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A meta-analysis looking into moderate acute malnutrition interventions

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This is a summary of the following paper: Cichon B, Das J, Salam R et al. (2023) Effectiveness of dietary management for moderate wasting among children >6 months of age – A systematic review and meta-analysis exploring different types, quantities, and durations. Nutrients, 15, 5. https://www.mdpi.com/2072-6643/15/5/1076

This systematic review and meta-analysis investigated the effect of multiple food intervention categories alongside standard clinical care on moderate acute malnutrition. A broad spectrum of interventions was included at different doses, roughly broken down into: non-specially formulated foods (e.g., home foods); lipid-based nutrient supplements (LNS); fortified blended foods; and non-fortified blended foods. A flowchart describing the detailed categories of interventions, as well as the exact search terminology employed across the nine selected databases, can be found in the original paper.

The study population was children aged >6 months with moderate wasting.1 The outcomes of interest were: i) anthropometric recovery / outcomes (weight-for-length, weight-for-age, mid-upper arm circumference, weight and height gain); ii) sustained recovery; iii) deterioration to severe wasting; iv) time to recovery; and v) non-response relapse. No language or date restrictions were applied to the search up until 23 August 2021.

The initial search yielded 32,180 studies, which was reduced to 22 papers (17 studies) after review. Studies were randomised controlled trials conducted in Africa (n=16) and Asia (n=1) between 2009 and 2021.

Due to the size of the analysis, a full breakdown of each outcome category and intervention vs intervention sub questions is beyond the scope of this summary. Overall, LNS offered small benefits to recovery and anthropometric indices compared to fortified blended foods. There was no significant difference in LNS vs enhanced fortified blended foods for recovery, anthropometry, and morbidity. LNS may be superior to enhanced fortified blended foods for weight gain (weight-for-height and mid-upper arm circumference), but the effect size is small. There was no difference in recovery when ready-to-use therapeutic and ready-to-use supplementary food were compared.

The data in this study were heterogenous, making it difficult to compare so many different intervention categories, products, regimens, outcomes, and timelines. Essentially, this study only provides evidence in African settings, as 94% of the included studies came from the continent – which in itself is diverse – so we cannot extrapolate this to other settings without further evidence. No studies compared specially formulated foods to home foods, which is an evidence gap.

The use of multiple comparisons, and subsequent research questions asked, may increase the risk of findings being due to chance. Given that effect sizes were small, the results cautious, and the findings being broadly in line with other evidence, the authors note that:

“LNS may be preferable compared to the ‘outdated’ corn soy blend and less enhanced fortified blended cereals. However, given the small difference in treatment outcomes … any programmatic decision on which of these to choose may therefore want to consider acceptability, availability, as well as cost and cost-effectiveness.”

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1 Defined as weight-for-height z-score of ≥-3 and <-2 and/or a mid-upper arm circumference of ≥11.5cm and <12.5cm or a weight-for-height between >70 and <80% of the median and no oedema, treated either as inpatients or outpatients.

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A meta-analysis looking into moderate acute malnutrition interventions. Field Exchange 70, September 2023. p35. www.ennonline.net/fex/70/a-meta-analysis-looking-into-moderate-acute-malnutrition-interventions

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