A multicenter, randomized controlled comparison of three renutrition strategies for the management of moderate acute malnutrition among children aged from 6 to 24 months (the MALINEA project)

Muriel Vray, Boris G Hedible, Pierrick Adam, Laura Tondeur, Alexandre Manirazika, Rindra Randremanana, Halima Mainassara, André Briend, Cecile Artaud, Cassandre von Platen, Mathias Altmann, Ronan Jambou, Muriel Vray, Boris G Hedible, Pierrick Adam, Laura Tondeur, Alexandre Manirazika, Rindra Randremanana, Halima Mainassara, André Briend, Cecile Artaud, Cassandre von Platen, Mathias Altmann, Ronan Jambou

Abstract

Background: The aim of this open-label, randomized controlled trial conducted in four African countries (Madagascar, Niger, Central African Republic, and Senegal) is to compare three strategies of renutrition for moderate acute malnutrition (MAM) in children based on modulation of the gut microbiota with enriched flours alone, enriched flours with prebiotics or enriched flours coupled with antibiotic treatment.

Methods: To be included, children aged between 6 months and 2 years are preselected based on mid-upper-arm circumference (MUAC) and are included based on a weight-for-height Z-score (WHZ) between - 3 and - 2 standard deviations (SD). As per current protocols, children receive renutrition treatment for 12 weeks and are assessed weekly to determine improvement. The primary endpoint is recovery, defined by a WHZ ≥ - 1.5 SD after 12 weeks of treatment. Data collected include clinical and socioeconomic characteristics, side effects, compliance and tolerance to interventions. Metagenomic analysis of gut microbiota is conducted at inclusion, 3 months, and 6 months. The cognitive development of children is evaluated in Senegal using only the Developmental Milestones Checklist II (DMC II) questionnaire at inclusion and at 3, 6, and 9 months. The data will be correlated with renutrition efficacy and metagenomic data.

Discussion: This study will provide new insights for the treatment of MAM, as well as original data on the modulation of gut microbiota during the renutrition process to support (or not) the microbiota hypothesis of malnutrition.

Trial registration: ClinicalTrials.gov, ID: NCT03474276 Last update 28 May 2018.

Keywords: Azithromycin; Metagenomic; Microbiota; Moderate acute malnutrition; Prebiotic.

Conflict of interest statement

Ethics approval and consent to participate

This study was conducted according to the protocol and ethical principles with their origins in the Declaration of Helsinki. The research protocol was approved by (1) the FDA-approved IRB (Institutional Review Board) and the CoRC (Clinical Research Committee) of Institut Pasteur, (2) the National Ethics Committee of the four countries, and (3) the CCTIRS (Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la santé) and the CNIL (Commission Nationale de l’Information et des Libertés) in France. Written informed consent will be obtained from all children’s parents or legal guardians for both MAM and well-nourished children. The project will provide treatment and laboratory testing free of charge. An international insurance contract is already granted to cover all specific risk of the trial.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests. The funders had no role in the design of the protocol.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Timetable of the follow up of the children

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Source: PubMed

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