Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition: a randomised trial in India
Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition: a randomised trial in India
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DOI：
10.1136/bmjgh-2016-000144
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发表时间：
2016-11-01
影响因子：
8.1
通讯作者：
Bahl, Rajiv
中科院分区：
文献类型：
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作者：
Bhandari, Nita;Mohan, Sanjana Brahmawar;Bahl, Rajiv
目的：评估即食食疗食品（RUTF）、集中生产的RUTF（RUTF-C）或当地制备的RUTF（RUTF-L）与富含微量营养素的（增强）能量密集型家庭准备食品方法：在一项单独随机多中心试验中，我们招募了906名年龄在6-59个月的无并发症SAM儿童。入选儿童随机接受RUTF-C、RUTF-L或A-HPF治疗。我们提供食物，咨询和喂养支持，直到康复或16周，以较早者为准，每周测量结果（治疗阶段）。随后，我们为获得政府营养服务提供了便利，并在16周后（维持阶段）测量了一次结果。结果：RUTF-L、RUTF-C和A-HPF的恢复率分别为56.9%、47.5%和42.8%。与A-HPF相比，RUTF-L的调整OR为1.71（95% CI 1.20 - 2.43; p=0.003），RUTF-C为1.28（95% CI 0.90 - 1.82; p=0.164）。RUTF-L组的体重增加高于A-HPF组（校正差异0.90 g/kg/天，95% CI 0.30 - 1.50; p=0.003）。两个RUTF组的恢复时间较短。各组的发病率较高且相似。在研究结束时，身高体重Z评分（WHZ）>-2的儿童比例相似（调整后OR 1.12，95% CI 0.74 - 1.95; p=0.464），中度营养不良较高（WHZ=-3;调整OR 1.46，95% CI 1.02 - 2.08; p=0.039），SAM患者更低结论：第一个随机试验比较了家庭管理简单SAM的选择，证实了RUTF-L在家中比A-HPF更有效。尽管治疗时间更长，喂养支持更大，但恢复率低于非洲研究。
Objective: To assess the efficacy of ready-to-use therapeutic food (RUTF), centrally produced RUTF (RUTF-C) or locally prepared RUTF (RUTF-L) for home-based management of uncomplicated severe acute malnutrition (SAM) compared with micronutrient-enriched (augmented) energy-dense home-prepared foods (A-HPF, the comparison group).Methods: In an individually randomised multicentre trial, we enrolled 906 children aged 6-59 months with uncomplicated SAM. The children enrolled were randomised to receive RUTF-C, RUTF-L or A-HPF. We provided foods, counselling and feeding support until recovery or 16 weeks, whichever was earlier and measured outcomes weekly (treatment phase). We subsequently facilitated access to government nutrition services and measured outcomes once 16 weeks later (sustenance phase). The primary outcome was recovery during treatment phase (weight-for-height >=-2 SD and absence of oedema of feet).Results: Recovery rates with RUTF-L, RUTF-C and A-HPF were 56.9%, 47.5% and 42.8%, respectively. The adjusted OR was 1.71 (95% CI 1.20 to 2.43; p=0.003) for RUTF-L and 1.28 (95% CI 0.90 to 1.82; p=0.164) for RUTF-C compared with A-HPF. Weight gain in the RUTF-L group was higher than in the A-HPF group (adjusted difference 0.90 g/kg/day, 95% CI 0.30 to 1.50; p=0.003). Time to recovery was shorter in both RUTF groups. Morbidity was high and similar across groups. At the end of the study, the proportion of children with weight-for-height Z-score (WHZ) >-2 was similar (adjusted OR 1.12, 95% CI 0.74 to 1.95; p=0.464), higher for moderate malnutrition (WHZ=-3; adjusted OR 1.46, 95% CI 1.02 to 2.08; p=0.039), and lower for those with SAM (adjusted OR 0.58, 95% CI 0.40 to 0.85; p=0.005) in the RUTF-L when compared with the A-HPF group.Conclusions: This first randomised trial comparing options for home management of uncomplicated SAM confirms that RUTF-L is more efficacious than A-HPF at home. Recovery rates were lower than in African studies, despite longer treatment and greater support for feeding.