NUTRITIONAL SUPPLEMENTS AND THEIR USE IN THE TREATMENT OF MALNUTRITION IN DEVELOPING COUNTRIES
Abstract
Background: Despite the high global prevalence of malnutrition, it remains under-treated, or undetected. The high energy nutritional supplements are usually prescribed to promote rapid weight gain. However, there is no consensus on the most effective way to treat mild to moderate malnutrition. Methods: For identification of articles search engines of the databases OVID, MEDLINE, EMBASE and Pub med were used for papers published from 2003 to 2014 in English language. Results: The total energy intake including the supplements is significantly improved. However, the rate of weight gain by the high energy nutritional supplements in moderately malnourished children is less than the expected weight gain. Conclusion: While assessing the impact of the supplementation on child nutritional status, other factors should also be taken into account, including appetite suppression, replacement of habitual food intake and compliance to the intervention.References
Meier R, Stratton R. Basic concepts in nutrition: epidemiology of malnutrition. Eur J Clin Nutr Metabol 2008;3(4):e167–e70.
Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake. Clin Nutr 2010;29(2):160–9.
Alberda C, Graf A, McCargar L. Malnutrition: Etiology, consequences, and assessment of a patient at risk. Best Pract Res Clin Gastroenterol 2006;20(3):419–39.
Meijers JM, van Bokhorst-de van der Schueren MA, Schols JM, Soeters PB, Halfens RJ. Defining malnutrition: mission or mission impossible? Nutrition 2010;26(4):432–40.
Walton E, Allen S. Malnutrition in developing countries. Paediatr Child Health 2011;21(9):418–24.
Nemer L, Gelband H, Jha P, Duncan T. The evidence base for interventions to reduce malnutrition in children under five and school-age children in low and middle-income countries. Commission on Macro-economics and Health, CMH Working Paper Series, Paper No WG5: 11 Geneva: WHO. 2001.
Müller O, Garenne M, Kouyaté B, Becher H. The association between protein–energy malnutrition, malaria morbidity and all‐cause mortality in West African children. Trop Med Int Health 2003;8(6):507–11.
Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet 2003;361(9376):2226–34.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008;371(9608):243–60.
Imdad A, Sadiq K, Bhutta ZA. Evidence-based prevention of childhood malnutrition. Curr Opin Clin Nutr Metab Care 2011;14(3):276–85.
Blössner M, de Onis M. Malnutrition: quantifying the health impact at national and local levels: World Health Organization Geneva; 2005.
Golden MH. Proposed recommended nutrient densities for moderately malnourished children. Food Nutr Bull 2009;30(3 Suppl):S267–342.
Michaelsen KF, Hoppe C, Roos N, Kaestel P, Stougaard M, Lauritzen L, et al. Choice of foods and ingredients for moderately malnourished children 6 months to 5 years of age. Food Nutr Bull 2009;30(3 Suppl):S343–404.
Huybregts L, Houngbe F, Salpeteur C, Brown R, Roberfroid D, Ait-Aissa M, et al. The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity: a cluster-randomized controlled trial. PLoS Med 2012;9(9):e1001313.
Lazzerini M, Rubert L, Pani P. Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries. Cochrane Database Syst Rev 2013;6:CD009584.
Hirani SA. Malnutrition in young Pakistani children. J Ayub Med Coll Abbottabad 2012;24(2):150–3.
Gillespie SR, Haddad LJ. The double burden of malnutrition in Asia: causes, consequences, and solutions: Sage Publications India; 2003.
Muller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ 2005;173(3):279–86.
Brabin B, Coulter J. Nutrition-associated disease. Manson's tropical diseases London: Saunders 2003:561–80.
Grover Z, Ee LC. Protein energy malnutrition. Pediatr Clin North Am 2009;56(5):1055–68.
Young H, Borrel A, Holland D, Salama P. Public nutrition in complex emergencies. Lancet 2004;364(9448):1899–909.
Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev 2012;11(2):278–96.
Stratton RJ, Elia M. A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. Clin Nutr Suppl 2007;2(1):5–23.
Stratton RJ, Elia M. Encouraging appropriate, evidence-based use of oral nutritional supplements. Proc Nutr Soc 2010;69(04):477–87.
Lawson RM, Doshi MK, Ingoe LE, Colligan JM, Barton JR, Cobden I. Compliance of orthopaedic patients with postoperative oral nutritional supplementation. Clin Nutr 2000;19(3):171–5.
Diop EHI, Dossou NI, Ndour MM, Briend A, Wade S. Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. Am J Clin Nutr 2003;78(2):302–7.
Brewster DR. Critical appraisal of the management of severe malnutrition: 2. Dietary management. J Paediatr Child Health 2006;42(10):575–82.
Briend A. Highly nutrient-dense spreads: a new approach to delivering multiple micronutrients to high-risk groups. Br J Nutr 2001;85(2):S175.
Ashworth A. Efficacy and effectiveness of community-based treatment of severe malnutrition. Food Nutr Bull 2006;27(3 Suppl):S24–48.
