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Title: A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children

Author
item OAKLEY, ELEANOR - Washington University School Of Medicine
item REINKING, JASON - Washington University School Of Medicine
item SANDIGE, HEIDI - Washington University School Of Medicine
item TREHAN, INDI - Washington University School Of Medicine
item KENNEDY, GREGG - Washington University School Of Medicine
item MALETA, KENNETH - University Of Malawi
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/27/2010
Publication Date: 12/1/2010
Citation: Oakley, E., Reinking, J., Sandige, H., Trehan, I., Kennedy, G., Maleta, K., Manary, M. 2010. A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children. Journal of Nutrition. 140(12):2248-2252.

Interpretive Summary: Ready-to-use therapeutic food (RUTF) has become standard treatment for children with severe acute malnutrition and has achieved recovery rates of up to 90%. Milk is the most expensive ingredient in RUTF and in an effort to reduce cost and make RUTF more widely available, replacing milk with soy has been suggested. This study compares the efficacy of RUTF recipes containing 25% milk and 10% milk with soy. The study found higher recovery rates for children fed with the 25% milk RUTF as well as higher rates of height and weight gain. The results of this study recommends maintaining milk at 25% in RUTF and highlights the importance of testing the efficacy of new therapeutic food recipes before they are widely introduced in such populations.

Technical Abstract: Standard therapy for severe acute malnutrition (SAM) is a home-based therapy with ready-to-use therapeutic food (RUTF) containing 25% milk. In an effort to lower the cost of RUTF and increase availability, some have suggested that a portion of milk be replaced with soy. This trial was designed to determine whether treating children with SAM with 10% milk RUTF containing soy would result in a similar recovery rate compared with the 25% milk RUTF. This was a randomized, doubleblind, controlled, clinical, quasi-effectiveness trial of isoenergetic amounts of 2 locally produced RUTF to treat SAM in Malawi among children aged 6–59 mo. A total of 1874 children were enrolled. Children were assessed every fortnight and participated in the study until they clinically recovered or received 8 wk of treatment. The primary outcome was recovery (weight-for-height Z score . 22 and no edema). Secondary outcomes were rates of weight and height gain. Survival analysis was used to compare the recovery rates. Recovery among children receiving 25% milk RUTF was greater than children receiving 10% milk RUTF, 64% compared with 57% after 4 wk, and 84% compared with 81% after 8 wk (P<0.001). Children receiving 25% milk RUTF also had higher rates of weight and height gain compared with children receiving 10% milk RUTF. Treating children with SAM with 10% milk RUTF is less effective compared with treatment with the standard 25% milk RUTF. These findings also emphasize that clinical evidence should be examined before recommending any changes to the formulation of RUTF.