Figures & Tables
Figures
- FIGURE 1
CONSORT Flow Diagram
Abbreviation: RUTF, ready-to-use therapeutic food.
- FIGURE 2
Comparison of Outcomes Between A-RUTF and S-RUTF Among Ghanaian Children With Severe Acute Malnutrition
Abbreviations: A-RUTF, alternative ready-to-use therapeutic food; CI, confidence interval; S-RUTF, standard ready-to-use therapeutic food.
A: Recovery rates for A-RUTF and S-RUTF compared with intention-to-treat analysis (Fisher's exact test, **P≤.01).
B: Median rate of weight gain during the first 4 weeks of treatment for A-RUTF and S-RUTF; error bar indicates 95% CIs, *P≤.05.
C: Median rate of MUAC gain during first 4 weeks of treatment for A-RUTF and S-RUTF; error bar indicates 95% CIs, Mann-Whitney U test, *P≤.05.
- FIGURE 3
Comparison of Recovery Rates Between A-RUTF and S-RUTF Among Ghanaian Children With Moderate Acute Malnutrition
Abbreviations: A-RUTF, alternative ready-to-use therapeutic food; S-RUTF, standard ready-to-use therapeutic food.
Intention-to-treat analysis used (Fisher's exact test, **P<.01).
Tables
- TABLE 1.
Comparison of Project Peanut Butter and Ghana Health Service Malnutrition Management Protocols in Brong Ahafo, Ghana
Project Peanut Butter Protocol Ghana Health Service CMAM Protocol SAM enrollment criteria MUAC <11.5 cm or WLZ < −3 SD
Bilateral pitting edemaMUAC <11.5 cm or WLZ below −3 SD
Bilateral pitting edemaMAM treatment
MUAC ≥11.5 cm, <12.5 cm
WLZ between −2 and −3 SDEnrolled and treated with RUTF Increased nutrition counseling during CWC RUTF dosage 150 kcal/kg/day for SAM
75 kcal/kg/day for MAM200 kcal/kg/day for SAM Follow-up Biweekly Weekly Graduation criteria MUAC >12.4 cm, or WFL > −2 SD for 1 visit (2 weeks) MUAC >12.4 cm, 3 consecutive weeks
No edema, 3 consecutive weeksDischarge criteria 3 consecutive visits missed (6 weeks) 3 consecutive weeks missed Maximum duration of treatment 12 weeks 16 weeks Abbreviations: CMAM, community management of acute malnutrition; CWC, Child Welfare Clinics; MAM, moderate acute malnutrition; MUAC, mid-upper arm circumference; RUTF, ready-to-use food; SAM, severe acute malnutrition; WLZ, weight-for-length z score.
Ingredient/Nutrient Alternative-RUTF Standard-RUTF Ingredient Cereal/grain, sorghum, g/100 g 9.00 — Legume, g/100 g Groundnut 14.00 27.00 Soybean 2.00 — Milk, g/100 g Dry, nonfat, regular, without added vitamin A and vitamin D 5.00 25.00 Whey protein concentrate 34% 20.18 — Oil, g/100 g Canola 20.50 — Palm — 15.48 Soybean — 2.92 Sugar, g/100 g 25.00 24.64 Micronutrient and vitamin premix, g/100 g 2.92 2.96 Emulsifier, g/100 g 1.40 2.00 Nutrient Energy, kcal/100 g 560 559 Protein, g/100 g 14.5 15.8 Lipids, g/100 g 29.2 33.0 n-6 fatty acids, g/100 g 6.3 5.7 n-3 fatty acids, g/100 g 1.9 0.03 Abbreviation: RUTF, ready-to-use therapeutic food.
↵a Both foods were a soft, brown, homogeneous paste with small granules perceptible to the tongue. They were packaged in identical, unlabeled metalized polyethylene terephthalate sachets with the only marking being a colored dot to indicate the type of RUTF.
Characteristic Severe Acute Malnutrition Moderate Acute Malnutrition A-RUTF (n=199) S-RUTF (n=202) A-RUTF (n=443) S-RUTF (n=426) Male, No. (%) 88 (44.2) 94 (46.5) 189 (42.7) 163 (38.3) Age, months, mean (SD) 14.38 (8.0) 13.25 (7.6) 15.79 (9.3) 13.89 (7.2) Roof made of metal, No. (%) 152 (76.4) 153 (75.7) 358 (80.8) 346 (81.2) Animals sleep with child, No. (%) 120 (60.3) 127 (62.9) 259 (58.5) 275 (64.6) Electricity in home, No. (%) 111 (55.8) 113 (55.9) 285 (65.2) 267 (62.7) Clean water source, No. (%) 83 (41.7) 91 (45.0) 206 (46.5) 206 (48.4) Edema, No. (%) 5 (2.5) 3 (1.5) — — Mid-upper arm circumference, cm, mean (SD) 11.1 (0.9) 11.0 (0.8) 12.2 (0.4) 12.2 (0.4) Weight, kg, mean (SD) 6.28 (1.3) 6.12 (1.2) 7.34 (1.3) 7.19 (1.2) Length, cm, mean (SD) 69.8 (7.5) 68.5 (6.6) 72.4 (7.2) 71.2 (6.6) Weight-for-length, z score, mean (SD) -3.16 (0.8) -3.07 (0.9) −2.08 (0.6) −1.97 (0.6) Length-for-age, z score, mean (SD) -2.56 (1.4) -2.64 (1.4) −1.98 (1.2) −1.80 (1.1) Weight-for-age, z score, mean (SD) -3.65 (0.9) -3.64 (1.0) −2.59 (0.7) −2.41 (0.9) Abbreviations: A-RUTF, alternative ready-to-use therapeutic food; SD, standard deviation; S-RUTF, standard ready-to-use therapeutic food.
