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ORIGINAL ARTICLE
Open Access

Alternative Ready-To-Use Therapeutic Food Yields Less Recovery Than the Standard for Treating Acute Malnutrition in Children From Ghana

Kristin Kohlmann, Meghan Callaghan-Gillespie, Julia M. Gauglitz, Matilda Steiner-Asiedu, Kwesi Saalia, Carly Edwards and Mark J. Manary
Global Health: Science and Practice June 2019, 7(2):203-214; https://doi.org/10.9745/GHSP-D-19-00004
Kristin Kohlmann
aDepartment of Pediatrics, Washington University, St. Louis, MO, USA.
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Meghan Callaghan-Gillespie
aDepartment of Pediatrics, Washington University, St. Louis, MO, USA.
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Julia M. Gauglitz
bCollaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, USA.
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Matilda Steiner-Asiedu
cDepartment of Nutrition and Food Science, University of Ghana, Legon, Ghana.
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Kwesi Saalia
cDepartment of Nutrition and Food Science, University of Ghana, Legon, Ghana.
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Carly Edwards
dProject Peanut Butter, Kumasi, Ghana.
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Mark J. Manary
aDepartment of Pediatrics, Washington University, St. Louis, MO, USA.
eChildren's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA.
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  • For correspondence: manarymj@wustl.edu
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In Ghana, an alternative ready-to-use food (RUTF) formulation that met all specifications was not as good as standard RUTF in affecting recovery from acute malnutrition among children aged 6 to 59 months.

ABSTRACT

Background:

Only 20% of children with severe acute malnutrition (SAM) have access to ready-to-use therapeutic food (RUTF), and RUTF cost limits its accessibility.

Methods:

This randomized, double-blind controlled study involved a clinical equivalence trial comparing the effectiveness of an alternative RUTF with standard RUTF in the home-based treatment of uncomplicated SAM and moderate malnutrition in Ghanaian children aged 6 to 59 months. The primary outcome was recovery, equivalence was defined as being within 5 percentage points of the control group, and an intention-to-treat analysis was used. Alternative RUTF was composed of whey protein, soybeans, peanuts, sorghum, milk, sugar, and vegetable oil. Standard RUTF included peanuts, milk, sugar, and vegetable oil. The cost of alternative RUTF ingredients was 14% less than standard RUTF. Untargeted metabolomics was used to characterize the bioactive metabolites in the RUTFs.

Results:

Of the 1,270 children treated for SAM or moderate malnutrition, 554 of 628 (88%) receiving alternative RUTF recovered (95% confidence interval [CI]=85% to 90%) and 516 of 642 (80%) receiving standard RUTF recovered (95% CI=77% to 83%). The difference in recovery was 7.7% (95% CI=3.7% to 11.7%). Among the 401 children with SAM, the recovery rate was 130 of 199 (65%) with alternative RUTF and 156 of 202 (77%) with standard RUTF (P=.01). The default rate in SAM was 60 of 199 (30%) for alternative RUTF and 41 of 202 (20%) for standard RUTF (P=.04). Children enrolled with SAM who received alternative RUTF had less daily weight gain than those fed standard RUTF (2.4 ± 2.4 g/kg vs. 2.9 ± 2.6 g/kg, respectively; P<.05). Among children with moderate wasting, recovery rates were lower for alternative RUTF, 386 of 443 (87%), than standard RUTF, 397 of 426 (93%) (P=.003). More isoflavone metabolites were found in alternative RUTF than in the standard.

Conclusion:

The lower-cost alternative RUTF was less effective than standard RUTF in the treatment of severe and moderate malnutrition in Ghana.

  • Received: December 22, 2018.
  • Accepted: April 2, 2019.
  • Published: June 24, 2019.
  • © Kohlmann et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-19-00004

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Global Health: Science and Practice: 7 (2)
Global Health: Science and Practice
Vol. 7, No. 2
June 24, 2019
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Alternative Ready-To-Use Therapeutic Food Yields Less Recovery Than the Standard for Treating Acute Malnutrition in Children From Ghana
Kristin Kohlmann, Meghan Callaghan-Gillespie, Julia M. Gauglitz, Matilda Steiner-Asiedu, Kwesi Saalia, Carly Edwards, Mark J. Manary
Global Health: Science and Practice Jun 2019, 7 (2) 203-214; DOI: 10.9745/GHSP-D-19-00004

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Alternative Ready-To-Use Therapeutic Food Yields Less Recovery Than the Standard for Treating Acute Malnutrition in Children From Ghana
Kristin Kohlmann, Meghan Callaghan-Gillespie, Julia M. Gauglitz, Matilda Steiner-Asiedu, Kwesi Saalia, Carly Edwards, Mark J. Manary
Global Health: Science and Practice Jun 2019, 7 (2) 203-214; DOI: 10.9745/GHSP-D-19-00004
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