Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trialReport as inadecuate




Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trial - Download this document for free, or read online. Document in PDF available to download.

BMC Medicine

, 13:93

Medicine for Global Health

Abstract

BackgroundReady-to-use therapeutic foods RUTF are lipid-based pastes widely used in the treatment of acute malnutrition. Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid PUFA content and low n-3 PUFA, with no stipulated requirements for preformed long-chain n-3 PUFA. The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact, with and without fish oil supplementation, on children’s PUFA status during treatment of severe acute malnutrition.

MethodsThis randomized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were randomized to receive i RUTF with standard composition; ii RUTF with elevated short chain n-3 PUFA; or iii RUTF with elevated short chain n-3 PUFA plus fish oil capsules. Participants were followed-up for 3 months. The primary outcome was erythrocyte PUFA composition.

ResultsErythrocyte docosahexaenoic acid DHA content declined from baseline in the two arms not receiving fish oil. Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or standard RUTF alone: 3 months after enrolment, DHA content was 6.3% interquartile range 6.0–7.3, 4.5% 3.9–4.9, and 3.9% 2.4–5.7 of total erythrocyte fatty acids P <0.001, respectively, while eicosapentaenoic acid EPA content was 2.0% 1.5–2.6, 0.7% 0.6–0.8, and 0.4% 0.3–0.5 P <0.001. RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers, and there were no significant differences in safety outcomes.

ConclusionsPUFA requirements of children with SAM are not met by current formulations of RUTF, or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA. Clinical and growth implications of revised formulations need to be addressed in large clinical trials.

Trial registrationClinicaltrials.gov NCT01593969. Registered 4 May 2012.

KeywordsFatty acid Fish oils Growth Omega-3 Ready-to-use therapeutic food Severe acute malnutrition AbbreviationsAAArachidonic acid

ALAAlpha-linolenic acid

ANOVAAnalysis of variance

DHADocosahexaenoic acid

DPADocosapentaenoic acid

EPAEicosapentaenoic acid

FFO-RUTFTrial arm receiving flax seed oil-containing RUTF and fish oil capsules

F-RUTFTrial arm receiving flax seed oil-containing RUTF without fish oil capsules

IFN-γInterferon gamma

IGF-1Insulin-like growth factor-1

KCHKilifi County Hospital

KEMRIKenya Medical Research Institute

LALinoleic acid

LC-PUFALong-chain polyunsaturated fatty acid

MUACMid-upper arm circumference

OTPOutpatient therapeutic feeding programme

PHAPhytohemagglutinin

PUFAPolyunsaturated fatty acid

RUTFReady-to-use therapeutic food

SAMSevere acute malnutrition

S-RUTFTrial arm receiving standard-formulation RUTF without fish oil capsules

TTTetanus toxoid

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-015-0315-6 contains supplementary material, which is available to authorized users.

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Author: Kelsey DJ Jones - Rehema Ali - Maureen A Khasira - Dennis Odera - Annette L West - Grielof Koster - Peter Akomo - Alison

Source: https://link.springer.com/



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