Providing energy dense food supplements within a general household food distribution has little effect on the weight of children at risk of malnutrition

Giving energy dense food supplements- Ready-to-Use Supplementary Food (RUSF), a lipid-based nutrient supplement-to young children in addition to a general food distribution in a country with food shortages (Chad) did not reduce levels of wasting (low weight for height, a sign of acute undernutrition) but slightly increased their height and haemoglobin levels according to a study conducted by the international non-governmental organization Action Against Hunger-France (ACF-France) in collaboration with European researchers published in this week's PLOS Medicine.

In emergency situations, international aid organizations support affected populations by distributing food and sometimes by also providing nutritional supplements such as RUSF, to children at risk of malnutrition.

In a cluster randomized controlled trial, researchers from Belgium and France, led by Lieven Huybregts from Ghent University in Belgium, investigated the effect of a targeted daily dose of RUSF in 6-month old children by randomly assigning fourteen household clusters in the city of Abeche, Chad, into an intervention or control arm.

All the households received a general food distribution that included staple foods but eligible children in the intervention households were also given a daily RUSF ration.

At the end of the study period, the researchers found that the addition of RUSF to the household food rations had little effect on the incidence of wasting.

However, compared to the children in the control group, those in the intervention group had a greater gain in height-for-age, slightly higher hemoglobin levels, and lower rates of diarrhea and fever, as reported by the child's parents.

The authors say: "Adding child-targeted RUSF supplementation to a general food distribution resulted in increased hemoglobin status and linear growth, accompanied by a reduction in diarrhea and fever episodes. However, we could not find clear evidence that adding RUSF to a household food ration distribution of staple foods was more effective in preventing acute malnutrition."

The authors continue: "Other context-specific alternatives for preventing acute malnutrition should therefore be investigated."

And in an accompanying Perspective article, Kathryn Dewey and Mary Arimond from the University of California in the USA (uninvolved in the study), say: "There is clearly a need for additional research to understand the potential growth-promoting effect of certain ingredients in Lipid-based Nutritional supplements (e.g., milk powder, essential fatty acids). The new study by Huybregts et al. is an important contribution to the evidence base."

Dewey and Arimond add: "High-quality programmatic studies can help provide urgently needed information on the cost and comparative cost effectiveness of different integrated strategies for filling nutrient gaps and promoting healthy growth."

Citation: Huybregts L, Houngbe' F, Salpe'teur C, Brown R, Roberfroid D, et al. (2012) 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 9(9): e1001313. doi:10.1371/journal.pmed.1001313