Location: Children's Nutrition Research CenterTitle: Protein quality in ready-to-use supplementary foods for moderate wasting
|ROEDIGER, REBECCA - Washington University|
|STEIN, HANS - University Of Illinois|
|CALLAGHAN-GILLESPIE, MEGHAN - Washington University|
|BLACKMAN, JEFFREY - Washington University|
|KOHLMANN, KRISTIN - Washington University|
|MALETA, KENNETH - University Of Malawi|
|MANARY, MARK - Children'S Nutrition Research Center (CNRC)|
Submitted to: Maternal and Child Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/14/2020
Publication Date: 5/19/2020
Citation: Roediger, R., Stein, H.H., Callaghan-Gillespie, M., Blackman, J.K., Kohlmann, K., Maleta, K., Manary, M. 2020. Protein quality in ready-to-use supplementary foods for moderate wasting. Maternal and Child Nutrition. e13019. https://doi.org/10.1111/mcn.13019.
Interpretive Summary: Dietary protein is described in three ways, by its source, such as dairy or vegetable, by its amount and by its type; type is measured numerically as protein quality. Children with moderate malnutrition were fed one of two foods; the foods had the same source, dairy, and amount of protein, but different protein qualities. Children receiving these foods recovered similarly, and with remarkable efficiency, suggesting the measures of protein quality are not important.
Technical Abstract: There are no guidelines for the optimal protein quality of ready-to-supplementary food (RUSF) for moderate acute malnutrition (MAM). This randomized, controlled, double-blinded, clinical effectiveness trial evaluated two RUSFs in the treatment of MAM. Both foods contained greater than 7% dairy protein, but the protein-optimized RUSF had a calculated digestible indispensable amino acid score (DIAAS) of 95%, whereas the control RUSF had a calculated DIAAS of 63%. There were 1,737 rural Malawian children 6-59 months of age treated with 75 kcal/kg/day of either control or protein quality-optimized RUSF for up to 12 weeks. There was no difference in the proportion of children who recovered from MAM between the group that received protein-optimized RUSF (759/860, 88%) and the group that received control RUSF (766/877, 87%, difference 1%, 95% CI, -2.1 to 4.1, p=0.61). There were no differences in time to recovery or average weight gain; nor were adverse effects reported. Both RUSFs showed indistinguishable clinical outcomes, with recovery rates higher than typically seen in treatment for MAM. The DIAAS of these two RUSFs was measured using a pig model. Unexpectedly, the protein quality of the optimized RUSF was inferior to the control RUSF: DIAAS = 82% for the protein quality optimized RUSF and 96% for control RUSF. The controlled conditions of this trial suggest that in supplementary food products for MAM, protein quality is not an independent predictor of clinical effectiveness.