Cambodia: Vitamin A and iron status remain unaffected by ready-to-use therapeutic food

This randomised controlled trial collected baseline and follow-up data on micronutrient status after an eight-week intervention on uncomplicated severely wasted children aged 6–59 months. Severe wasting was defined as a weight-for-height z-score ≤-2.8 or mid-upper-arm circumference ≤115mm and/or the presence of nutritional oedema.

The intervention was a novel ready-to-use therapeutic food (RUTF) (NumTrey: a wafer filled with a fish-based paste) compared to a regular milk-based RUTF (BP-100TM) as a control. The trial took place between September 2015 and January 2017 in an urban setting (Phnom Penh, Cambodia). Food rations in each arm were based on national standards by child weight (160–180 kcal/kg). Analysis of results showed minimal impact of both locally produced and standard RUTF on micronutrient status, which is a similar finding to other relevant studies. There was no significant difference for haemoglobin, iron status, inflammation, vitamin A status, or anaemia between baseline and discharge (p>0.05), and no significant difference for any of these measures between control and intervention groups (p>0.05). Given these results, the authors suggest the need for further research on how to enhance the effectiveness of SAM treatment on micronutrient status.

However, the results of this study should be interpreted with caution due to several caveats.

Minimal impact could be attributed to the short follow-up period, which may not have been long enough to reflect changes in micronutrient status – which can take 1–6 months in some cases. A standard sample size calculation indicated that the study should include 120 children to detect a 10% difference in effect. A high dropout rate (≈40%) resulted in 37 participants per arm included in the final analysis – so this trial was underpowered, reducing the chance of detecting a true effect. Although micronutrient status was a secondary outcome, meaning this calculation is not relevant for this aspect of the study, the dropout rate and subsequent small sample size remain significant considerations when interpreting these results.

At baseline, the prevalence of anaemia, haemoglobinopathies, iron deficiency, low body iron, and vitamin A deficiency was higher among those randomised to the control group, which may inflate the effects of the intervention arm. More males (60%) featured in this study than females (40%) at admission, but this was more pronounced in the control (64:36%) compared to intervention (55:45%) arm. This may be the cause of greater anaemia prevalence in the control arm, as male children are more likely to be anaemic.¹,² This highlights the importance of matching control and intervention groups in small studies³ to minimise the challenges of interpreting results.