The management of Moderate Acute Malnutrition (MAM) in children aged 6-59 months: A systematic review and meta-analysis

Background Malnutrition is a leading cause of morbidity and mortality in children aged under five years, especially in low- and middle-income countries (LMICs). Although severe acute malnutrition (SAM) is considered the most serious form of malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally and, unlike SAM, guidelines lack a robust evidence-base. This systematic review and meta-analysis assessed the evidence for lipid-based nutrient supplements (LNS), fortified-blended-flours (FBF) and nutrition counselling, in the treatment of MAM. Methods Five databases were systematically searched for studies conducted in LMICs that compared the effectiveness of food-based products versus any comparator group in promoting recovery from MAM in children aged 6-59 months. Where appropriate, pooled estimates of effect were estimated using random-effects meta-analyses. Results A total of thirteen trials were identified for inclusion. All used active controls rather than ‘standard care’, which is often minimal in most settings. There was evidence of increased probability of recovery (as assessed by gaining normal weight-for-height and/or MUAC) among children treated with LNS compared to children treated with FBF (RR 1·05, 95%CI 1·01-1·09, p=0·009). Treatment with an LNS was also associated with a lower risk of persistent MAM at the end of treatment compared with a FBF (RR 0·82, 95%CI 0·71-0·95, p=0·007). Conclusion Based on a relatively small number of studies mainly from Africa, LNS are superior to FBF in improving anthropometric recovery from MAM. The true benefit of MAM treatment may be underestimated due to all studies using active controls rather than usual care which is minimal. More high-quality evidence is needed to evaluate nutrition education/counselling alone as a MAM intervention. Studies should also assess a wider range of outcomes including body composition, morbidity and development – not weight-gain alone.