Ready-to-Use Therapeutic Food for Catch-Up Growth in Children after an Episode of Plasmodium falciparum Malaria: An Open Randomised Controlled Trial

Saskia Van Der Kam,Alyson Froud,Peter Tinnemann,Leslie Shanks,Todd Swarthout,Stephanie Roll,Oscar Niragira,Clair Mills,Eric Mukomena Sompwe,David Joseph Diemert

doi:10.1371/journal.pone.0035006

Abstract

BackgroundCatch-up growth after an infection is essential for children to maintain good nutritional status. To prevent malnutrition, WHO recommends that children are given one additional healthy meal per day during the 2 weeks after onset of illness. We investigated to what extent ready-to-use therapeutic food (RUTF) promotes catch-up growth in children after an acute, uncomplicated episode of Plasmodium falciparum malaria.MethodsWe did an open randomised trial of children aged 6–59 months with confirmed malaria who attended a Médecins Sans Frontières-supported outpatient clinic in Katanga Province, Democratic Republic of Congo. All children received a clinical examination and malaria treatment. Patients were then randomly assigned to either an RUTF group, who received daily supplemental RUTF (a high-protein peanut-based paste) for 14 days, or to a control group, who received no supplemental food. Children were weighed at baseline and on days 14 and 28. The primary outcome was mean weight change after 14 days' RUTF. Analysis was by intention-to-treat.Results93 children received RUTF and 87 received no food supplementation. At day 14, the RUTF group had a mean weight gain of 353 g compared with 189 g in the control group (difference 164 [95%CI 52–277], p = 0.005). However, at day 28 there was no statistically significant difference between the groups (539 g versus 414 g, respectively [p = 0.053]). Similarly, rate of weight gain per kg bodyweight per day was significantly higher at day 14 in the RUTF group (2.4 g/kg per day versus 1.3 g/kg per day, p = 0.005) but at day 28 was 1.9 g/kg per day in the RUTF group versus 1.5 g/kg per day in the control group (p = 0.076).ConclusionsChildren receiving RUTF for 14 days after effective treatment of an uncomplicated malaria episode had a faster weight gain than children not given supplementation, reducing the period that children were at risk of malnutrition.Trial RegistrationClinicalTrials.gov NCT00819858

Highlights

The causes of malnutrition are multifactorial, involving an inadequate diet and recurrent infections [1,2]
Twenty children were excluded: one did not meet the inclusion criteria, three chose to not participate after the being informed through the consent procedure, and 16 had blood slide results that were negative for malaria
The 180 participants who were recruited were randomly assigned by the study coordinator to either the control group (n = 87) or the ready-to-use therapeutic food (RUTF) group (n = 93; Figure 1)

Summary

Introduction

The causes of malnutrition are multifactorial, involving an inadequate diet and recurrent infections [1,2]. Young children have an especially high susceptibility to acute infectious diseases such as malaria, diarrhoea, and acute respiratory infections, which are generally associated with weight loss [3]. This occurs because infections can decrease food intake due to poor appetite, impair nutrient absorption, cause direct nutrient losses by diarrhoea or vomiting, increase metabolic requirements or catabolic losses [4], and impair transport of nutrients to target tissues. In the group that did not receive supplementation, no significant overall weight gain occurred This finding raised the question of whether supplementation with a nutrient-rich food would be effective for convalescence after infections other than acute diarrhoea, such as malaria. We investigated to what extent ready-to-use therapeutic food (RUTF) promotes catch-up growth in children after an acute, uncomplicated episode of Plasmodium falciparum malaria

Methods

Results

Discussion

Conclusion