Writing in the Journal of Pediatric Gastroenterology and Nutrition, the research team noted that children treated for moderate acute malnutrition experience a ‘disturbingly high’ rate of relapse and even death in the year following treatment and recovery.
But without clear evidence that any one feeding regimen trumps another, the global health community has been divided on how best to treat these children and reduce the 37% rate of relapse.
Led by Professor Mark Manary from Washington University School of Medicine in St. Louis, the new research found that while supplementary feeding for a set time period of 12 weeks makes an impact on malnourished children, it may not be as important as treating children until they reach target weights and measures of arm circumference.
While the latter is a strategy is already recommended by the World Health Organization (WHO), the US-based team were ‘surprised’ to find that the WHO targets are insufficient - and that raising the weight and arm thresholds could significantly lower the rate of relapse.
"These findings support a more sustainable recovery for malnourished children and move us another step closer to improving their care and long-term health," said Manary. "While relapse rates remain a challenge we still need to overcome, this evidence should help us trim those rates. As it stands, far too many malnourished children relapse."
The findings come from a study based in rural Malawi, which involved 2,349 moderately malnourished children ages 6 months to 5 years who were fed nutritious, soy-based supplements and evaluated for 12 months following treatment.
Manary and his colleagues evaluated two feeding regimens. In the first, 1,967 children were treated until they met weight-for-height and arm circumference targets set by WHO, and in the other, 382 children were treated for 12 weeks.
The team found that when moderately malnourished children were treated to the WHO targets, 62% remained well-nourished. This compares with 71% of children fed nutritional supplements for 12 weeks.
"When you're talking about a disease that affects more than 30 million children a year, a nearly 9% increase in kids who remain well-nourished becomes a pretty significant improvement," commented study lead author Dr Indi Trehan.
When the team analysed the data further, they found other factors at play.
Indeed, while tried to pinpoint just what it was about the children who did better after having been treated for 12 weeks, they zeroed in on a compelling detail: that the greater a child's weight-for-height score (WHZ) and the bigger the child's mid-upper arm circumference (MUAC), the more likely it was that he or she would not suffer a relapse.
"Even kids who weren't treated for that long but quickly recovered their weight-for-height score or mid-upper arm circumference did just as well as the kids who were treated longer," Trehan said.
"That made us realise that the problem wasn't so much that we weren't treating kids long enough - it was that we weren't treating them to the correct weight and MUAC targets.”
“Both targets currently being used are insufficient. We need to adjust them higher,” said Trehan. "Establishing a higher threshold appears to be a better way to prevent relapse rather than treating all children for 12 weeks."
"A higher threshold could provide a more optimal balance between conserving costs of treatment and scarce food resources and ensuring that as many children as possible don't relapse following treatment."
Trehan added that it would be preferable if the research could be tested with a randomised control trial but that such an undertaking is unlikely because of the resources it would require.
Source: Journal of Pediatric Gastroenterology & Nutrition
Published online ahead of print, doi: 10.1097/MPG.0000000000000639
"Extending Supplementary Feeding for Children Under Five with Moderate Acute Malnutrition Leads to Lower Relapse Rates”
Authors: Trehan, Indi; et al