Cochrane · systematic review · CD009000
Ready‐to‐use therapeutic food (RUTF) for home‐based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age
Schoonees, A, Lombard, MJ, Musekiwa, A, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
12
current version
GRADE rated
12
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 4 · 33.3%Low 4 · 33.3%Moderate 2 · 16.7%High 2 · 16.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyStandard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements versus an alternative dietary approach
Population: children aged 6 months‐5 years with SAM (and mixed HIV comorbidity), some of whom had been stabilised as inpatients pre‐trial
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery during intervention defined as achieving WHZ ≥ −2 and absence of oedema in 1 study; reaching a WHZ score > −2 and without oedema in 1 study; WHZ > −2 in 1 study; having a WHZ score ≥ 0 in 1 study; reaching 100% weight for height in 1 stud... Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs an alternative dietary approach | RR 1.33 [1.16, 1.54] | 6 studies · 1852 participants | Moderate Downgraded: risk of bias, imprecision |
Relapse during intervention defined as admission to inpatient therapeutic care or recurrence of oedema or systematic infections during the study period, and dropouts during intervention period Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs an alternative dietary approach | RR 0.55 [0.3, 1.01] | 4 studies · 1505 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Mortality during intervention Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs an alternative dietary approach | RR 1.05 [0.51, 2.16] | 4 studies · 1505 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Rate of weight gain (g/kg/day) during intervention 3 studies measured weight gain during the first 4 weeks of the intervention period and 1 study until recovery or 16 weeks after enrolment, whichever was earlier Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs an alternative dietary approach | no estimate extracted | 4 studies · 1450 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements versus as a supplement to the usual diet
Population: children aged 6 months‐5 years with SAM (1 study included HIV‐uninfected children; 1 study included HIV‐infected children), all of whom had been stabilised as inpatients pre‐trial.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery during intervention defined as WHZ > 0 in 1 study; 100% weight for height in 1 study Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs as a supplement to the usual diet | RR 1.41 [1.19, 1.68] | 2 studies · 210 participants | Low Downgraded: risk of bias, indirectness |
Relapse during intervention defined as admission to inpatient therapeutic care or recurrence of oedema or systematic infections during the study period, and dropouts during intervention period Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs as a supplement to the usual diet | RR 0.11 [0.01, 0.85] | 2 studies · 210 participants | Low Downgraded: risk of bias, indirectness |
Mortality during intervention Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs as a supplement to the usual diet | RR 1.36 [0.46, 4.04] | 2 studies · 210 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Rate of weight gain (g/kg/day) during intervention defined as change between baseline and week 4 of the intervention period Standard ready‐to‐use therapeutic food (RUTF) provided at a dose that meets total daily nutritional requirements vs as a supplement to the usual diet | no estimate extracted | 2 studies · 206 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Standard ready‐to‐use therapeutic food (RUTF) versus RUTF using an alternative formulation
Population: children aged 6 months‐5 years with SAM (and mixed HIV comorbidity), some of whom had been stabilised as inpatients pre‐trial
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery during intervention defined as weight gain ≥ 15% in relation to baseline weight, absence of complications and oedema, and MUAC > 110 mm in 2 studies; MUAC > 12.4 cm without oedema in 1 study; WHZ ≥ 80% for two consecutive visits in 1 stud... Standard ready‐to‐use therapeutic food (RUTF) vs RUTF using an alternative formulation | RR 1.03 [0.99, 1.08] | 6 studies · 4188 participants | High |
Relapse during intervention defined as admission to inpatient therapeutic care, remain wasted, and dropouts during intervention period Standard ready‐to‐use therapeutic food (RUTF) vs RUTF using an alternative formulation | RR 0.84 [0.72, 0.98] | 6 studies · 4188 participants | High |
Mortality during intervention Standard ready‐to‐use therapeutic food (RUTF) vs RUTF using an alternative formulation | RR 1 [0.8, 1.24] | 7 studies · 4309 participants | Moderate Downgraded: imprecision |
Rate of weight gain (g/kg/day) during intervention defined as change over first 4, 8, 10, 16 weeks of the intervention period in 4 studies; change until end of intervention period (no maximum number of weeks applied) in 1 study; and regression ana... Standard ready‐to‐use therapeutic food (RUTF) vs RUTF using an alternative formulation | no estimate extracted | 6 studies · 3807 participants | Low Downgraded: imprecision, inconsistency |
Ready‐to‐use therapeutic food (RUTF) compared to standard diet for children aged six months to five years with severe acute malnutrition
Population: children aged 6 months to 5 years with severe acute malnutrition
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery Different definitions1 Ready‐to‐use therapeutic food (RUTF) vs standard diet | RR 1.32 [1.16, 1.5] | 3 studies · 599 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Relapse Admission to inpatient therapeutic care Ready‐to‐use therapeutic food (RUTF) vs standard diet | no estimate extracted | 3 studies · 599 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Mortality Ready‐to‐use therapeutic food (RUTF) vs standard diet | RR 0.97 [0.46, 2.05] | 3 studies · 599 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Weight gain (g/kg/day) Ready‐to‐use therapeutic food (RUTF) vs standard diet | no estimate extracted | 3 studies · 595 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Ready‐to‐use therapeutic food (RUTF) supplement compared to RUTF (total daily requirements) for children aged six months to five years with severe acute malnutrition
Population: children aged 6 months to 5 years with severe acute malnutrition
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery Different definitions1 Ready‐to‐use therapeutic food (RUTF) supplement vs RUTF (total daily requirements) | RR 0.71 [0.6, 0.84] | 2 studies · 210 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Relapse Admission to inpatient therapeutic care Ready‐to‐use therapeutic food (RUTF) supplement vs RUTF (total daily requirements) | RR 8.95 [1.18, 67.77] | 2 studies · 210 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Mortality Ready‐to‐use therapeutic food (RUTF) supplement vs RUTF (total daily requirements) | RR 0.73 [0.25, 2.18] | 2 studies · 210 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Weight gain: HIV‐uninfected children (g/kg/day) Ready‐to‐use therapeutic food (RUTF) supplement vs RUTF (total daily requirements) | no estimate extracted | 1 study · 158 participants | Very low Downgraded: risk of bias, indirectness |
Weight gain: HIV‐infected children (g/kg/day) Ready‐to‐use therapeutic food (RUTF) supplement vs RUTF (total daily requirements) | no estimate extracted | 1 study · 48 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Ready‐to‐use therapeutic food (RUTF) containing less milk powder compared to standard RUTF for children aged six months to five years with severe acute malnutrition
Population: children aged 6 months to 5 years with severe acute malnutrition
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery Having a WHZ > ‐2 without oedema Ready‐to‐use therapeutic food (RUTF) containing less milk powder vs standard RUTF | RR 0.97 [0.93, 1.01] | 1 study · 1874 participants | Moderate Downgraded: imprecision, indirectness |
Relapse Children who remained wasted plus children referred to inpatient care Ready‐to‐use therapeutic food (RUTF) containing less milk powder vs standard RUTF | RR 1.33 [1.03, 1.72] | 1 study · 1874 participants | Low Downgraded: imprecision, indirectness |
Mortality Ready‐to‐use therapeutic food (RUTF) containing less milk powder vs standard RUTF | RR 0.9 [0.55, 1.45] | 1 study · 1874 participants | Very low Downgraded: imprecision, indirectness |
Weight gain (g/kg/day) Ready‐to‐use therapeutic food (RUTF) containing less milk powder vs standard RUTF | no estimate extracted | 1 study · 1874 participants | Low Downgraded: imprecision, indirectness |