Body Composition Changes in Children during Treatment for Moderate Acute Malnutrition: Findings from a 4-Arm Cluster-Randomized Trial in Sierra Leone

Devika J Suri, Isabel Potani, Akriti Singh, Stacy Griswold, William W Wong, Breanne Langlois, Ye Shen, Kwan Ho Kenneth Chui, Irwin H Rosenberg, Patrick Webb, Beatrice L Rogers, Devika J Suri, Isabel Potani, Akriti Singh, Stacy Griswold, William W Wong, Breanne Langlois, Ye Shen, Kwan Ho Kenneth Chui, Irwin H Rosenberg, Patrick Webb, Beatrice L Rogers

Abstract

Background: Measures that better describe "healthy" and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed.

Objectives: We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes.

Methods: The study was nested within a prospective, cluster-randomized, community-based, cost-effectiveness trial assessing 4 SNFs to treat children aged 6-59 mo with MAM [midupper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema] in Sierra Leone. Biweekly SNF rations (1 of 3 fortified-blended foods or a lipid-based nutrient supplement) were given until children recovered (MUAC ≥12.5 cm), or up to 7 rations (∼12 wk). Deuterium dilution was used to estimate fat-free mass (FFM) and fat mass (FM) at enrollment and after 4 wk of treatment to ensure similar treatment exposure among the participants. Another MUAC measurement was performed among recovered children 4 wk after program exit to determine whether recovery was sustained. ANOVA, paired t tests, and linear regression models were used to determine significant differences in changes from baseline to 4 wk.

Results: Among 312 analyzed participants, mean baseline weight comprised ∼80% FFM; mean weight gained after 4 wk comprised ∼82% FFM. Changes in FM and FFM among 4 SNFs were similar. Children who recovered gained more weight (241%), FFM (179%), and weight-for-height z score (0.44 compared with 0) compared with those who did not recover; sustainers gained 150% more weight. FM gains were positive among recovered children and sustainers, as well as negative among those who did not recover or sustain recovery, but not significantly different.

Conclusions: Four SNFs had similar effects on body composition in children after 4 wk of treatment for MAM, showing a healthy pattern of weight gain, the majority being FFM. Differential responses to treatment underscore a need for further research to provide targets for healthy, sustainable recovery. This trial was registered at clinicaltrials.gov as NCT03146897.

Keywords: Sierra Leone; body composition; corn-soy blend; deuterium dilution; moderate acute malnutrition; preschool children; ready-to-use supplementary food; relapse; supplementary nutritious foods.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1
FIGURE 1
Flow diagram of participants through the study. CSB+, corn-soy blend plus; CSWB, corn-soy-whey blend; RUSF, ready-to-use supplementary food; SAM, severe acute malnutrition; SC+, super cereal plus; TBW, total body water.
FIGURE 2
FIGURE 2
Comparison of adjusted mean changes to body composition and anthropometric indicators in children after 4 wk of treatment for MAM among 4 study arms. Error bars represent 95% confidence intervals. No significant differences by indicator among study arms based on linear regression models adjusted for baseline measure, age, sex and wealth quintile. n = 218, MUAC; n = 225, WHZ; n = 312, weight; n = 311, FFM; n = 311, FM; n = 205, FFM index. CSB+, corn-soy blend plus; CSWB, corn-soy-whey blend; FFM, fat-free mass; FM, fat mass; MAM, moderate acute malnutrition; MUAC, midupper arm circumference; RUSF, ready-to-use supplementary food; SC + A, super cereal plus amylase; WHZ, weight-for-height z score.
FIGURE 3
FIGURE 3
Mean changes in anthropometric and body composition measures in children after 4 wk of treatment for MAM, by study outcome. Error bars represent 95% confidence intervals. Recovered defined as achieving a MUAC ≥12.5 cm (n = 149); developed SAM defined as deteriorating to SAM (n = 26); failed defined as receiving up to 7 rations but remaining MAM (n = 35). Other outcomes not included: lost to follow-up (n = 7) and died (n = 1). FFM, fat-free mass; FM, fat mass; MAM, moderate acute malnutrition; MUAC, midupper arm circumference; SAM, severe acute malnutrition; WHZ, weight-for-height z score.

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Source: PubMed

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