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Title: Alternative ready-to-use therapeutic food yields less recovery than the standard for treating acute malnutrition in children from Ghana

item KOHLMANN, K - Washington University
item CALLAGHAN-GILLESPIE, M - Washington University
item GAUGLITZ, J - University Of California
item STEINER-ASIEDU, M - University Of Ghana
item SAALIA, K - University Of Ghana
item EDWARDS, C - Project Peanut Butter
item MANARY, M - Children'S Nutrition Research Center (CNRC)

Submitted to: Global Health: Science and Practice
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/2/2019
Publication Date: 6/12/2019
Citation: Kohlmann, K., Callaghan-Gillespie, M., Gauglitz, J.M., Steiner-Asiedu, M., Saalia, K., Edwards, C., Manary, M.J. 2019. Alternative ready-to-use therapeutic food yields less recovery than the standard for treating acute malnutrition in children from Ghana. Global Health: Science and Practice. 7(2):203-214.

Interpretive Summary: Approximately 200 million children with acute malnutrition, manifest as wasting, have a 5-12 fold increased risk for morbidity and mortality. Such children are typically given a full or partial food ration designed to provide the essential nutrients. An alternative recipe for a ready-to-use food was compared in a clinical trial for acute malnutrition to a standard recipe in Ghana. A total of 1270 children were treated and lower recovery rates were seen when the child received the alternative recipe, 80%, than with the standard recipe was given, 88%. The decreased effectiveness of this local alternative indicates it will not be a cost-effective alternative for wasted children in Ghana.

Technical Abstract: Only 20% of children with severe acute malnutrition (SAM) have access to ready-to-use therapeutic food (RUTF), and RUTF cost limits its accessibility. This randomized, double-blind controlled study involved a clinical equivalence trial comparing the effectiveness of an alternative RUTF with standard RUTF in the home-based treatment of uncomplicated SAM and moderate malnutrition in Ghanaian children aged 6 to 59 months. The primary outcome was recovery, equivalence was defined as being within 5 percentage points of the control group, and an intention-to-treat analysis was used. Alternative RUTF was composed of whey protein, soybeans, peanuts, sorghum, milk, sugar, and vegetable oil. Standard RUTF included peanuts, milk, sugar, and vegetable oil. The cost of alternative RUTF ingredients was 14% less than standard RUTF. Untargeted metabolomics was used to characterize the bioactive metabolites in the RUTFs. Of the 1,270 children treated for SAM or moderate malnutrition, 554 of 628 (88%) receiving alternative RUTF recovered (95% confidence interval [CI]=85% to 90%) and 516 of 642 (80%) receiving standard RUTF recovered (95% CI=77% to 83%). The difference in recovery was 7.7% (95% CI=3.7% to 11.7%). Among the 401 children with SAM, the recovery rate was 130 of 199 (65%) with alternative RUTF and 156 of 202 (77%) with standard RUTF (P=.01). The default rate in SAM was 60 of 199 (30%) for alternative RUTF and 41 of 202 (20%) for standard RUTF (P=.04). Children enrolled with SAM who received alternative RUTF had less daily weight gain than those fed standard RUTF (2.4 +/- 2.4 g/kg vs. 2.9 +/- 2.6 g/kg, respectively; P<.05). Among children with moderate wasting, recovery rates were lower for alternative RUTF, 386 of 443 (87%), than standard RUTF, 397 of 426 (93%) (P=.003). More isoflavone metabolites were found in alternative RUTF than in the standard. The lower-cost alternative RUTF was less effective than standard RUTF in the treatment of severe and moderate malnutrition in Ghana