Response to malnutrition treatment in low weight-for-age children: secondary analyses of children 6–59 months in the ComPAS cluster randomized controlled trial

Journal article

Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a simplified, combined protocol for severe and moderate acute malnutrition (SAM and MAM) vs. standard care that treats SAM and MAM, separately. Children with a moderately low MUAC (11.5–12.5 cm) and a severely low WAZ (<−3) respond similarly to treatment in terms of both weight and MUAC gain on either 2092 kJ (500 kcal)/day of therapeutic or supplementary food. Children with a severely low MUAC (<11.5 cm), with/without a severely low WAZ (<−3), have similar recovery with the combined protocol or standard treatment, though WAZ gain may be slower in the combined protocol. A limitation is this analysis was not powered for these sub-groups specifically. Adding WAZ < −3 as an admission criterion for therapeutic feeding programs admitting children with MUAC and/or oedema may help programs target high-risk children who can benefit from treatment. Future work should evaluate the optimal treatment protocol for children with a MUAC < 11.5 and/or WAZ < −3.0.

Authors: Bailey, J; Lelijveld, N; Khara, T; Dolan, C; Stobaugh, H

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: MDPI
• Journal: Nutrients
• Volume: 13
• Issue: 4
• Publication date: 2021-03-24
• Acceptance date: 2021-03-19
• DOI: 10.3390/nu13041054
• EISSN: 2072-6643
• Language: English
• Keywords: stunting; wasting; concurrent wasting and stunting; weight-for-age; community-based management of acute malnutrition; acute malnutrition; mid-upper arm circumference; FFR; ready-to-use therapeutic food