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

Volumn 13, Issue 1, 2015, Pages

  Jones, Kelsey ^a,b   Ali, Rehema ^a   Khasira, Maureen A ^a   Odera, Dennis ^a   West, Annette L ^c   Koster, Grielof ^c   Akomo, Peter ^d   Talbert, Alison ^a   Goss, Victoria M ^e   Ngari, Moses ^a   Thitiri, Johnstone ^a   Ndoro, Said ^f   Knight, Miguel Garcia A ^a,g   Omollo, Kenneth ^a   Ndungu, Anne ^a   Mulongo, Musa M ^a   Bahwere, Paluku ^h   Fegan, Greg ^a,g   Warner, John O ^b   Postle, Anthony D ^c   Collins, Steve ^d,h   Calder, Philip C ^c,e   Berkley, James A ^a,g   more..

^a KEMRI WELLCOME TRUST RESEARCH PROGRAMME   (Kenya)

^b IMPERIAL COLLEGE LONDON   (United Kingdom)

^c UNIVERSITY OF SOUTHAMPTON   (United Kingdom)

^d Bantry General Hospital   (Ireland)

^e NATIONAL INSTITUTES OF HEALTH   (United States)

^f MINISTRY OF HEALTH   (Kenya)

^g UNIVERSITY OF OXFORD   (United Kingdom)

^h VALID INTERNATIONAL   (United Kingdom)

Author keywords

Fatty acid; Fish oils; Growth; Omega 3; Ready to use therapeutic food; Severe acute malnutrition

Indexed keywords

DIHOMO GAMMA LINOLENIC ACID; DOCOSAHEXAENOIC ACID; FISH OIL; GAMMA INTERFERON; GAMMA INTERFERON INDUCIBLE PROTEIN 10; HEMOGLOBIN; ICOSAPENTAENOIC ACID; ICOSATETRAENOIC ACID; INTERLEUKIN 10; INTERLEUKIN 12; INTERLEUKIN 8; LINSEED OIL; OMEGA 3 FATTY ACID; PEROXIDE; PHOSPHATIDYLCHOLINE; PHOSPHATIDYLETHANOLAMINE; PROGRAMMED DEATH 1 RECEPTOR; SATURATED FATTY ACID; LIPID; UNSATURATED FATTY ACID;

ARTICLE; CAUSE OF DEATH; CD4+ T LYMPHOCYTE; CD8+ T LYMPHOCYTE; CEREBRAL PALSY; CHILD; CONGENITAL HEART DISEASE; CONTROLLED STUDY; CYTOKINE RELEASE; DIARRHEA; DIET SUPPLEMENTATION; DISEASE SEVERITY; ERYTHROCYTE; ERYTHROCYTE MEMBRANE; FEMALE; FOLLOW UP; FOOD; GAS CHROMATOGRAPHY; HEMOGLOBIN BLOOD LEVEL; HUMAN; INFANT; INTENTION TO TREAT ANALYSIS; LENGTH OF STAY; LIPID COMPOSITION; LIPID PEROXIDATION; LIPIDOMICS; LOWER RESPIRATORY TRACT INFECTION; MAJOR CLINICAL STUDY; MALE; MALNUTRITION; OUTCOME ASSESSMENT; PALATABILITY; PATIENT SAFETY; PNEUMONIA; PROTEIN EXPRESSION; RANDOMIZED CONTROLLED TRIAL; READY TO USE THERAPEUTIC FOOD; REGULATORY MECHANISM; RURAL AREA; SHOCK; THROMBOCYTOSIS; UPPER RESPIRATORY TRACT INFECTION; VOMITING; ACUTE DISEASE; BLOOD; DIET THERAPY; DOUBLE BLIND PROCEDURE; FAST FOOD; KENYA; PRESCHOOL CHILD;

ACUTE DISEASE; CHILD, PRESCHOOL; DIETARY SUPPLEMENTS; DOCOSAHEXAENOIC ACIDS; DOUBLE-BLIND METHOD; EICOSAPENTAENOIC ACID; FAST FOODS; FATTY ACIDS, OMEGA-3; FATTY ACIDS, UNSATURATED; FEMALE; FISH OILS; HUMANS; INFANT; KENYA; LIPIDS; MALE; MALNUTRITION;

EID: 84928230072     PISSN: None     EISSN: 17417015     Source Type: Journal    
DOI: 10.1186/s12916-015-0315-6     Document Type: Article

