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Weight Gain Among Children with Severe Malnutrition in Therapeutic Feeding Programmes: A Systematic Review and Meta-Analysis

31 Pages Posted: 20 Aug 2024

See all articles by Grace O'Donovan

Grace O'Donovan

London School of Hygiene & Tropical Medicine

Daniel Allen

London School of Hygiene & Tropical Medicine

Thandile Nkosi-Gondwe

London School of Hygiene & Tropical Medicine

Kenneth Anujuo

University of Cambridge

Mubarek Abera

Jimma University (JU)

Amir Kirolos

University of Liverpool

Laurentya Olga

University of Cambridge

Debbie Thompson

The University of the West Indies

Kimberley McKenzie

The University of the West Indies

Elizabeth Wimborne

University of Southampton

Tim J. Cole

University College London - Great Ormond Street Institute of Child Health

Albert Koulman

University of Cambridge - Core Metabolomics and Lipidomics Laboratory

Natasha Lelijveld

Emergency Nutrition Network

Amelia C. Crampin

Malawi Epidemiology and Intervention Research Unit (MEIRU); London School of Hygiene & Tropical Medicine - Faculty of Epidemiology and Population Health

Charles Opondo

London School of Hygiene & Tropical Medicine - Faculty of Epidemiology and Population Health

Suvi T. Kangas

International Rescue Committee

Asha Badaloo

The University of the West Indies

Gemechu Ameya

Kotebe Metropolitan University

Marko Kerac

London School of Hygiene & Tropical Medicine

More...

Abstract

Background: Globally, some 45 million children under five years of age are wasted (severely malnourished). Although 2023 WHO guidelines on their care did not aim to identify optimal weight gain, they did mention 5-10g/kg/day as a target, which is a change from prior guidelines that recommended 10-15g/kg/day, when inpatient-only care was the norm. We aimed to inform future policy/programming on weight gain targets. 


Methods: For this systematic review and meta-analysis, we searched Embase, Global Health and Medline. The final search was on 23/02/2024. Papers were included if they reported weight gain of children aged 6-59 months with severe malnutrition during treatment. Summary data were extracted, and quality was assessed using a NICE Quality Appraisal Checklist. We conducted random-effects meta-analysis to describe pooled mean weight gain by programme type. Meta-regression investigated potential associations of weight gain with length of stay and programme outcomes. We registered the study on PROSPERO (CRD42023266472). 

Findings: Our search yielded 3,173 papers. We reviewed 321 full texts, identifying 132 eligible papers. Of these, 110 papers, including some 247,980 participants, reported weight gain as g/kg/day and were eligible for meta-analysis. Details of weight gain calculation methods varied. Mean rate of weight gain was 9·2g/kg/day (95% CI 8·0–10·3) across 20 inpatient programmes, and 3·9g/kg/day (95% CI 3·4–4·3) across 63 outpatient programmes. We found some evidence of an association between slower weight gain and higher mortality after adjusting for programme type (p=0·02). There was high heterogeneity between studies (I2>75%). 

Interpretation: Weight gain in outpatient programmes was markedly slower than in inpatient treatment. Clearer reporting of weight gain and a better understanding of the sequelae of faster/slower recovery is important to set future weight gain targets. Our results set an important baseline for current programmes to benchmark against. 

Study Registration: We registered the study on PROSPERO (CRD42023266472). 

Funding: Medical Research Council/Global Challenges Research Fund, grant number: MR/V000802/1. 

Declaration of Interest: We declare no competing interests.

Keywords: severe malnutrition, weight gain, therapeutic feeding programmes, child health, growth, nutrition, catch-up growth

Suggested Citation

O'Donovan, Grace and Allen, Daniel and Nkosi-Gondwe, Thandile and Anujuo, Kenneth and Abera, Mubarek and Kirolos, Amir and Olga, Laurentya and Thompson, Debbie and McKenzie, Kimberley and Wimborne, Elizabeth and Cole, Tim J. and Koulman, Albert and Lelijveld, Natasha and Crampin, Amelia C. and Opondo, Charles and Kangas, Suvi T. and Badaloo, Asha and Ameya, Gemechu and Kerac, Marko, Weight Gain Among Children with Severe Malnutrition in Therapeutic Feeding Programmes: A Systematic Review and Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=4929775

Grace O'Donovan (Contact Author)

London School of Hygiene & Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Daniel Allen

London School of Hygiene & Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Thandile Nkosi-Gondwe

London School of Hygiene & Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Kenneth Anujuo

University of Cambridge ( email )

Trinity Ln
Cambridge, CB2 1TN
United Kingdom

Mubarek Abera

Jimma University (JU) ( email )

Amir Kirolos

University of Liverpool ( email )

Chatham Street
Brownlow Hill
Liverpool, L69 7ZA
United Kingdom

Laurentya Olga

University of Cambridge ( email )

Trinity Ln
Cambridge, CB2 1TN
United Kingdom

Debbie Thompson

The University of the West Indies ( email )

Kimberley McKenzie

The University of the West Indies ( email )

Elizabeth Wimborne

University of Southampton ( email )

Southampton Business School
Southampton
United Kingdom

Tim J. Cole

University College London - Great Ormond Street Institute of Child Health ( email )

30 Guilford Street
London, England WC1N 1EH
United Kingdom

Albert Koulman

University of Cambridge - Core Metabolomics and Lipidomics Laboratory ( email )

United Kingdom

Natasha Lelijveld

Emergency Nutrition Network ( email )

United Kingdom

Amelia C. Crampin

Malawi Epidemiology and Intervention Research Unit (MEIRU)

London
United Kingdom

London School of Hygiene & Tropical Medicine - Faculty of Epidemiology and Population Health ( email )

London, WC1E 7HT
United Kingdom

Charles Opondo

London School of Hygiene & Tropical Medicine - Faculty of Epidemiology and Population Health ( email )

Suvi T. Kangas

International Rescue Committee ( email )

New York, NY
United States

Asha Badaloo

The University of the West Indies ( email )

Gemechu Ameya

Kotebe Metropolitan University ( email )

Ethiopia

Marko Kerac

London School of Hygiene & Tropical Medicine ( email )