Christian Fabiansen1, Kevin Pq Phelan2, Bernardette Cichon3, Christian Ritz3, André Briend4, Kim F Michaelsen3, Henrik Friis3, Susan Shepherd5. 1. Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark; Médecins Sans Frontières-Denmark, Copenhagen, Denmark; 2. Alliance for International Medical Action, Dakar, Senegal; and. 3. Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark; 4. Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark; Department for International Health, University of Tampere School of Medicine, Tampere, Finland. 5. Alliance for International Medical Action, Dakar, Senegal; and susan.shepherd@alima-ngo.org.
Abstract
BACKGROUND: The management of children with moderate acute malnutrition (MAM) is based on food supplementation in outpatient programs. When midupper arm circumference (MUAC) is used as the sole admission criterion, it is common practice to exclude children with lengths <67 cm from treatment. The WHO calls for research to determine the treatment effect among children with MAM included by MUAC and aged ≥6 mo with lengths <67 cm. OBJECTIVE: We hypothesized that among children given supplementary feeding based on an MUAC of 115-124 mm as the sole criterion, there would be no difference in growth rate between children <67 cm and those ≥67 cm in length at program admission. DESIGN: This was an observational study nested in a randomized trial that investigated the effectiveness of new formulations of corn-soy blend and lipid-based nutrient supplements. Children aged 6-23 mo were included if their MUAC was between 115 and 124 mm but with a weight-for-height z score (WHZ) ≥-2. This cohort was divided into 2 groups by length at admission: <67 cm ("short") and ≥67 cm ("long"). Linear mixed-effects models and regression models were used to compare gains in weight and MUAC while adjusting for intervention, season, sex, age, and site. RESULTS:Weight-gain velocity (expressed as g · kg(-1) · d(-1)) and MUAC-gain velocity (expressed as 0.01 mm · cm(-1) · d(-1)) were not different between short and long children. Weight-gain velocity was slightly higher in the shortest quartile of length (P = 0.03), whereas there was no effect modification by stunting across length quartiles (P = 0.32). CONCLUSIONS: We found no evidence of a difference in percentage of weight gain or weight-gain velocity during supplementary feeding in short or long children aged 6-23 mo. We recommend a policy change to include children <67 cm in supplementary feeding programs if their MUAC is between 115 and 124 mm and their WHZ is ≥-2. This could benefit millions of children currently excluded from supplementary feeding. This trial was registered at www.controlled-trials.com as ISRCTN42569496.
RCT Entities:
BACKGROUND: The management of children with moderate acute malnutrition (MAM) is based on food supplementation in outpatient programs. When midupper arm circumference (MUAC) is used as the sole admission criterion, it is common practice to exclude children with lengths <67 cm from treatment. The WHO calls for research to determine the treatment effect among children with MAM included by MUAC and aged ≥6 mo with lengths <67 cm. OBJECTIVE: We hypothesized that among children given supplementary feeding based on an MUAC of 115-124 mm as the sole criterion, there would be no difference in growth rate between children <67 cm and those ≥67 cm in length at program admission. DESIGN: This was an observational study nested in a randomized trial that investigated the effectiveness of new formulations of corn-soy blend and lipid-based nutrient supplements. Children aged 6-23 mo were included if their MUAC was between 115 and 124 mm but with a weight-for-height z score (WHZ) ≥-2. This cohort was divided into 2 groups by length at admission: <67 cm ("short") and ≥67 cm ("long"). Linear mixed-effects models and regression models were used to compare gains in weight and MUAC while adjusting for intervention, season, sex, age, and site. RESULTS:Weight-gain velocity (expressed as g · kg(-1) · d(-1)) and MUAC-gain velocity (expressed as 0.01 mm · cm(-1) · d(-1)) were not different between short and long children. Weight-gain velocity was slightly higher in the shortest quartile of length (P = 0.03), whereas there was no effect modification by stunting across length quartiles (P = 0.32). CONCLUSIONS: We found no evidence of a difference in percentage of weight gain or weight-gain velocity during supplementary feeding in short or long children aged 6-23 mo. We recommend a policy change to include children <67 cm in supplementary feeding programs if their MUAC is between 115 and 124 mm and their WHZ is ≥-2. This could benefit millions of children currently excluded from supplementary feeding. This trial was registered at www.controlled-trials.com as ISRCTN42569496.
Authors: Suvi T Kangas; Cécile Salpéteur; Victor Nikièma; Christian Ritz; Henrik Friis; André Briend; Pernille Kaestel Journal: PLoS One Date: 2022-05-31 Impact factor: 3.752
Authors: C W Yaméogo; B Cichon; C Fabiansen; M J H Rytter; D Faurholt-Jepsen; K D Stark; A Briend; S Shepherd; A S Traoré; V B Christensen; K F Michaelsen; H Friis; L Lauritzen Journal: Nutr J Date: 2017-07-13 Impact factor: 3.271
Authors: Charles W Yaméogo; Bernardette Cichon; Christian Fabiansen; Ann-Sophie Iuel-Brockdorf; Susan Shepherd; Suzanne Filteau; Alfred S Traoré; Vibeke B Christensen; Kim F Michaelsen; Soren Brage; Henrik Friis; Daniel Faurholt-Jepsen Journal: J Pediatr Date: 2016-11-18 Impact factor: 4.406
Authors: Mueni Mutunga; Alexandra Rutishauser-Perera; Arnaud Laillou; Sophonneary Prak; Jacques Berger; Frank T Wieringa; Paluku Bahwere Journal: PLoS One Date: 2021-11-18 Impact factor: 3.240
Authors: Franck G B Alé; Kevin P Q Phelan; Hassan Issa; Isabelle Defourny; Guillaume Le Duc; Geza Harczi; Kader Issaley; Sani Sayadi; Nassirou Ousmane; Issoufou Yahaya; Mark Myatt; André Briend; Thierry Allafort-Duverger; Susan Shepherd; Nikki Blackwell Journal: Arch Public Health Date: 2016-09-06