Abstract
Ready-to-use therapeutic food (RUTF) with adequate quality protein is used to treat children with oedematous and non-oedematous severe acute malnutrition (SAM). The plasma amino acid (AA) profile reflects the protein nutritional status; hence, its assessment during SAM treatment is useful in evaluating AA delivery from RUTFs. The objective was to evaluate the plasma AAs during the treatment of oedematous and non-oedematous SAM in community-based management of acute malnutrition (CMAM) using amino acid-enriched plant-based RUTFs with 10% milk (MSMS-RUTF) or without milk (FSMS-RUTF) compared to peanut milk RUTF (PM-RUTF). Plasma AA was measured in a non-blinded, 3-arm, parallel-group, simple randomized controlled trial conducted in Malawi. The RUTFs used for SAM were FSMS-RUTF, MSMS-RUTF or PM-RUTF. A non-inferiority hypothesis was tested to compare plasma AA levels from patients treated with FSMS-RUTF or MSMS-RUTF with those from patients treated with PM-RUTF at discharge. For both types of SAM, FSMS-RUTF and MSMS-RUTF treatments were non-inferior to the PM-RUTF treatment in restoration of the EAA and cystine except that for FSMS-RUTF, methionine and tryptophan partially satisfied the non-inferiority criteria in the oedematous group. Amino-acid-enriched milk-free plant-source-protein RUTF has the potential to restore all the EAA, but it is possible that enrichment with amino acids may require more methionine and tryptophan for oedematous children.
Highlights
Severe acute malnutrition (SAM) is still a major global issue, with more than 19 million children suffering from severe acute malnutrition (SAM) in 2011, and SAM accounts for 7.3% of total deaths among children under 5 years of age[1]
In an attempt to develop plant protein-based Ready-to-use therapeutic food (RUTF) intended to be as efficacious as animal protein-based RUTFs, we incorporated the novel concept of amino acid balance in formulating these products and developed RUTFs that are based on locally available ingredients comprising soy, maize, and sorghum (SMS): an amino acid-enriched milk-free RUTF formulation (FSMS-RUTF) and an amino acid-enriched low-milk RUTF formulation containing 9.3% (w/w) milk (MSMS-RUTF)
In non-oedematous malnutrition, the decrease in EAAs is milder than in oedematous malnutrition[8,23]. These results suggest that the metabolism of proteins and/or amino acids is different between patients with oedematous and non-oedematous malnutrition
Summary
Severe acute malnutrition (SAM) is still a major global issue, with more than 19 million children suffering from SAM in 2011, and SAM accounts for 7.3% of total deaths among children under 5 years of age[1]. There are several hypotheses for oedematous malnutrition, such as the possible role of insufficient intake of some amino acids; dysadaptation to a low-protein, high carbohydrate diet; aflatoxins and/or a result of an imbalance between the production of free radicals and their safe d isposal[4]; disruption of sulfated glycosaminoglycans; and a possible role of the gut microbiota. Giovanni et al showed that children with oedematous malnutrition (kwashiorkor) were metabolically distinct from those with nonoedematous malnutrition (marasmus) and were more prone to severe metabolic d isruptions[8] According to these data, the 2 types of SAM seem to have different mechanisms.
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