Acute malnutrition recovery energy requirements based on mid-upper arm circumference: Secondary analysis of feeding program data from 5 countries, Combined Protocol for Acute Malnutrition Study (ComPAS) Stage 1

Authors: CHASE, RACHEL - Johns Hopkins University; KERAC, MARKO - London School Of Hygiene & Tropical Medicine; GRANT, ANGELINE - Action Against Hunger; MANARY, MARK - Children'S Nutrition Research Center (CNRC); BRIEND, ANDRÉ - University Of Tampere Medical School; OPONDO, CHARLES - London School Of Hygiene & Tropical Medicine; BAILEY, JEANETTE - International Rescue Committee

Submitted to: PLOS ONE
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/1/2020
Publication Date: 6/3/2020
Citation: Chase, R.P., Kerac, M., Grant, A., Manary, M., Briend, A., Opondo, C., Bailey, J. 2020. Acute malnutrition recovery energy requirements based on mid-upper arm circumference: Secondary analysis of feeding program data from 5 countries, Combined Protocol for Acute Malnutrition Study (ComPAS) Stage 1. PLoS One. 15(6):e0230452. https://doi.org/10.1371/journal.pone.0230452.
DOI: https://doi.org/10.1371/journal.pone.0230452

Interpretive Summary: Severe and moderate acute malnutrition (SAM and MAM) account for approximately 900,000 deaths annually and are currently addressed with different food products in different doses in separate programs. Using data from thousands of children recovering from SAM and MAM from 5 counties, 95% of visits were successfully treated with 1,000 kilocalories a day. A simplified approach using the same dose of food for all children is suitable for both types of malnutrition, providing the nutritional needs for this pediatric group.

Technical Abstract: Severe and moderate acute malnutrition (SAM and MAM) are currently treated with different food products in separate treatment programs. The development of a unified and simplified treatment protocol using a single food product aims to increase treatment program efficiency and effectiveness. This study, the first stage of the ComPAS trial, sought to assess rate of growth and energy requirements among children recovering from acute malnutrition in order to design a simplified, MUAC-based dosage protocol. We obtained secondary data from patient cards of children aged 6–59 months recovering from SAM in outpatient therapeutic feeding programs (TFPs) and from MAM in supplementary feeding programs (SFPs) in five countries in Africa and Asia. We used local polynomial smoothing to assess changes in MUAC and proportional weight gain between clinic visits and assessed their normalized differences for a non-zero linear trend. We estimated energy needs to meet or exceed the growth observed in 95% of visits. This analysis used data from 5518 patients representing 33942 visits. Growth trends in MUAC and proportional weight gain were not significantly different, each lower at higher MUAC values: MUAC growth averaged 2mm/week at lower MUACs (100 to <110mm) and 1mm/week at higher MUACs (120mm to <125mm); and proportional weight gain declined from 3.9g/kg/day to 2.4g/kg/day across the same MUAC values. In 95% of visits by children with a MUAC 100mm to <125mm who were successfully treated, energy needs could be met or exceeded with 1,000 kilocalories a day. Two 92g sachets of Ready-to-Use Therapeutic Food (RUTF) (1,000kcal total) is proposed to meet the estimated total energy requirements of children with a MUAC 100mm to <115mm, and one 92g sachet of RUTF (500kcal) is proposed to meet half the energy requirements of children with a MUAC of 115 to <125mm. A simplified, combined protocol may enable a more holistic continuum of care, potentially contributing to increased coverage for children suffering from acute malnutrition.