Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Weight Gain Among Children with Severe Malnutrition in Therapeutic Feeding Programmes: A Systematic Review and Meta-Analysis
Malawi Epidemiology and Intervention Research Unit (MEIRU); London School of Hygiene & Tropical Medicine - Faculty of Epidemiology and Population Health
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
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