Treating high-risk moderate acute malnutrition using therapeutic food compared with nutrition counseling (Hi-MAM Study): A cluster-randomized controlled trial

Authors: LELIJVELD, NATASHA - Hospital For Sick Children (SICKKIDS); GODBOUT, CLAIRE - Project Peanut Butter; KRIETEMEYER, DESTINY - Washington University; LOS, ALYSSA - Washington University; WEGNER, DONNA - Washington University; HENDRIXSON, DAVID - Washington University; BANDSMA, ROBERT - Hospital For Sick Children (SICKKIDS); KOROMA, AMINATA - Ministry Of Health & Sanitation; MANARY, MARK - Washington University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/1/2021
Publication Date: 5/8/2021
Citation: Lelijveld, N., Godbout, C., Krietemeyer, D., Los, A., Wegner, D., Hendrixson, D.T., Bandsma, R., Koroma, A., Manary, M. 2021. Treating high-risk moderate acute malnutrition using therapeutic food compared with nutrition counseling (Hi-MAM Study): A cluster-randomized controlled trial. American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqab137.
DOI: https://doi.org/10.1093/ajcn/nqab137

Interpretive Summary: There is a lack of consensus on what is the most appropriate treatment of moderate acute malnutrition (MAM). Children were provided 6-wks of nutrition counseling and those determined to be high-risk at the intervention sites received ready-to-use therapeutic food (RUTF) and the antibiotic amoxicillin. Providing RUTF and antibiotics to high-risk MAM children improved short-term recovery and reduced short-term risk of deterioration. A longer intervention may be necessary for future study.

Technical Abstract: There is a lack of consensus on what is the most appropriate treatment of moderate acute malnutrition (MAM). We aimed to determine if provision of ready-to-use-therapeutic food (RUTF) and antibiotics to "high-risk" MAM (HR-MAM) children in addition to nutritional counseling would result in higher recovery and less deterioration than nutrition counseling alone. At the 11 intervention clinics, HR-MAM children were given RUTF and amoxicillin along with standard nutrition counseling, for 2–12 wk. All others received 6 wk of nutrition counseling alone. HR-MAM was defined as midupper arm circumference (MUAC) <11.9 cm, weight-for-age z score (WAZ) <-3.5, mother not the main caregiver, or a child <2y old not being breastfed. Outcomes were compared using intention-to-treat analysis. Analysis included 573 children at the intervention sites and 714 children at the control sites. Of the intervention group, 317 (55%) were classified as HR-MAM. Short-term recovery was greater at the intervention sites [48% compared with 39% at week 12; risk difference (rd): 0.08; 95% CI: 0.03, 0.13]. The intervention group had lower risk of deteriorating to severe acute malnutrition (SAM)(18% compared with 24%; rd: -0.07; 95% CI: -0.11, -0.04), lower risk of dying (1.8% compared with 3.1%; rd: -0.02; 95%CI: -0.03, -0.00), and greater gains in MUAC and weight than did children at the control sites. However, by 24 wk, the risk of SAM was similar between the 2 arms (31% compared with 34%; rd:-0.03; 95% CI: -0.09, 0.02). Control group data identified recent illness, MUAC <12.0 cm, WAZ <-3, dropping anthropometry, age <12 mo, being a twin, and a history of previous SAM as risk factors for deterioration. Provision of RUTF and antibiotics to HR-MAM children improved short-term recovery and reduced short-term risk of deterioration. However, recovery rates were still suboptimal and differences were not sustained by 6 mo post enrollment.