evidence-based blog of Filippo Dibari

Posts Tagged ‘India’

Efficacy and Safety of Therapeutic Nutrition Products for Home Based Therapeutic Nutrition for Severe Acute Malnutrition: A Systematic Review

In Under-nutrition on May 20, 2012 at 9:41 am

by Tarun Gera

Indian Pediatrics (2010); vol. 47. Pages: 709-718.

(Free text available)


Context: Severe acute malnutrition (SAM) in children is a significant public health problem in India with associated increased morbidity and mortality. The current WHO recommendations on management of SAM are based on facility based treatment. Given the large number of children with SAM in India and the involved costs to the care-provider as well as the care-seeker, incorporation of alternative strategies like home based management of uncomplicated SAM is important. The present review assesses (a) the efficacy and safety of home based management of SAM using ‘therapeutic nutrition products’ or ready to use therapeutic foods (RUTF); and (b) efficacy of these products in comparison with F-100 and home-based diet.

Evidence Acquisition: Electronic database (Pubmed and Cochrane Controlled Trials Register) were scanned using keywords ‘severe malnutrition’, ‘therapy’, ‘diet’, ‘ready to use foods’ and ‘RUTF’. Bibliographics of identified articles, reviews and books were scanned. The information was extracted from the identified papers and graded according to the CEBM guidelines.

Results: Eighteen published papers (2 systematic reviews, 7 controlled trials, 7 observational trials and 2 consensus statements) were identified. Systematic reviews and RCTs showed RUTF to be at least as efficacious as F-100 in increasing weight (WMD=3.0 g/kg/day; 95% CI -1.70, 7.70) and more effective in comparison to home based dietary therapies. Locally made RUTFs were as effective as imported RUTFs (WMD=0.07 g/kg/d; 95% CI=-0.15, 0.29). Data from observational studies showed the energy intake with RUTF to be comparable to F-100. The pooled recovery rate, mortality and default in treatment with RUTF was 88.3%, 0.7% and 3.6%, respectively with a mean weight gain of 3.2 g/kg/day. The two consensus statements supported the use of RUTF for home based management of uncomplicated SAM.

Conclusions: The use of therapeutic nutrition products like RUTF for home based management of uncomplicated SAM appears to be safe and efficacious. However, most of the evidence on this promising strategy has emerged from observational studies conducted in emergency settings in Africa. There is need to generate more robust evidence, design similar products locally and establish their efficacy and cost-effectiveness in a ‘non-emergency’ setting, particularly in the Indian context.

Neonatal anthropometry: the thin–fat Indian baby. The Pune Maternal Nutrition Study

In Under-nutrition on May 17, 2012 at 9:44 pm

International Journal of Obesity (2003) 27, 173–180. doi:10.1038/sj.ijo.802219

CS Yajnik, CHD Fall, KJ Coyaji, SS Hirve, S Rao, DJP Barker, C Joglekar, and S Kellingray


“OBJECTIVE: To examine body size and fat measurements of babies born in rural India and compare them with white Caucasian babies born in an industrialised country.

“DESIGN: Community-based observational study in rural India, and comparison with data from an earlier study in the UK, measured using similar methods.

“SUBJECTS: A total of 631 term babies born in six rural villages, near the city of Pune, Maharashtra, India, and 338 term babies born in the Princess Anne Hospital, Southampton, UK.

“MEASUREMENTS: Maternal weight and height, and neonatal weight, length, head, mid-upper-arm and abdominal circumferences, subscapular and triceps skinfold thicknesses, and placental weight.

“RESULTS: The Indian mothers were younger, lighter, shorter and had a lower mean body mass index (BMI) (mean age, weight, height and BMI: 21.4 y, 44.6 kg, 1.52 m, and 18.2 kg/m2) than Southampton mothers (26.8 y, 63.6 kg, 1.63 m and 23.4 kg/m2). They gave birth to lighter babies (mean birthweight: 2.7 kg compared with 3.5 kg). Compared to Southampton babies, the Indian babies were small in all body measurements, the smallest being abdominal circumference (s.d. score: 2.38; 95% CI:2.48 to 2.29) and mid-arm circumference (s.d. score: 1.82; 95% CI: 1.89 to 1.75), while the most preserved measurement was the subscapular skinfold thickness (s.d. score: 0.53; 95% CI: 0.61 to 0.46). Skinfolds were relatively preserved in the lightest babies (below the 10th percentile of birthweight) in both populations.

“CONCLUSIONS: Small Indian babies have small abdominal viscera and low muscle mass, but preserve body fat during their intrauterine development. This body composition may persist postnatally and predispose to an insulin-resistant state.”


Other posts about India are available on this blog. Search using the tags above the main title of this post.

Are you working in a nutrition intervention or you are doing nutrition research in India? I would love to hear about your project, experience and opinions from you. Please, leave a comment here beneath or get in touch with me.

Malnutrition and gender equality in India

In Under-nutrition on April 30, 2012 at 8:56 am

: 31/ott/2007

“KOLARAS, India, 30 October 2007 — When nine-month-old twins Devki and Rahul were brought by their mother to the Nutrition Rehabilitation Centre in Kolaras — located in the Indian state of Madhya Pradesh — Rahul was a normal weight and size for his age, yet his sister Devki weighed just over half of what she should have. Devki’s condition was the result of severe malnutrition.

“Both babies showed such varied weight and health that doctors suspected less food was given to Devki, a common occurrence in some areas of India where boys are often given more attention than girls.

“According to a UNICEF report, half of the world’s undernourished children live in South Asia. In India, 30 per cent of children are born with low birth weight and almost 50 per cent remain underweight by the age of three.

“One of the Millennium Development Goals is to eradicate extreme poverty and hunger by 2015, which would mean halving the proportion of children who are underweight for their age. UNICEF has warned that the world is not on track to meet that goal.”

To read the full story, visit:http://www.unicef.org/infobycountry/india_41484.html

Patterns of stunting and wasting: potential explanatory factors.

In Under-nutrition on April 25, 2012 at 6:38 am

R Martorell and MF Young
Adv Nutr, January 1, 2012; 3(2): 227-33.

Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA

“We investigated the causes of stunting and wasting using nationally representative data on preschool children from India (2005-2006, N = 41,306) and Guatemala (2008-2009, N = 10,317). We estimated stunting and wasting using the 2006 WHO standard and the 1976 WHO/National Center for Health Statistics (NCHS) reference. India and Guatemala had high levels of stunting; wasting was common in India but rare in Guatemala. Use of the WHO standard (based on breast-fed children) increased the prevalence of stunting in both countries but dramatically changed the pattern of wasting by age in India. In Indian children 0-5 mo of age, wasting more than tripled, from 8% to 30%, leading to the highest prevalence of wasting. Using the NCHS reference, the lowest and highest prevalence among Indian children occurred in children 0-5 and 12-23 mo, respectively. Also, we showed that household wealth and the condition of women were related to both stunting and wasting; review of the literature on wasting failed to identify factors that were not also related to stunting (e.g., seasonality, infections, and intrauterine growth retardation). Possible explanations for high levels of wasting in India include the poor status of women, the “thin-fat” infant phenotype, chronic dietary insufficiency, poor dietary quality, marked seasonality, and poor levels of sanitation. Use of the WHO standard calls for urgent attention to improving prenatal and infant nutrition and uncovers an alarming level of wasting in the young infant in India that use of the NCHS growth reference (based on bottle-fed infants) had masked.”


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