Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition in Burkina Faso

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Research snapshot¹

A randomised non-inferiority trial was undertaken to investigate the efficacy of a reduced ready-to-use therapeutic food (RUTF) dose in community-based treatment of uncomplicated severe acute malnutrition (SAM) in Burkina Faso. Between October 2016 and July 2018, 801 children aged 6–59 months with uncomplicated SAM were enrolled from 10 community health centres and randomly assigned into one of two study arms: (a) a standard RUTF dose for two weeks, followed by a reduced dose thereafter (reduced); or (b) a standard RUTF dose throughout the treatment (standard). The mean weight gain velocity from admission to discharge was 3.4 g/kg/day and did not differ between study arms (Δ 0.0 g/kg/day; 95% CI −0.4 to 0.4; p = 0.92), confirming non-inferiority (p = 0.013). No differences were found in length of stay or recovery rate between arms, nor in mid-upper arm circumference (MUAC) gain velocity. However, after two weeks, the weight gain velocity was significantly lower in the reduced dose, with a mean of 2.3 g/kg/day compared with 2.7 g/kg/day in the standard dose (Δ −0.4 g/kg/day; 95% CI −0.8 to −0.02; p = 0.041). The reduced RUTF dose also led to a small but significant negative effect, 0.2 mm/week (95% CI 0.04 to 0.4; p = 0.015), on height gain velocity, with a mean height gain of 2.6 mm/week with reduced and 2.8 mm/week with standard RUTF dose. The impact was more pronounced in children under 12 months of age (interaction, p = 0.019). The authors recommend that a reduced-dose approach is tested in a routine programmatic setting and in different food-security contexts before scale-up.

Endnote

¹Kangas ST, Salpe´teur C, Nikièma V, Talley L, Ritz C, Friis H, et al. (2019) Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomised non-inferiority trial in Burkina Faso. PLoS Med 16(8): e1002887. https://doi.org/10.1371/journal.pmed.1002887