Ciliberto MA, Sandige H, Ndekha MJ, Ashorn P, Briend A, Ciliberto HM, et al. Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. Am J Clin Nutr 2005;81(4):864–70.
Chang CY, Trehan I, Wang RJ, Thakwalakwa C, Maleta K, Deitchler M, et al. Children Successfully Treated for Moderate Acute Malnutrition Remain at Risk for Malnutrition and Death in the Subsequent Year after Recovery. J Nutr 2013;143(2):215–20.
Caulfield LE, de Onis M, Blössner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 2004;80(1):193–8.
Thakwalakwa C, Ashorn P, Phuka J, Cheung YB, Briend A, Puumalainen T, et al. A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6-to 18-month-old moderately underweight children in rural Malawi. J Nutr 2010;140(11):2008–13.
Stratton RJ, Hebuterne X, Elia M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Ageing Res Rev 2013;12(4):884–97.
Collins PF, Elia M, Stratton RJ. Nutritional support and functional capacity in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Respirology 2013;18(4):616–29.
Norman K, Pirlich M, Smoliner C, Kilbert A, Schulzke JD, Ockenga J, et al. Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study. Eur J Clin Nutr 2011;65(6):735–42.
Norman K, Kirchner H, Freudenreich M, Ockenga J, Lochs H, Pirlich M. Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease--a randomized controlled trial. Clin Nutr 2008;27(1):48–56.
Olofsson B, Stenvall M, Lundstrom M, Svensson O, Gustafson Y. Malnutrition in hip fracture patients: an intervention study. J Clin Nurs 2007;16(11):2027–38.
Botella-Carretero JI, Iglesias B, Balsa JA, Zamarron I, Arrieta F, Vazquez C. Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. JPEN J Parenter Enteral Nutr 2008;32(2):120–8.
Stratton RJ, Elia M. Who benefits from nutritional support: what is the evidence? Eur J Gastroenterol Hepatol 2007;19(5):353–8.
Gariballa S, Forster S. Effects of dietary supplements on depressive symptoms in older patients: A randomised double-blind placebo-controlled trial. Clin Nutr 2007;26(5):545–51.
Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 2006;144(1):37–48.
Gariballa S, Forster S, Walters S, Powers H. A randomized, double-blind, placebo-controlled trial of nutritional supplementation during acute illness. Am J Med 2006;119(8):693–9.
Stratton RJ, Bircher G, Fouque D, Stenvinkel P, de Mutsert R, Engfer M, et al. Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis. Am J Kidney Dis 2005;46(3):387–405.
Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev 2005;4(3):422–50.
Stratton RJ. Summary of a systematic review on oral nutritional supplement use in the community. Proc Nutr Soc 2000;59(03):469–76.
Stratton RJ, Elia M. Are oral nutritional supplements of benefit to patients in the community? Findings from a systematic review. Curr Opin Clin Nutr Metab Care 2000;3(4):311–5.
Lauque S, Arnaud-Battandier F, Mansourian R, Guigoz Y, Paintin M, Nourhashemi F, et al. Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial. Age Ageing 2000;29(1):51–6.
Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clin Nutr 2012;31(3):293–312.
Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: an evidence-based approach to treatment: Cabi; 2003.
Stratton RJ. Elucidating effective ways to identify and treat malnutrition. Proc Nutr Soc 2005;64(3):305–11.
Carlsson P, Tidermark J, Ponzer S, Söderqvist A, Cederholm T. Food habits and appetite of elderly women at the time of a femoral neck fracture and after nutritional and anabolic support. J Hum Nutr Diet 2005;18(2):117–20.
Edington J, Barnes R, Bryan F, Dupree E, Frost G, Hickson M, et al. A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clin Nutr 2004;23(2):195–204.
Bourdel-Marchasson I, Barateau M, Rondeau V, Dequae-Merchadou L, Salles-Montaudon N, Emeriau JP, et al. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. Nutrition 2000;16(1):1–5.
Fatima S, Gerasimidis K, Wright C, Tsiountsioura M, Arvanitidou EI, Malkova D. Response of appetite and potential appetite regulators following intake of high energy nutritional supplements. Appetite 2015;95:36–43.
Walker SP, Powell CA, Grantham-McGregor SM, Himes JH, Chang SM. Nutritional supplementation, psychosocial stimulation, and growth of stunted children: the Jamaican study. Am J Clin Nutr 1991;54(4):642–8.
Gershoff SN, McGandy RB, Nondasuta A, Tantiwongse P. Nutrition studies in Thailand: effects of calories, nutrient supplements, and health interventions on growth of preschool Thai village children. Am J Clin Nutr 1988;48(5):1214–8.
Matilsky DK, Maleta K, Castleman T, Manary MJ. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. J Nnutr 2009;139(4):773–8.
Nackers F, Broillet F, Oumarou D, Djibo A, Gaboulaud V, Guerin PJ, et al. Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger. J Trop Pediatr 2010;56(6):407–13.
