Weight Gain among Children with Severe Malnutrition in Therapeutic Feeding Programmes: A Systematic Review and Meta-Analysis

The 14th European Nutrition Conference FENS 2023 Pub Date : 2024-02-19 DOI:10.3390/proceedings2023091338

Grace O’Donovan, Daniel Allen, Thandile Nkosi-Gondwe, Kenneth Anujuo, Mubarek Abera, Amir Kirolos, C. Opondo, L. Olga, Debbie Thompson, A. Koulman, N. Lelijveld, Amelia C. Crampin, Marko Kerac, Change Study Collaborators Group CHANGE Study Collaborators Group

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Abstract

: Background: Although 45 million children under five are wasted, the optimal rate of weight gain during treatment for severe malnutrition is unknown. Historically, inpatient treatment programmes focused on rapid weight gain (WG), with the rationale that this would optimise outcomes. However, recent evidence suggests that too rapid WG might be associated with higher cardiometabolic risk. Our objectives are as follows: describe WG in different programme types (e.g., inpatient, outpatient); explore any association between WG, average length of stay, and mortality/recovery; describe heterogeneity in WG reporting. Methods: For this systematic review and meta-analysis, we searched three databases: Embase (1947–2023), Global Health (1910–2023), and Medline (1946–2023), running the final search on 2nd May 2023. Papers were included if they re-ported average WG of children aged 6–59 months with severe malnutrition undergoing treatment. Non-English language and grey literature were excluded, except Emergency Nutrition Network Field Exchange articles. Summary data were extracted, and quality appraisal was done using a NICE Quality Appraisal Checklist. We conducted meta-analysis to describe pooled mean WG by programme type. We conducted meta-regression to investigate potential associations of WG with length of stay and programme outcomes. This study is registered with PROSPERO (CRD42023266472). Results: Our search yielded 3001 papers. We reviewed 307 full texts, identifying 127 eligible papers. Of these, 105 papers, with over 240,000 participants in total, reported WG as grams per kilogram per unit time and were eligible for meta-analysis. Mean rate of WG was 9.1 g/kg/d (95%CI 7.9, 10.3) across 19 inpatient programmes, and 3.9 g/kg/d (95%CI 3.5, 4.3) across 58 outpatient programmes. Faster WG was associated with shorter length of stay ( p < 0.001), but this was moderated by programme type. There was no association between WG and mortality/recovery in unadjusted analyses. There was high heterogeneity between studies. Lastly, 17% of papers did not report WG as grams per kilogram per unit time. Conclusions: Slower WG can be expected in outpatient programmes, compared to

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治疗性喂养计划中严重营养不良儿童的体重增加：系统回顾与元分析

:背景：尽管有 4500 万五岁以下儿童消瘦，但严重营养不良治疗期间的最佳体重增长速度尚不清楚。从历史上看，住院治疗计划的重点是快速增加体重（WG），理由是这样可以优化治疗效果。然而，最近的证据表明，过快的体重增加速度可能与较高的心脏代谢风险有关。我们的目标如下：描述不同项目类型（如住院病人、门诊病人）的体重增加情况；探讨体重增加、平均住院时间和死亡率/康复之间的关联；描述体重增加报告的异质性。方法：为了进行此次系统回顾和荟萃分析，我们检索了三个数据库：Embase（1947-2023 年）、Global Health（1910-2023 年）和 Medline（1946-2023 年），最终检索日期为 2023 年 5 月 2 日。凡是报道了接受治疗的 6-59 个月严重营养不良儿童平均 WG 的论文均被纳入。除紧急营养网络实地交流文章外，不包括非英语文献和灰色文献。我们提取了摘要数据，并使用 NICE 质量评估检查表进行了质量评估。我们进行了荟萃分析，以描述按项目类型划分的集合平均 WG。我们进行了元回归，以研究 WG 与住院时间和项目结果之间的潜在关联。本研究已在 PROSPERO 注册（CRD42023266472）。研究结果我们搜索到了 3001 篇论文。我们审查了 307 篇全文，确定了 127 篇符合条件的论文。其中有 105 篇论文以单位时间内每公斤克数为单位报告了 WG，符合荟萃分析的条件，这些论文的参与者总数超过 24 万人。19项住院治疗项目的平均减重率为9.1克/千克/天（95%CI为7.9-10.3），58项门诊治疗项目的平均减重率为3.9克/千克/天（95%CI为3.5-4.3）。更快的 WG 与更短的住院时间相关（p < 0.001），但这一关系因项目类型而有所缓和。在未经调整的分析中，WG与死亡率/康复率之间没有关联。不同研究之间的异质性很高。最后，17%的论文没有以单位时间内每公斤克数的形式报告 WG。结论：门诊治疗项目的 WG 值较低，而住院治疗项目的 WG 值较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The 14th European Nutrition Conference FENS 2023

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