Effect of fatty acid profiles in varying recipes of ready-to-use therapeutic foods on neurodevelopmental and clinical outcomes of children (6-59 months) with severe wasting: a systematic review

Arista Nienaber; Cornelia Conradie; Geoffrey Manda; Bernadette Chimera-Khombe; Ettienne Nel; Edith B Milanzi; Robin C Dolman-Macleod; Martani J Lombard

doi:10.1093/nutrit/nuad151

Effect of fatty acid profiles in varying recipes of ready-to-use therapeutic foods on neurodevelopmental and clinical outcomes of children (6-59 months) with severe wasting: a systematic review

Nutr Rev. 2023 Dec 22:nuad151. doi: 10.1093/nutrit/nuad151. Online ahead of print.

Authors

Arista Nienaber¹, Cornelia Conradie¹, Geoffrey Manda², Bernadette Chimera-Khombe³, Ettienne Nel⁴, Edith B Milanzi⁵, Robin C Dolman-Macleod¹, Martani J Lombard¹

Affiliations

¹ Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
² Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
³ Interdisciplinaire Sciences Santé, Universite Claude Bernard Lyon 1, Lyon, France.
⁴ Department of Paediatrics and Child Health, University Stellenbosch, Bellville, Cape Town, South Africa.
⁵ Medical Research Council Clinical Trials, University College London, London, United Kingdom.

PMID: 38134960
DOI: 10.1093/nutrit/nuad151

Abstract

Context: In 2020, 13.6 million children under 5 years suffered from severe acute malnutrition (SAM)/wasting. Standard ready-to-use therapeutic foods (RUTFs) improve polyunsaturated fatty acid (PUFA) status but contain suboptimal amounts of omega-3 (n-3) PUFAs with unbalanced n-6-to-n-3 PUFA ratios.

Objectives: The aim was to compare the effects of RUTFs with different essential fatty acid contents on PUFA status, neurodevelopmental, and clinical outcomes (mortality, comorbidities, and recovery) of children with severe wasting.

Data sources: Twelve databases, trial repositories, and article references with no publication limitations.

Data extraction: Ten studies from randomized, quasi, and cluster-randomized controlled trials providing RUTFs as home treatment to children 6-59 months with SAM/wasting were included.

Data analysis: Plasma phospholipid eicosapentaenoic acid content was higher in children receiving RUTF with altered essential fatty acid contents compared with standard RUTF (0.20 [0.15-0.25], P < 0.00001). Docosahexaenoic acid (DHA) status only improved in children receiving RUTF with added fish oil (0.33 [0.15-0.50], P = 0.0003). The Malawi Developmental Assessment tool (MDAT) global development and problem-solving assessment scores were higher in global assessment and gross motor domains in children receiving added fish oil compared with standard formulation (0.19 [0.0-0.38] and 0.29 [0.03-0.55], respectively). Children receiving high-oleic-acid RUTF (lowering the n-6:n-3 PUFA ratio of the RUTF) with or without fish oil had significantly higher scores in social domains compared with those receiving the standard formulation (0.16 [0.00-0.31] and 0.24 [0.09-0.40]). Significantly higher mortality risk was found in children receiving a standard formulation compared with RUTF with a lower n-6:n-3 PUFA ratio (0.79 [0.67-0.94], P = 0.008).

Conclusion: Although lowering n-6:n-3 PUFA ratios did not increase plasma DHA, it improved specific neurodevelopmental scores and mortality due to lower linoleic acid (high-oleic-acid peanuts), higher alpha-linolenic acid (altered oil), or both. Additional preformed n-3 long-chain PUFAs (fish oil) with RUTF improved the children's DHA status, neurodevelopmental outcomes, and weight-for-height z score. More research is needed regarding cost, availability, stability, acceptability, and the appropriate amount of n-3 long-chain PUFAs required in RUTFs for the best clinical outcomes.

Systematic review registration: PROSPERO registration no. CRD42022303694.

Keywords: docosahexaenoic acid; fatty acids; malnutrition; neurodevelopment; ready-to-use therapeutic foods; severe acute; wasting.