References (60)

1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427-51.
2. Briend A, Myatt M, Dent N, Brown R. Putting kwashiorkor on the map. CMAM Forum 2013. http://www.cmamforum.org/Pool/Resources/Putting-kwashiorkor-on-the-map-CMAM-Forum-2013.pdf.
3. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243-60.
4. Rytter MJ, Kolte L, Briend A, Friis H, Christensen VB. The immune system in children with malnutrition-a systematic review. PLoS One. 2014;9:e105017.
5. Bejon P, Mohammed S, Mwangi I, Atkinson SH, Osier F, Peshu N, et al. Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya. Am J Clin Nutr. 2008;88:1626-31.
6. World Health Organization, World Food Programme, United Nations System Standing Committee on Nutrition, United Nations Children's Fund. Community-based management of severe acute malnutrition: a joint statement. Geneva: WHO; 2007. http://www.who.int/nutrition/topics/Statement_community_based_man_sev_acute_mal_eng.pdf?ua=1
7. United Nations Development Programme - Inter-Agency Procurement Support Office. Emergency relief items - compendium of generic specifications, volume 1. Copenhagen: UNDP; 1995.
8. UNICEF. Supply Catalogue. 2014. https://supply.unicef.org/.
9. Calder PC. n-3 fatty acids, inflammation and immunity: new mechanisms to explain old actions. Proc Nutr Soc. 2013;72:326-36.
10. Calder PC. Very long chain omega-3 (n-3) fatty acids and human health. Eur J Lipid Sci Technol. 2014;116:1280-300.
11. Kenya Open Data. Poverty rate by district. https://opendata.go.ke/Poverty/Poverty-Rate-by-District/i5bp-z9aq.
12. Nackers F, Broillet F, Oumarou D, Djibo A, Gaboulaud V, Guerin PJ, et al. Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger. J Trop Pediatr. 2010;56:407-13.
13. Food and Agriculture Organization of the United Nations. Fats and fatty acids in human nutrition: report of an expert consultation, FAO Food and Nutrition Paper, vol. 91. Rome: FAO; 2010.
14. Thienprasert A, Samuhaseneetoo S, Popplestone K, West AL, Miles EA, Calder PC. Fish oil n-3 polyunsaturated fatty acids selectively affect plasma cytokines and decrease illness in Thai schoolchildren: a randomized, double-blind, placebo-controlled intervention trial. J Pediatr. 2009;154:391-5.
15. Ryan P. RALLOC: Stata module to design randomized controlled trials. EconPapers. 2011. http://EconPapers.repec.org/RePEc:boc:bocode:s319901.
16. Bligh EG, Dyer WJ. A rapid method of total lipid extraction and purification. Can J Biochem Physiol. 1959;37:911-7.
17. Browning LM, Walker CG, Mander AP, West AL, Madden J, Gambell JM, et al. Incorporation of eicosapentaenoic and docosahexaenoic acids into lipid pools when given as supplements providing doses equivalent to typical intakes of oily fish. Am J Clin Nutr. 2012;96:748-58.
18. Sewell GW, Hannun YA, Han X, Koster G, Bielawski J, Goss V, et al. Lipidomic profiling in Crohn's disease: abnormalities in phosphatidylinositols, with preservation of ceramide, phosphatidylcholine and phosphatidylserine composition. Int J Biochem Cell Biol. 2012;44:1839-46.
19. Postle AD, Henderson NG, Koster G, Clark HW, Hunt AN. Analysis of lung surfactant phosphatidylcholine metabolism in transgenic mice using stable isotopes. Chem Phys Lipids. 2011;164:549-55.
20. Dondorp AM, Angus BJ, Chotivanich K, Silamut K, Ruangveerayuth R, Hardeman MR, et al. Red blood cell deformability as a predictor of anemia in severe falciparum malaria. Am J Trop Med Hyg. 1999;60:733-7.
21. World Health Organisation. The WHO Child Growth Standards. 2006. http://www.who.int/childgrowth/en/.
22. Maitland K, Berkley JA, Shebbe M, Peshu N, English M, Newton CR. Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol? PLoS Med. 2006;3:e500.
