evidence-based blog of Filippo Dibari

Posts Tagged ‘CSB’

Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali

In Under-nutrition on May 6, 2019 at 3:20 pm

source: BMJ webpage

By Sheila Isanaka1, Dale A Barnhart2, Christine M McDonald3, Robert S Ackatia-Armah4, Roland Kupka5, Seydou Doumbia6, Kenneth H Brown4, Nicolas A Menzies7

Abstract

Introduction Moderate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.

Methods We conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.

Results Compared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.

Conclusion MAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.

Affiliation of the authors:

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. Children’s Hospital Oakland Research Institute, Oakland, California, USA
  4. Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, CA, USA
  5. United Nations Children’s Fund, Nutrition Section, New York, NY, USA
  6. Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
  7. Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  8. Correspondence toDr Sheila Isanaka; sisanaka@hsph.harvard.edu

Impact of lipid-based nutrient supplements and corn-soy blend on energy and nutrient intake among moderately underweight 8-18-month-old children participating in a clinical trial

In Under-nutrition on November 7, 2014 at 6:08 pm

by Thakwalakwa CM, Ashorn P, Phuka JC, Cheung YB, Briend A, Maleta KM

from Matern Child Nutr. 2014 Feb 17

 

Abstract

Nutrition interventions have an effect on growth, energy and nutrient intake, and development, but there are mixed reports on the effect of supplementation of energy-dense foods on dietary intake.

This substudy aimed at assessing the effect of supplementation with corn-soy blend (CSB) or lipid-based nutrient supplement (LNS) on energy and nutrient intake in moderately underweight children participating in a clinical trial. A total of 188 children aged 8-18 months participated and received daily either 284 kcal from CSB or 220 kcal from LNS and no supplements (control).

An interactive 24-h recall method was used to estimate energy and nutrient intakes in the groups. Total mean energy intake was 548 kcal, 551 kcal and 692 kcal in the control, CSB and LNS groups, respectively (P = 0.011). The mean (95% confidence interval) intake of energy and protein were 144 (37-250; P < 0.001) and 46 (1.5-7.6; P < 0.001) larger, respectively, in the LNS group than among the controls. No significant differences were observed between the control and CSB groups. Energy intake from non-supplement foods was significantly lower in the CSB group compared with the control group, but not in the LNS group, suggesting a lower displacement of non-supplement foods with LNS. Both CSB and LNS supplementation resulted in higher intakes of calcium, iron, zinc and vitamin C compared with controls (all P ≤ 0.001).

This study indicates that LNS might be superior to CSB to supplement underweight children as it results in higher energy intake, but this requires confirmation in other settings.

Lipid-Based Nutrient Supplements Do Not Affect the Risk of Malaria or Respiratory Morbidity in 6- to 18-Month-Old Malawian Children in a Randomized Controlled Trial

In Under-nutrition on September 28, 2014 at 7:03 am

by Charles Mangani, Per Ashorn, Kenneth Maleta, John Phuka,Chrissie Thakwalakwa,Kathryn Dewey, Mark Manary, Taneli Puumalainen, and Yin Bun Cheung

from J. Nutr. November 1, 2014

(download)

Abstract

Background: There is evidence to support the use of lipid-based nutrient supplements (LNSs) to promote child growth and development in low-income countries, but there is also a concern regarding the safety of using iron-fortified products in malaria-endemic areas.

Objective: The objective of this study was to test the hypothesis that 6- to 18-mo-old rural Malawian children receiving iron-containing (6 mg/d) LNSs would not have excess morbidity compared with infants receiving no supplementation.

Methods: A randomized controlled trial allocated 840 children to receive daily supplementation with 54 g/d LNS with milk protein base (milk-LNS), 54 g/d LNS with soy protein base (soy-LNS), 71 g/d corn-soy blend (CSB), or no supplementation from 6 to 18 mo of age. Morbidity was compared using a non-inferiority margin set at 20% excess morbidity in supplemented groups compared with the nonsupplemented group.

