TECHNICAL REPORT FANTA 2 FOOD AND NUTRITION TECHNICAL ASSISTANCE Comparing Milk Fortified Corn-Soy Blend (CSB++), Soy Ready-to-Use Supplementary Food (RUSF), and Soy/Whey RUSF (Supplementary Plumpy®) in the Treatment of Moderate Acute Malnutrition Mark Manary MD Cindy Y. Chang March 2012 FANTA-2 Bridge FHI 360 1825 Connecticut Ave., NW Washington, DC 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 Email: [email protected] Website: www.fantaproject.org Comparing Milk Fortified Corn-Soy Blend (CSB++), Soy Ready-to-Use Supplementary Food (RUSF), and Soy/Whey RUSF (Supplementary Plumpy®) in the Treatment of Moderate Acute Malnutrition Mark Manary MD Cindy Y. Chang March 2012 FANTA-2 Bridge FHI 360 1825 Connecticut Avenue, NW Washington, DC 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 Email: [email protected] Website: www.fantaproject.org This draft is made possible by the generous Recommended Citation: support of the American people through the support of the Office of Health, Infectious Manary, Mark and Chang, Cindy Y. 2012. Diseases, and Nutrition, Bureau for Global Comparing Milk Fortified Corn-Soy Blend Health, and the Office of Food for Peace, Bureau (CSB++), Soy Ready-to-Use Supplementary for Democracy, Conflict and Humanitarian Food (RUSF), and Soy/Whey RUSF Assistance, United States Agency for (Supplementary Plumpy®) in the Treatment of International Development (USAID), under terms Moderate Acute Malnutrition. Washington, DC: of Cooperative Agreement No. AID-OAA-A-11- FANTA-2 Bridge/FHI 360. 00014, through the FANTA-2 Bridge, managed by FHI 360. Contact information: The contents are the responsibility of FHI 360 and do not necessarily reflect the views Food and Nutrition Technical Assistance II of USAID or the United States Government. Project (FANTA-2) Bridge FHI 360 Published March 2012 1825 Connecticut Avenue, NW Washington, DC 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 Email: [email protected] Website: www.fantaproject.org Comparing Milk Fortified Corn-Soy Blend (CSB++), Soy Ready-to-Use Supplementary Food (RUSF), and Soy/Whey RUSF (Supplementary Plumpy®) in the Treatment of Moderate Acute Malnutrition Contents Abbreviations and Acronyms ..................................................................................................................... i Abstract ........................................................................................................................................................ ii Introduction ................................................................................................................................................. 1 Subjects and Methods ................................................................................................................................ 2 Study Area ....................................................................................................................................... 2 Subjects ......................................................................................................................................... 2 Study Design .................................................................................................................................... 2 Study Participation ........................................................................................................................... 3 Food Products and Distribution ........................................................................................................ 3 Data Analysis ................................................................................................................................... 4 Results ......................................................................................................................................................... 5 Initial Treatment ............................................................................................................................... 5 1-year follow-up ................................................................................................................................ 5 Treated to WHZ ≥ −2 ....................................................................................................................... 6 Treated to 12 Weeks ........................................................................................................................ 6 Treated to WHZ ≥ -2 versus to 12 Weeks ........................................................................................ 6 Discussion ................................................................................................................................................... 7 References ................................................................................................................................................... 9 Annex 1. Tables ......................................................................................................................................... 11 Table 1. Nutrient Composition of the Supplementary Foods per Daily Ration for a 7.5 kg Child 11 Table 2. Enrollment Characteristics of Children Treated for MAM .............................................. 12 Table 3. Outcomes of Moderately Wasted Malawian Children That Received Approximately 75 kcal/kg/day of Supplementary Food ......................................................................... 13 Table 4. Binary Logistic Regression Model of Factors Associated with Recovery from MAM after Supplementary Feeding ........................................................................................ 14 Table 5. Characteristics of Children That Recovered from MAM upon Treatment to WHZ ≥ −2 at the Time of Follow-Up Enrollment ............................................................................. 15 Table 6. Clinical Outcomes of Children That Were Treated to WHZ ≥ −2 at 12 Months after Follow-Up Enrollment .................................................................................................... 16 Table 7. Clinical Outcomes of Children That Were Treated to WHZ ≥ −2 at 3, 6, and 12 Months after Follow-Up Enrollment .......................................................................... 16 Table 8. Characteristics of Children That Did Not Relapse versus Those That Relapsed at Least Once during the 1-Year Follow-Up after Treatment to WHZ ≥ −2 at the Time of Follow-Up Enrollment ................................................................................................ 17 Table 9. Characteristics of Children That Did Not Relapse versus Those That Relapsed Once, Twice, or More than Twice after Treatment to WHZ ≥ −2 at the Time of Follow-Up Enrollment ...................................................................................................................... 18 Table 10. Characteristics of Children That Died versus Those That Survived after Treatment to WHZ ≥ −2 at the Time of Follow-Up Enrollment ............................................................ 19 Table 11. Characteristics of Children That Died, Developed SAM, Relapsed, or Did Not Relapse after Treatment to WHZ ≥ −2 at the Time of Follow-Up Enrollment ................ 20 Table 12. Characteristics of Children That Did Not Relapse for 12 Months versus All Others at Follow-Up Enrollment ................................................................................................ 21 Table 13. Characteristics of Children That Did Not Relapse for 12 Months versus Those That Died by 3-Month Follow-Up at Follow-Up Enrollment.................................................... 22 Table 14. Characteristics of Children That Survived versus Those That Died by 3-Month Follow-Up at Follow-Up Enrollment ............................................................................... 23 Table 15. Characteristics of Children That Did Not Relapse versus Those That Died by 3-Month Follow-Up at Follow-Up Enrollment ................................................................. 24 Table 16. Characteristics of Children That Did Not Relapse, Did Relapse, and Died by 3-Month Follow-Up at Follow-Up Enrollment ................................................................. 25 Comparing Milk Fortified Corn-Soy Blend (CSB++), Soy Ready-to-Use Supplementary Food (RUSF), and Soy/Whey RUSF (Supplementary Plumpy®) in the Treatment of Moderate Acute Malnutrition Table 17. Characteristics of Children That Were Lost to Follow-Up versus Those That Completed 12-Month Follow-Up after Treatment to WHZ ≥ −2 at the Time of Follow-Up Enrollment .................................................................................................... 26 Table 18. Clinical Outcomes of Children That Were Treated for 12 Weeks at 12 Months after Follow-Up Enrollment .................................................................................................... 27 Table 19. Clinical Outcomes of Children That Were Treated for 12 Weeks at 3, 6, and 12 Months after Follow-Up Enrollment .......................................................................... 27 Table 20. Comparisons of Children That Were Treated for 12 Weeks and Relapsed versus Those That Did Not Relapse over the Course of 12 Months ......................................... 28 Table 21. Comparison of Children That Were Treated for 12 Weeks and Developed SAM, Relapsed, or Did Not Relapse for 12 Months ................................................................ 28 Table 22. Comparison of Children That Were Treated for 12 Weeks and Died or Survived for 12 Months .....................................................................................................................