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Linear Growth During Treatment With a Simplified, Combined Protocol: Secondary Analyses of Severely Wasted Children

Grace Heymsfield1, Kevin Stephenson2, Zachary Tausanovitch1

  • 1International Rescue Committee, New York City, New York, USA.

Maternal & Child Nutrition
|December 2, 2024
PubMed

Insights

A simplified treatment protocol for acute malnutrition in children using reduced ready-to-use therapeutic food (RUTF) doses showed similar linear growth outcomes compared to standard treatments. This simplified approach effectively manages moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without compromising child development.

Area of Science:

  • Pediatrics
  • Global Health
  • Nutrition Science

Background:

  • Acute malnutrition, including moderate acute malnutrition (MAM) and severe acute malnutrition (SAM), affects millions of children globally.
  • Standard treatment protocols often involve weight-based dosing of ready-to-use therapeutic food (RUTF), which can be resource-intensive.
  • A simplified, combined protocol using fixed daily RUTF sachets for MAM and SAM has shown comparable recovery rates to standard treatments.

Purpose of the Study:

  • To conduct a secondary analysis of a cluster-randomized controlled trial to compare linear growth in children with severe acute malnutrition (SAM) treated with a simplified versus a standard RUTF dosing protocol.
  • To evaluate the impact of reduced RUTF dosage on linear and ponderal growth velocity in children admitted with mid-upper arm circumference (MUAC) < 115 mm.

Main Methods:

  • Secondary analysis of data from a cluster-based randomized controlled trial in Kenya and South Sudan.
  • Comparison of linear growth (height-for-age z-score change) and ponderal growth (MUAC and weight gain velocity) between children receiving a simplified RUTF protocol and those receiving standard treatment.
  • Growth curves were visualized, and statistical analyses were performed to compare growth velocities between treatment arms.

Main Results:

  • Adjusted height-for-age z-score (HAZ) change was negative but similar across both the standard and simplified treatment arms (difference: 0.03; 95% CI: -0.12, 0.18).
  • Unadjusted linear growth velocity was comparable between the standard (1.8 ± 0.7 mm/week) and simplified (1.7 ± 0.7 mm/week) arms, with adjusted analysis showing similar results.
  • No significant differences were observed in MUAC and weight gain velocities between the treatment groups.

Conclusions:

  • Reducing the RUTF dose for children with severe acute malnutrition (SAM) within a simplified treatment protocol does not negatively impact linear growth or other growth velocities during treatment.
  • The simplified, combined protocol offers a viable alternative for managing acute malnutrition, potentially simplifying logistics and resource allocation without compromising growth outcomes.

Keywords:
KenyaSouth Sudanacute malnutritionlinear growthsecondary analyses

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