Journal
AMERICAN JOURNAL OF CLINICAL NUTRITION
Volume 101, Issue 3, Pages 632-645Publisher
OXFORD UNIV PRESS
DOI: 10.3945/ajcn.113.069807
Keywords
CSB plus; locally milled flours; Misola; moderate acute malnutrition; Supplementary Plumpy
Categories
Funding
- UNICEF Mali
- UNICEF West and Central Africa (WA-ARO)
- World Food Program (WFP)
- Goldman Fund
- Helen Keller International (HKI)
- World Food Program, Rome, Italy
- Nutriset, Malaunay, France
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Background: Moderate acute malnutrition (MAM), defined as weight-for-length z score between -3 and -2 or midupper arm circumference between 11.5 and 12.5 cm, affects similar to 33 million children aged <5 y worldwide. Objective: The objective was to compare the effects of 4 dietary supplements for the treatment of MAM. Design: Twelve community health centers in rural Mali were randomly assigned to provide to 1264 MAM children aged 6-35 mo one of 4 dietary supplements containing 500 kcal/d for 12 wk: 1) ready-to-use, lipid-based supplementary food (RUSF); 2) special corn-soy blend (CSB++); 3) locally processed, fortified flour (Misola); or 4) locally milled flours plus oil, sugar, and micronutrient powder (LMF). Results: In total, 1178 children (93.2%) completed the study. The adjusted mean (95% Cl) change in weight (kg) from baseline was greater with RUSF than with the locally processed blends and was intermediate with CSB++ [1.16 (1.08, 1.24) for RUSF, 1.04 (0.96, 1.13) for CSB++, 0.91 (0.82, 0.99) for Misola, and 0.83 (0.74, 0.92) for LMF; P < 0.001]. For length change, RUSF and CSB++ differed significantly from LMF. Sustained recovery rates were higher with RUSF (73%) than with Misola (61%) and LMF (58%), P < 0.0001; CSB++ recovery rates (68%) did not differ from any of the other groups. Conclusions: RUSF was more effective, but more costly, than other dietary supplements for the treatment of MAM; CSB++ yielded intermediate results. The benefits of treatment should be considered in relation to product costs and availability.
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