The management of moderate acute malnutrition in children aged 6-59 months in low- and middle-income countries: a systematic review and meta-analysis

Background: Malnutrition is a Leading cause of morbidity and mortality in children aged <5 y, especially in Low-and middle-income countries (LMICs). Unlike severe acute malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally, and guidelines Lack a robust evidence base. This systematic review and metaanalysis assessed the evidence for Lipid-based nutrient supplements (LNSs), fortified blended flours (FBFs) and nutrition counselling, in the treatment of MAM. Methods: Four databases were systematically searched for studies conducted in LMICs that compared the effectiveness of food-based products with any comparator group in promoting recovery from MAM in children aged 6-59 mo. Where appropriate, pooled estimates of effect were estimated using random-effects meta-analyses. Results: A total of 13 trials were identified for inclusion. ALL used active controls. There was evidence of increased probability of recovery (gaining normal weight-for-height and/or mid-upper arm circumference) among children treated with LNSs compared with children treated with FBFs (risk ratio 1.05, 95% CI 1.01 to 1.09, p=0.009). Conclusion: Based on a relatively small number of studies mainly from Africa, LNSs are superior to FBFs in improving a nthropometric recovery from MAM. Current evidence for the use of food supplements in MAM treat-ment is based on comparisons with active controls. Future studies should assess a wider range of comparator groups, such as nutrition education/counselling alone, and outcomes, including body composition, morbidity and development.