Body composition changes in children during treatment for moderate acute malnutrition: Findings from a 4-arm cluster-randomized trial in Sierra Leone

Authors: SURI, DEVIKA - Tufts University; POTANI, ISABEL - Tufts University; SINGH, AKRITI - Tufts University; GRISWOLD, STACY - Tufts University; WONG, WILLIAM - Children'S Nutrition Research Center (CNRC); LANGLOIS, BREANNE - Tufts University; SHEN, YE - Tufts University; CHUI, KWAN HO - Tufts University; ROSENBERG, IRWIN - Tufts University; WEBB, PATRICK - Tufts University; ROGERS, BEATRICE - Tufts University

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/1/2021
Publication Date: 4/20/2021
Citation: Suri, D.J., Potani, I., Singh, A., Griswold, S., Wong, W.W., Langlois, B., Shen, Y., Chui, K.K., Rosenberg, I.H., Webb, P., Rogers, B.L. 2021. Body composition changes in children during treatment for moderate acute malnutrition: Findings from a 4-arm cluster-randomized trial in Sierra Leone. Journal of Nutrition. https://doi.org/10.1093/jn/nxab080.
DOI: https://doi.org/10.1093/jn/nxab080

Interpretive Summary: The inability to get enough food to eat is a big health problem among babies and young children in developing countries because it leads to poor growth with increased risk of other illnesses including death. We tested four types of baby food made up of corn, soy, and cow's milk with and without oil on 578 infants and young children between 6 and 59 months of age in Sierra Leone. In this study, these infants and young children received one of these four baby foods for four weeks. The changes in their body weights were measured after four weeks of eating these baby foods. Our results showed that the infants and young children who received the baby food all gained weight, mostly in muscle and small amount in body fat, regardless of the type of baby food that they were fed. Therefore, our study showed that providing additional baby food to babies and young children in developing countries will help reduce poor growith in infants and young children.

Technical Abstract: Measures that better describe "healthy" and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed. We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes. The study was nested within a prospective, cluster-randomized, community-based, cost-effectiveness trial assessing 4 SNFs to treat children aged 6–59 months with MAM [mid-upper arm circumference (MUAC) >=11.5 cm and <12.5 cm without bipedal edema] in Sierra Leone. Biweekly SNF rations (1 of 3 fortified-blended foods or a lipid based nutrient supplement) were given until children recovered (MUAC >=12.5 cm), or up to 7 rations (~12 week). Deuterium dilution was used to estimate fat-free mass (FFM) and fat mass (FM) at enrollment and after 4 week of treatment to ensure similar treatment exposure among the participants. Another MUAC measurement was performed among recovered children 4 week after program exit to determine whether recovery was sustained. ANOVA, paired t tests, and linear regression models were used to determine significant differences in changes from baseline to 4 wk. Among 312 analyzed participants, mean baseline weight comprised ~80% FFM; mean weight gained after 4 week comprised ~82% FFM. Changes in FM and FFM among 4 SNFs were similar. Children who recovered gained more weight (241%), FFM (179%), and weight-for-height z score (0.44 compared with 0) compared with those who did not recover; sustainers gained 150% more weight. FM gains were positive among recovered children and sustainers, as well as negative among those who did not recover or sustain recovery, but not significantly different. Four SNFs had similar effects on body composition in children after 4 week of treatment for MAM, showing a healthy pattern of weight gain, the majority being FFM. Differential responses to treatment underscore a need for further research to provide targets for healthy, sustainable recovery.