Weight Gain in Malnourished Children after 5 Months Food Supplementation in a Slum Setting in Bangladesh

Mustafa Mahfuz, Tahmeed Ahmed, A. M. Shamsir Ahmed, M. Munirul Islam, M. I. Hossain

Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.

DOI: 10.4236/fns.2014.514149                

Abstract

We examined the rate of weight gain and absolute weight gain of underweight children (weight- for-age Z score < -2) aged between 6 - 24 months living in a slum of Dhaka city, in response to two different regimens of supplementary feeding. Comparison was also made with the weight gain of a healthy group of children from the same locality. In total 161 children, including 68 healthy children representing the control group, were enrolled for the 5 months supplementation. The two regimens of feeding were either ready-to-use therapeutic food (RUTF, Plumpy’Nut) or locally made cereal-based supplementary food Pushti packet which was recommended in the National Nutritional Program. No food supplementation was provided to control children. All children received vitamin A as part of the six-monthly national program, albendazole for deworming, immunization, and health and nutrition education. Multiple micronutrient powder (MNP) was provided only to Pushti packet and control children. The rate of weight gain on RUTF was 1.69 g/kg/day during the first month and gradually declined to 0.9 g/kg/day at the final month of the trial, whereas, the rate of weight gain on Pushti packet was 0.77 g/kg/day during the first month declining to 0.70 g/kg/day at the end of the trial. Rate of weight gain in the control group was steady between 0.47 - 0.50 g/kg/day. Absolute weight gains of 1085 g, 790 g and 730 g were observed in the RUTF, Pushti packet and the control groups, respectively which were significantly higher in the RUTF group. There was no statistically significant difference between the RUTF and Pushti packet groups in terms of rate of weight gain. Overall, weight gain was unsatisfactory for both supplementation groups. Better absolute weight gain was observed with RUTF supplementation compared to Pushti packet which prevented further deterioration in weight among the malnourished children.

Keywords

Malnutrition, RUTF, Supplementation, Underweight, Bangladesh

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., De Onis, M., et al. (2008) Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences. Lancet, 371, 243-260. http://dx.doi.org/10.1016/S0140-6736(07)61690-0
[2]	Ahmed, T., Haque, R., Shamsir Ahmed, A.M., Petri Jr., W.A. and Cravioto, A. (2009) Use of Metagenomics to Understand the Genetic Basis of Malnutrition. Nutrition Reviews, 67, S201-S206. http://dx.doi.org/10.1111/j.1753-4887.2009.00241.x
[3]	UNICEF (2013) Understanding Malnutrition Global Nutrition Cluster. www.unicef.org/nutritioncluster/files/M03P1.doc
[4]	WFP (2013) What Is Malnutrition? Hunger. http://www.wfp.org/hunger/malnutrition
[5]	Black, R.E., Victora, C.G., Walker, S.P., Bhutta, Z.A., Christian, P., et al. (2013) Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries. Lancet, 382, 427-451. http://dx.doi.org/10.1016/S0140-6736(13)60937-X
[6]	Lobo, D.A., Velayudhan, R., Chatterjee, P., Kohli, H. and Hotez, P.J. (2011) The Neglected Tropical Diseases of India and South Asia: Review of Their Prevalence, Distribution, and Control or Elimination. PLoS Neglected Tropical Diseases, 5, Article ID: e1222. http://dx.doi.org/10.1371/journal.pntd.0001222
[7]	Michaelsen, K.F., Hoppe, C., Roos, N., Kaestel, P., Stougaard, M., et al. (2009) Choice of Foods and Ingredients for Moderately Malnourished Children 6 Months to 5 Years of Age. Food & Nutrition Bulletin, 30, S343.
[8]	Protein Energy Malnutrition (PEM) (2009).
[9]	Briend, A. and Prinzo, Z.W. (2009) Dietary Management of Moderate Malnutrition: Time for a Change. Food & Nutrition Bulletin, 30, S265.
[10]	De Pee, S. and Bloem, M.W. (2009) Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children. Food & Nutrition Bulletin, 30, S434-S463.
[11]	Matilsky, D.K., Maleta, K., Castleman, T. and Manary, M.J. (2009) Supplementary Feeding with Fortified Spreads Results in Higher Recovery Rates than with a Corn/Soy Blend in Moderately Wasted Children. The Journal of Nutrition, 139, 773-778. http://dx.doi.org/10.3945/jn.108.104018
[12]	Nackers, F., Broillet, F., Oumarou, D., Djibo, A., Gaboulaud, V., et al. (2010) 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. Journal of Tropical Pediatrics, 56, 407-413. http://dx.doi.org/10.1093/tropej/fmq019
[13]	World Health Organization, World Food Programme, United Nations System Standing Committee on Nutrition, United Nations Children’s Fund (2007) Community-Based Management of Severe Acute Malnutrition. World Health Organization, Geneva, 1-8.
[14]	MAL-ED (2013) The Interactions of Malnutrition & Enteric Infections: Consequences for Child Health and Development. http://mal-ed.fnih.org/
[15]	Nutriset (2013) Plumpy’Nut® Ready-to-Use Therapeutic Food (RUTF). http://www.nutriset.fr/en/product-range/produit-par-produit/plumpy-nut-ready-to-use-therapeutic-food- rutf.html
[16]	Ciliberto, M.A., et al. (2005) 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. The American Journal of Clinical Nutrition, 81, 864-870.
[17]	Sphere Project (2004) Humanitarian Charter and Minimum Standards in Disaster Response.
[18]	Golden, M.H. (2009) Proposed Recommended Nutrient Densities for Moderately Malnourished Children. Food & Nutrition Bulletin, 30, S267.
[19]	Singh, A.S., Kang, G., Ramachandran, A., Sarkar, R., Peter, P., et al. (2010) Locally Made Ready-to-Use Therapeutic Food for Treatment of Malnutrition: A Randomized Controlled Trial. Indian Pediatrics, 47, 679-686. http://dx.doi.org/10.1007/s13312-010-0100-8