Am J Clin Nutr 2016;103:1145–61.
Paluku Bahwere, Bisimwa Balaluka, Jonathan CK Wells, Chobohwa N Mbiribindi, Kate Sadler, Peter Akomo,
Miche`le Dramaix-Wilmet, and Steve Collins.
Background: The cost of current standard ready-to-use therapeutic food (RUTF) is among the major obstacles to scaling up community-based management of acute malnutrition (CMAM), an important child survival strategy. Identifying a cheaper alternative is a global public health priority.
Objective: : We sought to compare the efficacy of soya-maize sorghum RUTF (SMS-RUTF) with that of standard peanut paste based RUTF (P-RUTF).
Design: We used a nonblinded, parallel-group, simple randomized controlled trial along with a day care approach that enrolled 2 groups of children aged 6–23 and 24–59 mo, respectively, with severe acute malnutrition (SAM).
Results: Intention-to-treat (ITT) and per-protocol (PP) analyses showed noninferiority of SMS-RUTF compared with P-RUTF for the recovery rate [ITT: ∆ = -2.0% (95% CI: -7.6%, 3.6%); PP: -1.9% (95% CI: -5.3%, 1.4%)], weight gain [∆ = 20.7 g kg-1 d-1 (95% CI: -1.3, 0.0 g kg-1 d-1)], and length of stay [∆ = 2.0 d (95% CI: -1.7, 5.8 d)] in children ≥24 mo of age. In children ≤23 mo of age, the recovery rate of SMS-RUTF was inferior tothat of P-RUTF [ITT: ∆ = -20.8% (95% CI: -29.9%, -11.7%); PP: -17.2% (95% CI: -25.6%, -8.7%)]. Treatment with SMS-RUTF resulted in a greater increase in hemoglobin [0.670 g/dL (95% CI: 0.420, 0.921 g/dL); P , 0.001]. Treatment with both RUTFs resulted in the replenishment of all of the amino acids tested except for methionine. There were no differences at discharge between RUTF groups in fat mass [∆ = 0.3 kg (95% CI: -0.6, 1.6 kg); P = 0.341] or fat mass index [∆ = 0.4 kg/m2 (95% CI: -0.3, 1.1 kg/m2); P = 0.262]. By contrast, comparisons of fat-free mass indicated lower concentrations than the community controls after treatment with either of the 2 RUTFs [∆ = -1.3 kg (95% CI: -2.4, -0.1 kg) and P = 0.034 for comparison between community controls and the SMS-RUTF group; ∆ = -1.8 kg (95% CI: -2.9, -0.6 kg) and P = 0.003 for comparison between community controls and the P-RUTF group].
Conclusion: SMS-RUTF can be used to treat SAM in children aged ≥24 mo to reduce the costs of CMAM programs. More research is required to optimize SMS-RUTF for younger children.