title: A novel fortified blended flour, corn-soy blend "plus-plus," is not inferior to lipid-based ready-to-use supplementary foods for the treatment of moderate acute malnutrition in Malawian children.
abstract: BACKGROUND
  Children with moderate acute malnutrition (MAM) are often treated with fortified blended flours, most commonly a corn-soy blend (CSB). However, recovery rates remain <75%, lower than the rate achieved with peanut paste-based ready-to-use supplementary foods (RUSFs). To bridge this gap, a novel CSB recipe fortified with oil and dry skim milk, "CSB++," has been developed.
  
  
  OBJECTIVE
  In this trial we compared CSB++ with 2 RUSF products for the treatment of MAM to test the hypothesis that the recovery rate achieved with CSB++ will not be >5% worse than that achieved with either RUSF.
  
  
  METHODS
  We conducted a prospective, randomized, investigator-blinded, controlled noninferiority trial involving rural Malawian children aged 6-59 mo with MAM. Children received 75 kcal CSB++ · kg(-1) · d(-1), locally produced soy RUSF, or an imported soy/whey RUSF for ≤12 wk.
  
  
  RESULTS
  The recovery rate for CSB++ (n = 763 of 888; 85.9%) was similar to that for soy RUSF (795 of 806, 87.7%; risk difference: -1.82%; 95% CI: -4.95%, 1.30%) and soy/whey RUSF (807 of 918, 87.9%; risk difference: -1.99%; 95% CI: -5.10%, 1.13%). On average, children who received CSB++ required 2 d longer to recover, and the rate of weight gain was less than that with either RUSF, although height gain was the same among all 3 foods studied.
  
  
  CONCLUSIONS
  A novel, locally produced, fortified blended flour (CSB++) was not inferior to a locally produced soy RUSF and an imported soy/whey RUSF in facilitating recovery from MAM. The recovery rate observed for CSB++ was higher than that for any other fortified blended flour tested previously. This trial is registered at clinicaltrials.gov as NCT00998517.
authors.affiliation: Department of Pediatrics, Washington University in St Louis, MO, USA.
authors.forename: Lacey N
authors.initials: LN
authors.lastname: LaGrone
authors.forename: Indi
authors.initials: I
authors.lastname: Trehan
authors.forename: Gus J
authors.initials: GJ
authors.lastname: Meuli
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wang
authors.forename: Chrissie
authors.initials: C
authors.lastname: Thakwalakwa
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D010367:Arachis; D001827:Body Height; D015362:Child Nutrition Disorders / Q000178:diet therapy; D002675:Child, Preschool; D004041:Dietary Fats / Q000627:therapeutic use*; D004044:Dietary Proteins / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D005433:Flour; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000178:diet therapy; D016015:Logistic Models; D008295:Malawi; D008297:Male; D018977:Micronutrients / Q000627:therapeutic use; D008894:Milk Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D010940:Plant Proteins / Q000627:therapeutic use; D011502:Protein-Energy Malnutrition / Q000178:diet therapy*; D016037:Single-Blind Method; D013024:Soybean Oil / Q000627:therapeutic use; D013025:Glycine max; D015430:Weight Gain; D000067816:Whey Proteins; D003313:Zea mays
chemical_list: D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients; D008894:Milk Proteins; D010940:Plant Proteins; D000067816:Whey Proteins; D013024:Soybean Oil