Poster Topical Area: Global Nutrition

Location: Hall D

Poster Board Number: 573

P12-069 - Dietary diversity in the response to treatment of uncomplicated severe acute malnutrition among children in Niger: a prospective study

Monday, Jun 11
8:00 AM – 3:00 PM

Objectives: Community-based treatment of severe acute malnutrition (SAM) has proven to be safe and cost-effective, although identifying additional factors that can increase recovery and decrease treatment failure may improve program effectiveness. We examine the association of dietary diversity and clinical and program treatment outcomes among children treated for uncomplicated SAM in Niger.




Methods:
2,399 children were enrolled in a randomized trial of routine amoxicillin in the treatment of uncomplicated SAM from 2012-2014. All children received ready to use therapeutic food (RUTF) and standard clinical care. Child dietary diversity was assessed using a 7-day food frequency questionnaire and 8-food group diet diversity score. We assessed the association of dietary diversity at admission with nutritional recovery, hospitalization, and death at program discharge and 12 weeks, and weight and height gain.




Results:
Food groups most commonly consumed by children in seven days preceding SAM treatment were cereals, roots and tubers (N=2364, 99.5%) and vitamin A rich fruits and vegetables (N=2253, 94.8%). Egg (N=472, 19.9%) and dairy (N=659, 27.7%) consumption was low. Mean (SD) diet diversity score was significantly lower in the lean vs. non-lean season [2.7 (1.1) vs. 2.9 (1.0)]. There was no evidence that dietary diversity increased nutritional recovery at discharge (RR: 1.02, 95% CI: 1.00, 1.04) or 12 weeks (RR: 0.98, 95%CI: 0.94, 1.02). No significant association was found with risk of hospitalization or death, or weight and height gain. Egg consumption was protective against death at discharge (RR: 0.53, 95% CI: 0.39, 0.70) and 12 weeks (RR: 0.66, 95% CI: 0.45, 0.96). Vitamin A rich fruits and vegetable consumption was associated with greater risk of mortality in children at discharge (RR: 1.30, 95% CI: 1.08, 1.56) and 12 weeks (RR: 1.19, 95% CI: 1.03, 1.36).




Conclusions:
We did not find evidence that dietary diversity influenced nutrition recovery or response to treatment for children with uncomplicated SAM in Niger. It is feasible that beyond dietary diversity, consumption of nutrient dense foods like eggs may be more important for recovery from SAM, therefore there is need for continued research to further elucidate drivers of nutritional recovery from acute malnutrition in different settings.




Funding Source: This work was supported by Médecins Sans Frontières - Operational Center Paris.

CoAuthors: Chistopher Duggan, Dr – Harvard School of Public Health; Fatou Berthé, Dr – Médecins Sans Frontières (MSF); Rebecca Grais, Dr – Médecins Sans Frontières (MSF); Sheila Isanaka, Dr – Médecins Sans Frontières (MSF)

Isabel Madzorera

Doctoral Student
Harvard University School of Public Health
Malden, Massachusetts