Effectiveness of Supplementary Feeding During Infection Among Moderately Malnourished Children

Not Applicable

Terminated

Conditions: Malnutrition
Infection

Interventions: Dietary Supplement: Ready to use supplementary food (RUSF)

Registration Number: NCT00890695

Lead Sponsor: University of Oxford

Brief Summary: The purpose of this study is to determine whether an outpatient-based strategy of short-term, ready to use supplementary food (RUSF) among moderately malnourished children with acute infections achieves greater improvement in anthropometric measurements of wasting than usual diet.

Detailed Description: Under nutrition is a contributing factor to at least a third of child deaths. Whilst severe malnutrition has the highest mortality risk, most malnutrition-related deaths are thought to be related to mild-moderate malnutrition.This is because moderate malnutrition is common, it directly increases the risk of death from common infectious diseases and may progress to severe malnutrition.

Malnutrition may arise from poverty, food insecurity or inadequate nutrition being offered, and may begin early in life. Malnutrition is exacerbated by the multiple effects of infectious diseases such as gastroenteritis, pneumonia, malaria or HIV. All these common infections are associated with net protein loss with diversion of essential amino acids to producing acute phase and immune response proteins. Fever is associated with an increased resting energy expenditure of 7 to 13% per degree Centigrade. Activation of inflammatory cascades also causes reduced appetite and loss of lean tissue and fat. Acute infection is therefore associated with growth faltering, resulting in a vicious cycle. Acute infection is therefore a potential target for intervention to interrupt the vicious cycle between malnutrition and infection in children.

This study aims to evaluate a strategy of giving short-term RUSF as a supplement to usual diet at home, without daily observed feeding, administered through existing health services at Kilifi District Hospital, Kenya. RUSF has a very low moisture content and is essentially a lipid-enveloped paste, it is microbiologically stable with a long shelf life at tropical temperatures and preserves delicate micronutrients such as vitamin A.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 64

Inclusion Criteria

Age 6 months to 5 years
Mid-upper arm circumference (MUAC) less than 12.5 cm
Resident in the Kilifi demographic surveillance (DSS) area
Presentation with acute (<5 days) illness including respiratory infection, malaria, diarrhoeal disease or other acute infection.
If admitted, admission of <5 days, recruited at discharge.

Exclusion Criteria

Severe malnutrition (WHZ score < -3 or Kwashiorkor)
Requiring admission to hospital in the opinion of clinician
Known allergy to maize, soya, sorghum, milk or any RUSF components.
Consent declined
Underlying condition precluding assessment or inclusion
Any other reason why the consenting investigator thinks it is not appropriate for them to take part.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Ready to use supplementary food (RUSF)	Ready to use supplementary food (RUSF)	The RUSF intervention consists of a food paste made of maize, soya, sorghum, vegetable oil, sugar, dried skim milk and vitamin/mineral premix, prepared by VALID Nutrition in collaboration with Insta Products, Kenya in accordance with composition specified by the latest WHO expert consultation in 2008. Children in the intervention arm receive 4 weeks supply of RUSF. The amount supplied is based on the child's weight to give energy supplement of 100kcal per kg per day, equivalent to 25g RUSF per kg per day.

Primary Outcome Measures

Name	Time	Method
Weight for Height z Score at 4 Weeks	between enrolment and 4 weeks	The primary endpoint is weight for height z scores (WHZ), calculated from weight and height measures with reference to the WHO growth standards 2006. WHZ is a measure of wasting and acute malnutrition. A WHZ of zero is the median value of the reference population. Negative scores indicate undernutrition. Moderate and severe acute malnutrition are defined as WHZ\<-2 and \<-3 respectively. These correspond to 2 and 3 standard deviations below the reference median. Of all the anthropometric measures in regular use, WHZ and mid upper arm circumference (MUAC) have the strongest associations with infectious disease incidence and risk of death. WHZ is more appropriate than Weight for Age (WAZ), which is normally used in growth monitoring, because WAZ measures a combination of wasting and stunting (chronic malnutrition). Stunting is unlikely to be affected by short term intervention. WHZ is assessed by anthropometry, following WHO guidelines.

Secondary Outcome Measures

Name	Time	Method
Development of Severe Malnutrition (WHZ Score <-3 and/or Kwashiorkor)	at 4 weeks and 3 months
MUAC for Age Z Score at 3 Months	between enrolment and 4 weeks and at 3 months
Anemia (Hb <9.3g/dl)	at 4 weeks
WHZ Score at 3 Months	between enrolment and 3 months
Hospital Admission or Death	from enrolment to 3 months