title: Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery.
abstract: Moderate acute malnutrition (MAM) affects 11% of children <5 y old worldwide and increases their risk for morbidity and mortality. It is assumed that successful treatment of MAM reduces these risks. A total of 1967 children aged 6-59 mo successfully treated for MAM in rural Malawi following randomized treatment with corn-soy blend plus milk and oil (CSB++), soy ready-to-use supplementary food (RUSF), or soy/whey RUSF were followed for 12 mo. The initial supplementary food was given until the child reached a weight-for-height Z-score (WHZ) >-2. The median duration of feeding was 2 wk, with a maximum of 12 wk. The hypothesis tested was that children treated with either RUSF would be more likely to remain well-nourished than those treated with CSB++. The primary outcome, remaining well-nourished, was defined as mid-upper arm circumference ≥12.5 cm or WHZ ≥-2 for the entire duration of follow-up. During the 12-mo follow-up period, only 1230 (63%) children remained well-nourished, 334 (17%) relapsed to MAM, 190 (10%) developed severe acute malnutrition, 74 (4%) died, and 139 (7%) were lost to follow-up. Children who were treated with soy/whey RUSF were more likely to remain well-nourished (67%) than those treated with CSB++ (62%) or soy RUSF (59%) (P = 0.01). A seasonal pattern of food insecurity and adverse clinical outcomes was observed. This study demonstrates that children successfully treated for MAM with soy/whey RUSF are more likely to remain well-nourished; however, all children successfully treated for MAM remain vulnerable.
authors.affiliation: Department of Pediatrics, Washington University, St. Louis, MO, USA.
authors.forename: Cindy Y
authors.initials: CY
authors.lastname: Chang
authors.forename: Indi
authors.initials: I
authors.lastname: Trehan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wang
authors.forename: Chrissie
authors.initials: C
authors.lastname: Thakwalakwa
authors.forename: Ken
authors.initials: K
authors.lastname: Maleta
authors.forename: Megan
authors.initials: M
authors.lastname: Deitchler
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D000818:Animals; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D008892:Milk; D008894:Milk Proteins; D010938:Plant Oils / Q000737:chemistry*; D012307:Risk Factors; D012423:Rural Health; D055502:Secondary Prevention; D012639:Seeds / Q000737:chemistry; D012720:Severity of Illness Index; D045730:Soy Foods; D000067816:Whey Proteins; D003313:Zea mays / Q000737:chemistry*
chemical_list: D008894:Milk Proteins; D010938:Plant Oils; D000067816:Whey Proteins