title: Reducing wasting in young children with preventive supplementation: a cohort study in Niger.
abstract: OBJECTIVE
  To compare the incidence of wasting, stunting, and mortality among children aged 6 to 36 months who are receiving preventive supplementation with either ready-to-use supplementary foods (RUSFs) or ready-to-use therapeutic foods (RUTFs).
  
  
  METHODS
  Children aged 6 to 36 months in 12 villages of Maradi, Niger, (n = 1645) received a monthly distribution of RUSFs (247 kcal [3 spoons] per day) for 6 months or RUTFs (500-kcal sachet per day) for 4 months. We compared the incidence of wasting, stunting, and mortality among children who received preventive supplementation with RUSFs versus RUTFs.
  
  
  RESULTS
  The effectiveness of RUSF supplementation depended on receipt of a previous preventive intervention. In villages in which a preventive supplementation program was previously implemented, the RUSF strategy was associated with a 46% (95% confidence interval [CI]: 6%-69%) and 59% (95% CI: 17%-80%) reduction in wasting and severe wasting, respectively. In contrast, in villages in which the previous intervention was not implemented, we found no difference in the incidence of wasting or severe wasting according to type of supplementation. Compared with the RUTF strategy, the RUSF strategy was associated with a 19% (95% CI: 0%-34%) reduction in stunting overall.
  
  
  CONCLUSIONS
  We found that the relative performance of a 6-month RUSF supplementation strategy versus a 4-month RUTF strategy varied with receipt of a previous nutritional intervention. Contextual factors will continue to be important in determining the dose and duration of supplementation that will be most effective, acceptable, and sustainable for a given setting.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. sisanaka@hsph.harvard.edu
authors.forename: Sheila
authors.initials: S
authors.lastname: Isanaka
authors.forename: Thomas
authors.initials: T
authors.lastname: Roederer
authors.forename: Ali
authors.initials: A
authors.lastname: Djibo
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Luquero
authors.forename: Nohelly
authors.initials: N
authors.lastname: Nombela
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Guerin
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D001835:Body Weight; D002391:Catchment Area, Health; D002675:Child, Preschool; D015331:Cohort Studies; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009548:Niger / Q000453:epidemiology; D019282:Wasting Syndrome / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D015431:Weight Loss