Patel MP, Sandige HL, Ndekha MJ, Briend A, Ashorn P, Manary MJ. Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition. J Health, Popul Nutr 2011;23(4):351–7.
Defourny I, Seroux G, Abdelkader I, Harczi G. Management of moderate acute malnutrition with RUTF in Niger. perspective 1994;124:2043S–6S.
Kuusipalo H, Maleta K, Briend A, Manary M, Ashorn P. Growth and change in blood haemoglobin concentration among underweight Malawian infants receiving fortified spreads for 12 weeks: a preliminary trial. J Pediatr Gastroenterol Nutr 2006;43(4):525–32.
Defourny I, Minetti A, Harczi G, Doyon S, Shepherd S, Tectonidis M, et al. A large-scale distribution of milk-based fortified spreads: evidence for a new approach in regions with high burden of acute malnutrition. PLoS One 2009;4(5):e5455.
Isanaka S, Nombela N, Djibo A, Poupard M, Van Beckhoven D, Gaboulaud V, et al. Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial. JAMA 2009;301(3):277–85.
Isanaka S, Roederer T, Djibo A, Luquero FJ, Nombela N, Guerin PJ, et al. Reducing wasting in young children with preventive supplementation: a cohort study in Niger. Pediatrics 2010;126(2):e442–50.
Ruel MT, Menon P, Habicht JP, Loechl C, Bergeron G, Pelto G, et al. Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial. Lancet 2008;371(9612):588–95.
de Onis M, Garza C, Onyango AW, Borghi E. Comparison of the WHO child growth standards and the CDC 2000 growth charts. J Nutr 2007;137(1):144–8.
Grellety E, Shepherd S, Roederer T, Manzo ML, Doyon S, Ategbo EA, et al. Effect of mass supplementation with ready-to-use supplementary food during an anticipated nutritional emergency. PLoS One 2012;7(9):e44549.
Karakochuk C, van den Briel T, Stephens D, Zlotkin S. Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial. Am J Clin Nutr 2012;96(4):911–6.
LaGrone LN, Trehan I, Meuli GJ, Wang RJ, Thakwalakwa C, Maleta K, et al. A novel fortified blended flour, corn-soy blend “plus-plus,” is not inferior to lipid-based ready-to-use supplementary foods for the treatment of moderate acute malnutrition in Malawian children. Am J Clin Nutr 2012;95(1):212–9.
Thakwalakwa CM, Ashorn P, Jawati M, Phuka JC, Cheung YB, Maleta KM. An effectiveness trial showed lipid-based nutrient supplementation but not corn–soya blend offered a modest benefit in weight gain among 6-to 18-month-old underweight children in rural Malawi. Public Health Nutr 2012;15(09):1755–62.
Bahwere P, Banda T, Sadler K, Nyirenda G, Owino V, Shaba B, et al. Effectiveness of milk whey protein-based ready-to-use therapeutic food in treatment of severe acute malnutrition in Malawian under-5 children: a randomised, double-blind, controlled non-inferiority clinical trial. Matern Child Nutr 2014;10(3):436–51.
Bisimwa G, Owino VO, Bahwere P, Dramaix M, Donnen P, Dibari F, et al. Randomized controlled trial of the effectiveness of a soybean-maize-sorghum-based ready-to-use complementary food paste on infant growth in South Kivu, Democratic Republic of Congo. Am J Clin Nutr 2012;95(5):1157–64.
Singh AS, Kang G, Ramachandran A, Sarkar R, Peter P, Bose A. Locally made ready-to-use therapeutic food for treatment of malnutrition: A randomized controlled trial. Indian Pediatr 2010;47(8):679–86.
Phuka J, Thakwalakwa C, Maleta K, Cheung YB, Briend A, Manary M, et al. Supplementary feeding with fortified spread among moderately underweight 6–18‐month‐old rural Malawian children. Matern Child Nutr 2009;5(2):159–70.
Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, et al. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Arch Pediatr Adolesc Med 2008;162(7):619–26.
Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr 2007;86(2):412–20.
Manary MJ, Ndkeha M, Ashorn P, Maleta K, Briend A. Home based therapy for severe malnutrition with ready-to-use food. Arch Dis Child 2004;89(6):557–61.
Sandige H, Ndekha MJ, Briend A, Ashorn P, Manary MJ. Home-based treatment of malnourished Malawian children with locally produced or imported ready-to-use food. J Pediatr Gastroenterol Nutr 2004;39(2):141–6.
Yebyo HG, Kendall C, Nigusse D, Lemma W. Outpatient therapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in tigray, northern ethiopia: a retrospective cohort study. PLoS One 2013;8(6):e65840.
Ali E, Zachariah R, Dahmane A, Van den Boogaard W, Shams Z, Akter T, et al. Peanut-based ready-to-use therapeutic food: acceptability among malnourished children and community workers in Bangladesh. Public Health Action 2013;3(2):128–35.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.