
- Secondary data analysis of an operational cohort in Mali.
- Children received a simplified therapeutic feeding protocol with varying initial energy levels.
- Linear mixed-effects regression models assessed the relationship between energy intake (kcal/kg/day) and growth velocity (g/kg/day), MUAC-for-age z-score, and weight-for-age z-score.
Main Results:
- A 10 kcal/kg/day increase in energy at admission was significantly associated with increased weight gain velocity.
- Adjusted analysis showed a mean increment of 0.466 g/kg/day in weight gain velocity for every 10 kcal/kg/day increase in energy.
- Positive associations were observed for changes in MUAC-for-age and weight-for-age z-scores.
Conclusions:
- Initial energy provision is positively associated with catch-up ponderal growth in children with SAM (MUAC < 115 mm).
- Optimizing energy intake at the start of treatment can enhance growth velocity.
- Further research is needed to determine the ideal energy intake for balancing benefits and risks during SAM treatment.
Abstract:
Treatment of severe acute malnutrition aims at producing quick catch-up growth in children to decrease their short-term mortality risk. The extent to which catch-up growth is influenced by the amount of energy provided is unclear. This study assessed whether energy provided at admission is associated with catch-up ponderal growth among children with mid-upper arm circumference (MUAC) < 115 mm at admission. We conducted a secondary data analysis an operational cohort in Mali. The children were treated with a simplified protocol providing 1000 kcal/day of therapeutic food until MUAC ≥ 115 mm was achieved for two consecutive weeks and 500 kcal/day thereafter until discharge with MUAC ≥ 125 mm for two consecutive weeks. Linear mixed-effects regression models were fitted to assess the relationship between energy provided at admission (kcal/kg/day) with weight gain velocity (g/kg/day) (primary outcome), change in MUAC -for-age z-score and change in weight-for-age z-score. Unadjusted models and models adjusted for sex, age, seasonality and MUAC at admission were fitted. Both models included the study site as a random effect. A 10 kcal/kg/day increase in energy provided at admission was associated with increments in all outcomes; for weight gain velocity, the mean (95% CI) increment was 0.340 [0.326, 0.354] g/kg/day and 0.466 [0.446, 0.485] g/kg/day in the unadjusted and adjusted analysis, respectively. A positive relationship exists between energy provided at admission and catch-up ponderal growth in children with MUAC < 115 mm treated using a simplified protocol. Determining the ideal weight gain rate remains essential for assessing the benefits and risks of increased energy intake during treatment.