23. Moisi JC, Gatakaa H, Berkley JA, Maitland K, Mturi N, Newton CR, et al. Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis. Bull World Health Organ. 2011;89:725-32. 732A.
24. Kerac M, Bunn J, Chagaluka G, Bahwere P, Tomkins A, Collins S, et al. Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. PLoS One. 2014;9:e96030.
25. Chisti MJ, Graham SM, Duke T, Ahmed T, Faruque AS, Ashraf H, et al. Post-discharge mortality in children with severe malnutrition and pneumonia in bangladesh. PLoS One. 2014;9:e107663.
26. Koletzko B, Lien E, Agostoni C, Bohles H, Campoy C, Cetin I, et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med. 2008;36:5-14.
27. Carlson SE. Early determinants of development: a lipid perspective. Am J Clin Nutr. 2009;89:1523S-9.
28. Grantham-McGregor S. A review of studies of the effect of severe malnutrition on mental development. J Nutr. 1995;125:2233S-8.
29. UNICEF. Ready-to-use therapeutic food for children with severe acute malnutrition. Position Paper. UNICEF, 2013. [ http://www.unicef.org/policyanalysis/files/UNICEF-Position-Paper_Ready-To-Use-Therapeutic-Food_June2013.pdf ]
30. Makhoul Z, Kristal AR, Gulati R, Luick B, Bersamin A, Boyer B, et al. Associations of very high intakes of eicosapentaenoic and docosahexaenoic acids with biomarkers of chronic disease risk among Yup'ik Eskimos. Am J Clin Nutr. 2010;91:777-85.
31. Glaser C, Lattka E, Rzehak P, Steer C, Koletzko B. Genetic variation in polyunsaturated fatty acid metabolism and its potential relevance for human development and health. Matern Child Nutr. 2011;7:27-40.
32. Brenna JT, Salem Jr N, Sinclair AJ, Cunnane SC. Alpha-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins Leukot Essent Fatty Acids. 2009;80:85-91.
33. Brenna JT, Carlson SE. Docosahexaenoic acid and human brain development: Evidence that a dietary supply is needed for optimal development. J Hum Evol. 2014;77:99-106.
34. Grindel A, Staps F, Kuhnt K. Cheek cell fatty acids reflect n-3 PUFA in blood fractions during linseed oil supplementation: a controlled human intervention study. Lipids Health Dis. 2013;12:173.
35. Gibson RA, Neumann MA, Lien EL, Boyd KA, Tu WC. Docosahexaenoic acid synthesis from alpha-linolenic acid is inhibited by diets high in polyunsaturated fatty acids. Prostaglandins Leukot Essent Fatty Acids. 2013;88:139-46.
36. Gregory MK, Gibson RA, Cook-Johnson RJ, Cleland LG, James MJ. Elongase reactions as control points in long-chain polyunsaturated fatty acid synthesis. PLoS One. 2011;6:e29662.
37. Carlson SE, Werkman SH, Peeples JM, Cooke RJ, Tolley EA. Arachidonic acid status correlates with first year growth in preterm infants. Proc Natl Acad Sci U S A. 1993;90:1073-7.
38. Gibson RA, Muhlhausler B, Makrides M. Conversion of linoleic acid and alpha-linolenic acid to long-chain polyunsaturated fatty acids (LCPUFAs), with a focus on pregnancy, lactation and the first 2 years of life. Matern Child Nutr. 2011;7:17-26.
39. Clark KJ, Makrides M, Neumann MA, Gibson RA. Determination of the optimal ratio of linoleic acid to alpha-linolenic acid in infant formulas. J Pediatr. 1992;120:S151-8.
40. Hsieh JC, Liu L, Zeilani M, Ickes S, Trehan I, Maleta K, et al. High oleic ready-to-use therapeutic food maintains docosahexaenoic acid status in severe malnutrition: a randomized, blinded trial. J Pediatr Gastroenterol Nutr. 2015 [epublished ahead of print].
41. Taha AY, Cheon Y, Faurot KF, Macintosh B, Majchrzak-Hong SF, Mann JD, et al. Dietary omega-6 fatty acid lowering increases bioavailability of omega-3 polyunsaturated fatty acids in human plasma lipid pools. Prostaglandins Leukot Essent Fatty Acids. 2014;90:151-7.
42. Liou YA, King DJ, Zibrik D, Innis SM. Decreasing linoleic acid with constant alpha-linolenic acid in dietary fats increases (n-3) eicosapentaenoic acid in plasma phospholipids in healthy men. J Nutr. 2007;137:945-52.