Results: Baseline characteristics were similar across groups. The proportion of days with febrile illness between 6 and 18 mo was 4.9%, and there were no differences between the groups: 4.9% (95% CI: 4.3, 5.5%), 4.5% (95% CI: 3.9, 5.1%), 4.7% (95% CI: 4.1, 5.3%), and 5.5% (95% CI: 4.7–6.3%) in the milk-LNS, soy-LNS, CSB, and control groups, respectively. The proportion of days with respiratory problems and diarrhea between 6 and 18 mo also did not differ between groups. Compared with controls, the incident rate ratio (95% CI) for clinical malaria was 0.80 (0.59, 1.09), 0.77 (0.56, 1.06), and 0.79 (0.58, 1.08) in milk-LNS, soy-LNS, and CSB, respectively, with 95% CIs confirming non-inferiority. The incidence of febrile episodes, diarrhea, respiratory problems or admission to hospital, prevalence of malaria parasitemia throughout the follow-up, and mean change in hemoglobin concentration from baseline were also similar between the groups.

Conclusions: Daily supplementation with 54 g of milk-based or soy protein–based LNS or 71 g of CSB did not result in increases in malaria or respiratory morbidity in children in a malaria-endemic setting. However, we could not conclude whether LNSs did or did not increase diarrheal morbidity. This trial was registered at clinicaltrials.gov as NCT00524446.

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A Lipid-Based Nutrient Supplement but Not Corn-Soy Blend Modestly Increases Weight Gain among 6- to 18-Month-Old Moderately Underweight Children in Rural Malawi

In Under-nutrition on April 19, 2014 at 9:07 am

by Thakwalakwa C, Ashorn P, Phuka J, Cheung YB, Briend A, Puumalainen T, Maleta K.

J. Nutr. November 1, 2010 vol. 140 no. 11 2008-2013

(download)

Abstract

Although widely used, there is little information concerning the efficacy of corn-soy blend (CSB) supplementation in the treatment of moderate underweight in African children. Lipid-based nutrient supplements (LNS), which have proven to be beneficial treatment for severely wasted children, could offer benefits to less severely affected individuals.

We conducted a clinical randomized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children. A total of 182 underweight [weight-for-age Z-score (WAZ) < −2] 6- to 15-mo-old children were randomized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB, providing 1189 and 921 kJ, respectively, or no supplementation (control). The primary outcome was weight change; secondary outcomes included changes in anthropometric indices, hemoglobin levels, and morbidity.

The body weight increases (mean ± SD) did not differ and were 620 ± 470, 510 ± 350, and 470 ± 350 g in the LNS, CSB, and control groups, respectively (P = 0.11). Compared with controls, infants and children in the LNS group gained more weight [mean (95% CI) = 150 g (0–300 g); P = 0.05] and had a greater increase in WAZ [0.33 (−0.02–0.65); P = 0.04]. Weight and WAZ changes did not differ between the control and CSB groups. In exploratory stratified analysis, the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [250 g (60–430 g; P = 0.01].

Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ.

 

 

FORMULATION OF SORGHUM-PEANUT BLEND USING LINEAR PROGRAMMING FOR TREATMENT OF MODERATE ACUTE MALNUTRITION IN UGANDA

In Under-nutrition on November 16, 2013 at 7:14 pm

by Andrew K. Amegovu, Patrick Ogwok, Sophie Ochola, Peter Yiga, Juliet H. Musalima, Emma Mutenyo

from Journal of Food Chemisty and Nutrition – Vol 1, No 2 (2013)

(download)

Abstract

Infant and young child feeding practices in low-income countries are still inadequate leading to high rates of acute malnutrition. Formulas from local food materials are vital in formulations for management of child malnutrition in poor countries because they are affordable. Nutrient composition of sorghum-peanut blend (SPB) mixed with honey and ghee, and micronutrient-fortified corn-soy blend (CSB), a traditional food supplement, were analyzed. Proximate components and beta-carotene amounts were high in both products. Vitamin A level was higher in CSB than SPB. Proportions of essential fatty acids were low. Levels of iron, zinc, calcium, magnesium, phosphorus, potassium, manganese and sodium were adequate for recovery from moderate acute malnutrition (MAM). Energy content of CSB was 421kcal/100g while that of SPB was 430kcal/100g. Levels of condensed tannin, phytates, trypsin inhibitors and aflatoxins were below prescribed limits. In conclusion, levels of nutrients in SPB and CSB were adequate for treatment of MAM in children.

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