The relationship between energy provided and growth during severe wasting treatment.

Treatment of severe acute malnutrition aims at producing quick catch‐up growth in children to decrease their short‐term mortality risk. The extent to which catch‐up growth is influenced by the amount of energy provided is unclear. This study assessed whether energy provided at admission is associated with catch‐up ponderal growth among children with mid‐upper arm circumference (MUAC) < 115 mm at admission. We conducted a secondary data analysis an operational cohort in Mali. The children were treated with a simplified protocol providing 1000 kcal/day of therapeutic food until MUAC ≥ 115 mm was achieved for two consecutive weeks and 500 kcal/day thereafter until discharge with MUAC ≥ 125 mm for two consecutive weeks. Linear mixed‐effects regression models were fitted to assess the relationship between energy provided at admission (kcal/kg/day) with weight gain velocity (g/kg/day) (primary outcome), change in MUAC ‐for‐age z‐score and change in weight‐for‐age z‐score. Unadjusted models and models adjusted for sex, age, seasonality and MUAC at admission were fitted. Both models included the study site as a random effect. A 10 kcal/kg/day increase in energy provided at admission was associated with increments in all outcomes; for weight gain velocity, the mean (95% CI) increment was 0.340 [0.326, 0.354] g/kg/day and 0.466 [0.446, 0.485] g/kg/day in the unadjusted and adjusted analysis, respectively. A positive relationship exists between energy provided at admission and catch‐up ponderal growth in children with MUAC < 115 mm treated using a simplified protocol. Determining the ideal weight gain rate remains essential for assessing the benefits and risks of increased energy intake during treatment. Key messages: Among children diagnosed with severe wasting (MUAC < 115 mm), higher provisions of energy at admission (kcal/kg/day) are associated with a higher rate of weight gain, higher changes in weight‐for‐age and MUAC‐for‐age z‐scores.Children treated for severe wasting (MUAC < 115 mm) receiving Ready‐to‐use therapeutic foods (RUTFs) at a dose higher at admission than the WHO 2023 recommendation of 150–185 kcal/kg/day experience higher rates of weight gain and higher changes in weight‐for‐age and MUAC‐for‐age z‐scores.The optimal rate of weight gain in children treated for severe wasting (MUAC < 115 mm) using RUTF remains unknown. [ABSTRACT FROM AUTHOR]