43. von Schacky C. Omega-3 fatty Acids in cardiovascular disease - An uphill battle. Prostaglandins Leukot Essent Fatty Acids. 2014. [In press]
44. McNamara RK. Evaluation of docosahexaenoic acid deficiency as a preventable risk factor for recurrent affective disorders: current status, future directions, and dietary recommendations. Prostaglandins Leukot Essent Fatty Acids. 2009;81:223-31.
45. Luxwolda MF, Kuipers RS, Sango WS, Kwesigabo G, Dijck-Brouwer DA, Muskiet FA. A maternal erythrocyte DHA content of approximately 6 g% is the DHA status at which intrauterine DHA biomagnifications turns into bioattenuation and postnatal infant DHA equilibrium is reached. Eur J Nutr. 2012;51:665-75.
46. Houssaini FZ, Foulon T, Iraqi MR, Payen N, Groslambert P. Lipids, lipoproteins, and fatty acids during infantile marasmus in the Fes area of Morocco. Biochem Pharmacol. 1999;53:278-83.
47. Koletzko B, Abiodun PO, Laryea MD, Bremer HJ. Fatty acid composition of plasma lipids in Nigerian children with protein-energy malnutrition. Eur J Pediatr. 1986;145:109-15.
48. Smit EN, Dijkstra JM, Schnater TA, Seerat E, Muskiet FA, Boersma ER. Effects of malnutrition on the erythrocyte fatty acid composition and plasma vitamin E levels of Pakistani children. Acta Paediatr. 1997;86:690-5.
49. Leichsenring M, Sutterlin N, Less S, Baumann K, Anninos A, Becker K. Polyunsaturated fatty acids in erythrocyte and plasma lipids of children with severe protein-energy malnutrition. Acta Paediatr. 1995;84:516-20.
50. Wolff JA, Margolis S, Bujdoso-Wolff K, Matusick E, MacLean Jr WC. Plasma and red blood cell fatty acid composition in children with protein-calorie malnutrition. Pediatr Res. 1984;18:162-7.
51. Holman RT, Johnson SB, Mercuri O, Itarte HJ, Rodrigo MA, De Tomas ME. Essential fatty acid deficiency in malnourished children. Am J Clin Nutr. 1981;34:1534-9.
52. Vajreswari A, Narayanareddy K, Rao PS. Fatty acid composition of erythrocyte membrane lipid obtained from children suffering from kwashiorkor and marasmus. Metab Clin Exp. 1990;39:779-82.
53. Franco VH, Hotta JK, Jorge SM, dos Santos JE. Plasma fatty acids in children with grade III protein-energy malnutrition in its different clinical forms: marasmus, marasmic kwashiorkor, and kwashiorkor. J Trop Pediatr. 1999;45:71-5.
54. Lauritzen L, Carlson SE. Maternal fatty acid status during pregnancy and lactation and relation to newborn and infant status. Matern Child Nutr. 2011;7:41-58.
55. Brenna JT, Varamini B, Jensen RG, Diersen-Schade DA, Boettcher JA, Arterburn LM. Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. Am J Clin Nutr. 2007;85:1457-64.
56. Michaelsen KF, Dewey KG, Perez-Exposito AB, Nurhasan M, Lauritzen L, Roos N. Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6-24 months), and pregnant and lactating women. Matern Child Nutr. 2011;7:124-40.
57. Prentice AM, Paul AA. Fat and energy needs of children in developing countries. Am J Clin Nutr. 2000;72:1253S-65.
58. Smit EN, Oelen EA, Seerat E, Boersma ER, Muskiet FA. Fish oil supplementation improves docosahexaenoic acid status of malnourished infants. Arch Dis Child. 2000;82:366-9.
59. van der Merwe LF, Moore SE, Fulford AJ, Halliday KE, Drammeh S, Young S, et al. Long-chain PUFA supplementation in rural African infants: a randomized controlled trial of effects on gut integrity, growth, and cognitive development. Am J Clin Nutr. 2013;97:45-57.
60. Jones KD, Hunten-Kirsch B, Laving AM, Munyi CW, Ngari M, Mikusa J, et al. Mesalazine in the initial management of severely acutely malnourished children with environmental enteric dysfunction: a pilot randomized controlled trial. BMC Med. 2014;12:133.