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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. [ABSTRACT FROM AUTHOR]

In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under‐5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under‐5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron‐supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000–180,000 IU, 3.1–7.7 mg per kg per day, and 3–5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended. Key messages: Vitamin A supplementation practice among infants and children under 5 years of age hospitalised with complicated severe acute malnutrition (SAM) was not fully based on the World Health Organisation (WHO) 2013 recommendations in some hospitals in Ghana and South Africa. High doses of vitamin A were given irrespective of the therapeutic feeds administered and the presence of deficiency signs.Iron and folic acid supplementation did not follow WHO guidelines for the treatment of complicated SAM in under‐5 children.Higher doses than recommended for both micronutrients were observed. Iron supplementation started in the initial phase of treatment (first week of admission). [ABSTRACT FROM AUTHOR]

ABSTRACT This secondary analysis of the Eggcel‐growth study investigated the effect of daily egg intake for 6 months in infants aged 6–9 months on environmental enteric dysfunction (EED) biomarkers and the association of EED markers with growth faltering. A randomised controlled trial was conducted in Jouberton, South Africa, among 500 infants randomly assigned equally to either an intervention group receiving a daily chicken egg or a control group. Both groups were followed up for 6 months. Data on infant and maternal sociodemographic information and anthropometric status of infants were collected. EED and inflammatory markers were analysed using Q‐Plex Human EED (11‐Plex) assay. There was a significant reduction in fibroblast growth factor 21 (FGF21) concentration in the intervention group (B = −0.132; 95% CI −0.255, −0.010; p = 0.035). Baseline, insulin‐like growth factor 1 (IGF‐1) was positively associated with endpoint length‐for‐age z‐score (LAZ), weight‐for‐age z‐score (WAZ) and weight‐for‐length z‐score (WLZ) and there was an inverse relationship between baseline FGF21 and intestinal fatty acid‐binding protein (I‐FABP) with endpoint growth indicators. Baseline IGF‐1 was positively associated with reduced odds of wasting, stunting and being underweight (p < 0.001) and baseline FGF21 was associated with increased odds of stunting (p = 0.002), wasting (p = 0.031) and being underweight (p = 0.035). There was a 20% increased odds of stunting with baseline I‐FABP (p = 0.045) and a 30% increased odds of being underweight with baseline soluble CD14 (p = 0.039). Complementary feeding with eggs decreased growth hormone resistance (reduced FGF21 levels); however, FGF21 and I‐FABP levels were linked to increased growth faltering.Trial Registration: ClinicalTrials.gov: NCT05168085 [ABSTRACT FROM AUTHOR]