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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

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
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
Background: ready-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.

Methods: this 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.

Results: erythrocyte 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.

Conclusions: PUFA 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
fatty acid, fish oils, growth, omega-3, ready-to-use therapeutic food, severe acute malnutrition
93-93
Jones, K.D.
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Ali, R.
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Khasira, M.A.
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Odera, D.
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West, A.L.
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Koster, G.
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Akomo, P.
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Talbert, A.W.
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Goss, V.M.
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Thitiri, J.
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Ndoro, S.
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Knight, M.A.
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Omollo, K.
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Ndungu, A.
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Mulongo, M.M.
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Bahwere, P.
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Fegan, G.
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Warner, J.O.
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Postle, A.D.
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Collins, S.
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Calder, P.C.
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Berkley, J.A.
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Ngari, M.
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Jones, K.D.
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Ali, R.
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Khasira, M.A.
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Odera, D.
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West, A.L.
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Koster, G.
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Akomo, P.
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Talbert, A.W.
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Goss, V.M.
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Ngari, M.
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Thitiri, J.
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Ndoro, S.
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Knight, M.A.
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Omollo, K.
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Ndungu, A.
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Mulongo, M.M.
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Bahwere, P.
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Fegan, G.
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Warner, J.O.
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Postle, A.D.
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Collins, S.
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Calder, P.C.
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Berkley, J.A.
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Jones, K.D., Ali, R., Khasira, M.A., Odera, D., West, A.L., Koster, G., Akomo, P., Talbert, A.W., Goss, V.M., Thitiri, J., Ndoro, S., Knight, M.A., Omollo, K., Ndungu, A., Mulongo, M.M., Bahwere, P., Fegan, G., Warner, J.O., Postle, A.D., Collins, S., Calder, P.C. and Berkley, J.A. , Ngari, M. (ed.) (2015) 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. BMC Medicine, 13, 93-93. (doi:10.1186/s12916-015-0315-6). (PMID:25902844)

Record type: Article

Abstract

Background: ready-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.

Methods: this 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.

Results: erythrocyte 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.

Conclusions: PUFA 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

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More information

Accepted/In Press date: 9 March 2015
e-pub ahead of print date: 23 April 2015
Published date: 23 April 2015
Keywords: fatty acid, fish oils, growth, omega-3, ready-to-use therapeutic food, severe acute malnutrition
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 376556
URI: http://eprints.soton.ac.uk/id/eprint/376556
PURE UUID: 659c139c-9803-4389-b3ba-a5c5aa017e0d
ORCID for A.D. Postle: ORCID iD orcid.org/0000-0001-7361-0756
ORCID for P.C. Calder: ORCID iD orcid.org/0000-0002-6038-710X

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Date deposited: 30 Apr 2015 09:31
Last modified: 15 Mar 2024 02:50

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Contributors

Author: K.D. Jones
Author: R. Ali
Author: M.A. Khasira
Author: D. Odera
Author: A.L. West
Author: G. Koster
Author: P. Akomo
Author: A.W. Talbert
Author: V.M. Goss
Editor: M. Ngari
Author: J. Thitiri
Author: S. Ndoro
Author: M.A. Knight
Author: K. Omollo
Author: A. Ndungu
Author: M.M. Mulongo
Author: P. Bahwere
Author: G. Fegan
Author: J.O. Warner
Author: A.D. Postle ORCID iD
Author: S. Collins
Author: P.C. Calder ORCID iD
Author: J.A. Berkley

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