The Role of Dairy in Effectiveness and Cost of Treatment of Children With Moderate Acute Malnutrition

Abstract

Background: Dairy is recommended in specially formulated supplementary foods to treat children with moderate acute malnutrition (MAM) but with limited evidence and added cost. Objective: Review studies of ready-to-use foods (RUFs) versus fortified blended foods (FBFs) to determine whether inclusion of dairy modifies the comparative effectiveness and cost. Methods: We reviewed literature comparing FBF and RUF in treatment of MAM among children younger than 5 years in developing countries. Outcomes of recovery from MAM, weight, and length gain were compared among treatment categories: FBF with dairy (FBF+), FBF without dairy (FBF−), RUF with dairy (RUF+), and RUF without dairy (RUF−). Supplement cost was compared per 500 kcal. Results: Eight studies were included. Rations were heterogeneous in energy and type of dairy. Overall, RUF+, RUF−, and FBF+ performed similarly, with higher recovery and weight gain compared with FBF−. RUF+ had higher recovery (in 5 of 6 comparisons), weight gain (4 of 4), and length gain (1 of 4) versus FBF−. The RUF+ had higher recovery (1 of 2) versus FBF+, with no other differences. The RUF− versus FBF+ had no differences (0 of 2). The RUF− had higher recovery (1 of 2), weight gain (2 of 2) versus FBF−. Four studies reported supplement costs, which averaged US$0.15 (FBF−), US$0.18 (FBF+), US$0.18 (RUF−), and US$0.37 (RUF+) per 500 kcal. Conclusions: There is a consistent benefit of FBF that include dairy in treatment of children with MAM. Benefits of dairy in RUF require further investigation. Evidence from rigorous quantitative analysis of existing data, cost-effectiveness, and prospective trials will be essential in determining policy on treatment for children with MAM.