Rameeza Kaleem, Nosheen Aziz, Shakeela Zaman, Munir Akhter Salimi.
Nutritional Rehabilitation of Severely Malnourished Children by High Density Diet in Comparison to Ready to Use Therapeutic Food.
Pak Paed J Jan ;38(4):235-43.

Objective: To compare the outcome of nutritional rehabilitation of severely malnourished children, with ready to use therapeutic food and high density diet with or without micronutrients supplementation. Study Design, setting and participants: A multicentre parallel randomized controlled trial was conducted between June 2011 and June 2012, at four Outpatient Therapeutic Program (OTP) units in District Muzaffargarh. Two hundred seventy (270) children with uncomplicated severe acute malnutrition of the ages 6 months to 59 months were randomly assigned to receive ready to use therapeutic food (RUTF), locally made high density diet (HDD), or high density diet along with micronutrient supplementation. Allocation concealment was by opaque sequentially numbered sealed envelopes. Principal investigator and data analyst were blinded while children and caregivers were not blinded to group assignment. Weekly follow up was done for 12 weeks. Main Outcome Measures: Recovery rate and duration of treatment to achieve recovery and mean weight gain. Results: Children (n=270) aged 6m-59m randomly allocated to receive RUTF (n=90) or HDD (n=90) or HDD with micronutrients (n=90). 18(6.7%) patients were dropouts who were excluded from analysis, leaving 252(n=85; n=85; n=82) children for analysis. Recovery rate was 92.2% in RUTF group, 92.2% with HDD and 90% with HDD and micronutrients. Median weight gain (g/kg/day) with RUTF was 5.7g/kg/day, with HDD it was 6.07g/kg/day, and 6.16 g/kg/day with HDD along with micronutrients (p =0.197). Duration of treatment to achieve recovery was 29 days for RUTF group, with HDD it was 30 days and 28 days with HDD and micronutrient supplementation. (p =0.784) Conclusion: There was no significant differences in recovery rates and weight gain between the three groups and severely malnourished children without complications can be rehabilitated at their homes with high energy diets made from local recipes.

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