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Am J Clin Nutr. 2015 Mar;101(3):632-45. doi: 10.3945/ajcn.113.069807. Epub 2015 Jan 7.

Malian children with moderate acute malnutrition who are treated with lipid-based dietary supplements have greater weight gains and recovery rates than those treated with locally produced cereal-legume products: a community-based, cluster-randomized trial.

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From the Program in Nutrition and Metabolism, Boston University School of Medicine, Boston, MA (RSA-A and DHH); Helen Keller International, New York, NY (RSA-A and KHB); the Program in International and Community Nutrition, University of California, Davis, CA (RSA-A and KHB); the Division of GI/Nutrition, Boston Children's Hospital, Boston, MA (CMM); the Department of Public Health, Faculty of Medicine, University of Bamako, Bamako, Mali (SD); the University of Indonesia, Jakarta, Indonesia (JGE); the Center for Global Health and Development, Boston University, Boston, MA (DHH); and the Department of Global Health, Boston University School of Public Health, Boston, MA (DHH).



Moderate acute malnutrition (MAM), defined as weight-for-length z score between -3 and -2 or midupper arm circumference between 11.5 and 12.5 cm, affects ∼33 million children aged <5 y worldwide.


The objective was to compare the effects of 4 dietary supplements for the treatment of MAM.


Twelve community health centers in rural Mali were randomly assigned to provide to 1264 MAM children aged 6-35 mo one of 4 dietary supplements containing ∼500 kcal/d for 12 wk: 1) ready-to-use, lipid-based supplementary food (RUSF); 2) special corn-soy blend (CSB++); 3) locally processed, fortified flour (Misola); or 4) locally milled flours plus oil, sugar, and micronutrient powder (LMF).


In total, 1178 children (93.2%) completed the study. The adjusted mean (95% CI) change in weight (kg) from baseline was greater with RUSF than with the locally processed blends and was intermediate with CSB++ [1.16 (1.08, 1.24) for RUSF, 1.04 (0.96, 1.13) for CSB++, 0.91 (0.82, 0.99) for Misola, and 0.83 (0.74, 0.92) for LMF; P < 0.001]. For length change, RUSF and CSB++ differed significantly from LMF. Sustained recovery rates were higher with RUSF (73%) than with Misola (61%) and LMF (58%), P < 0.0001; CSB++ recovery rates (68%) did not differ from any of the other groups.


RUSF was more effective, but more costly, than other dietary supplements for the treatment of MAM; CSB++ yielded intermediate results. The benefits of treatment should be considered in relation to product costs and availability.



CSB++; Misola; Supplementary Plumpy; locally milled flours; moderate acute malnutrition

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