Review updated! Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age

This review assessed the effects of home-based ready-to-use therapeutic food (RUTF) used during the rehabilitation phase of severe acute malnutrition (SAM) in children aged between six months and five years on recovery, relapse, mortality and rate of weight gain. It is an update of the original review, which found inconclusive evidence. 

The reviewers searched for randomised controlled trials (RCTs) and quasi-RCTs, where children aged between six months and five years with SAM were, during the rehabilitation phase, treated at home with RUTF compared to an alternative dietary approach, or with different regimens and formulations of RUTF compared to each other. They found 15 eligible studies with 7976 chldren. Eight studies were conducted in Malawi, four in India and one apiece in Kenya, Zambia and Cambodia. All of the studies lasted between 8 and 16 weeks. Of the 15 included studies, six were linked to funding or donations from industry, one did not report the source of funding, and eight studies reported funding where sponsors did not include industry. The reviewers rated the overall risk of bias as high for six studies, unclear for three studies and low for six studies. 

Seven studies (2261 children) compared home-based RUTF to alternative dietary approaches, and found that standard RUTF probably improves recovery (moderate-quality evidence) and may increase the rate of weight gain slightly (low-quality evidence), but the effects on relapse and death are unknown (very low-quality evidence). 

Two quasi, cluster-randomised RCTs compared standard home-based RUTF meeting total daily nutritional requirements with a similar RUTF given as a supplement to the usual diet, and found that it may improve recovery and relapse (low-quality evidence), but the effects for death and the rate of weight gain are not known (very low-quality evidence). 

Eight studies (5502 children) compared standard home-based RUTF with RUTFs of different formulations (e.g. using locally available ingredients), and found that it makes little or no difference for recovery whether a standard or alternative formulation RUTF is used (high-quality evidence). For relapse, using standard RUTF decreased relapse (high-quality evidence). It probably makes little or no difference to death (moderate-quality evidence) and to the rate of weight gain (low-quality evidence) whether standard or alternative formulation RUTF is used.

The reviewers concluded that, compared to alternative dietary approaches, standard RUTF probably improves recovery and may increase rate of weight gain slightly, but the effects on relapse and mortality are unknown. Standard RUTF meeting total daily nutritional requirements may improve recovery and replapse compared to a similar RUTF given as a supplement to the usual diet, but the effects on mortality and rate of weight gain are not clear. When comparing RUTFs with different formulations, the current evidence does not favour a particular formulation, except for realpse, which is reduced with standard RUTF. Well-designed, adequately powered, pragmatic RCTs with standardised outcome measures, stratified by HIV status, and that include diarrhoea as an outcome, are needed. 

The evidence is current to October 2018.