- TABLE 4.
Comparison of Outcomes Between Assigned Treatment Food for Ghanaian Children With Severe Acute Malnutrition and Moderate Acute Malnutrition
Outcome Assigned A-RUTF Assigned S-RUTF P Valuea All study participants n=642 n=628 Defaulted,b No. (%) 116 (18.1) 68 (10.8) <.001 Died, No. (%) 1 (0.2) 4 (0.6) .21 Recovered, No. (%) 516 (80.4) 554 (88.2) <.001 Remained malnourished, No. (%) 9 (1.4) 2 (0.3) .06 Rate of weight gain,c g/kg/d, mean (SD) 1.88 (1.8) 2.04 (2.0) .31 Rate of MUAC gain,c mm/d, mean (SD) 0.16 (0.2) 0.18 (0.2) .04 Participants with SAM n=199 n=202 Defaulted,b No. (%) 60 (30.1) 41 (20.3) .03 Died, No. (%) 1 (0.5) 3 (1.5) .62 Recovered, No. (%) 130 (65.3) 156 (77.2) .01 Remained malnourished, No. (%) 8 (4.0) 2 (1.0) .06 Rate of weight gain,c g/kg/d, mean (SD) 2.40 (2.4) 2.90 (2.6) .04 Rate of MUAC gain,c mm/d, mean (SD) 0.20 (0.2) 0.25 (0.2) .047 Participants with MAM n=443 n=426 Defaulted,b No. (%) 56 (12.6) 27 (6.3) .002 Died, No. (%) 0 (0.0) 1 (0.2) >.99 Recovered, No. (%) 386 (87.1) 398 (93.4) .003 Remained malnourished, No. (%) 1 (0.2) 0 (0) >.99 Rate of weight gain,c g/kg/d, mean (SD) 1.66 (1.5) 1.61 (1.5) .62 Rate of MUAC gain,c mm/d, mean (SD) 0.13 (0.2) 0.14 (0.2) .29 Abbreviations: A-RUTF, alternative ready-to-use therapeutic food; MAM, moderate acute malnutrition; MUAC, mid-upper arm circumference; SAM, severe acute malnutrition; S-RUTF, standard ready-to-use therapeutic food.
↵a Statistical comparisons made using Student's t test for continuous parameters and Fisher's exact test for categorical parameters.
↵b Defaulters were treated as unrecovered in the calculation of recovery rates.
↵c Calculated for the first 4 weeks of treatment.
Metabolite Class Specific Metabolites Identified Only in Alternative RUTF Pathobiological Significance Phosphatidylcholines 1,2-Dipalmitoleoyl-sn-glycero-3-phosphocholine
1-O-Hexadecyl-2-deoxy-2-thio-S-acetyl-sn-glyceryl-3 phosphorylcholine
1-Stearoyl-2-myristoyl-sn-glycero-3-phosphocholine
1-Palmitoyl-2-docosahexaenoyl-sn-glycero-3-phosphocholine
PC(O-16:0/16:1)
PC(18:1/20:2)
PC(18:0/20:4)
Palmitoyleicosapentaenoyl phosphatidylcholineMajor component of most biological membranes, found in soy foods Phosphoethanolamines 2-Arachidonoyl-1-palmitoyl-sn-glycero-3-phosphoethanolamine
2-Linoleoyl-1-palmitoyl-sn-glycero-3-phosphoethanolamineEthanolamine derivative of phospholipids Cholesterols 4-Cholestenone
7-Oxocholesterol
4-Beta-hydroxycholesterol 4-acetateOxidized forms of cholesterol, the likely source in RUTF is dairy products Ceramides Ceramide (18:1/16:0)
N-Palmitoyl-d-sphingosineA lipid component of cell membranes that enhances membrane rigidity and facilitates cell signaling through the membrane Phytosterols Cholestan-3-one
DihydrodaidzeinPlant-derived sterols typically found in soy products Isoflavones Genistin
Glycitin
6″-O-Acetylgenistin
6″-O-Acetylglycitin
DaidzinIsoflavonoid compounds almost entirely derived from legume species, interact with estrogen receptors Vitamins Flavine mononucleotide Form of riboflavin Glucosyl glucose (3beta,5xi,9xi,18xi,22beta)-22,25-Dihydroxyolean-12-en-3-yl 6-deoxy-alpha-l-mannopyranosyl-(1->2)-beta-d-xylopyranosyl-(1->2)-beta-d-glucopyranosiduronic acid A small carbohydrate component of cellulose Specific metabolites identified only in standard RUTF Phosphatidylcholines 1-Palmitoyl-2-stearoyl-sn-glycero-3-phosphocholine
1-Docosahexaenoyl-2-stearoyl-sn-glycero-3-phosphocholine
1-Palmitoyl-2-oleoyl-sn-glycerolMajor component of most biological membranes Lipids Erucic acid
Glycerol 1-myristateMinor components of edible oils; fatty acid and a monoglyceride Phenylpropranoids 14-(Methylpentadecanoylamino)-3-phenylpropanoic acid
3,5-Dimethoxy-4-hydroxycinnamic acid
3-Hydroxy-4-methoxycinnamic acidFood additive made from cinnamic acid and a natural product in coffee and tea Phenylethylamide Phenylethylamide 359 Flavoring agent, naturally occurs in peanut Abbreviations: A-RUTF, alternative ready-to-use therapeutic food; S-RUTF, standard ready-to-use therapeutic food.
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