Anyone who's ever had a nasty flu knows how hard it can be to stay hydrated and well-fed, but most of us with Internet access will recover soon enough. In the poorest parts of the world, it's a different story: Illness can lead to malnutrition, kicking off a vicious cycle of hunger and disease. Now, Médecins Sans Frontières researchers working in Nigeria and Uganda report in two papers a promising, though still uncertain, way to break the cycle: a peanut-based supplement called Plumpy'nut.
Plumpy'nut is what's known as a ready-to-use treatment food (RUTF). MSF and Unicef have already had success using RUTFs in treating malnutrition. (It's also got an unusual and controversial backstory, according to a New York Times report.) The question, according to researchers led by MSF nutrition specialist Saskia van der Kam, is whether RUTFs can help prevent malnutrition in sick kids—in particular, kids with diseases like malaria, often a precursor to malnourishment.
The question is whether ready to use treatment foods can help prevent malnutrition in sick kids.
To find out, the researchers conducted two separate studies with a total of 4,415 children under the age of five who suffered from malaria, diarrhea, or lower respiratory tract infections, all of which can ultimately lead to malnutrition. Importantly, none of those kids were malnourished at the time they were treated with Plumpy'nut. About half of them lived in the Kaabong region in northern Uganda, a place where chronic malnutrition continues to be a problem for many of the semi-nomadic people who live there. The other half lived in Goronyo in northwest Nigeria, where malnutrition and disease are even more severe.
The approach was pretty simple: In addition to ordinary treatment for their ailments, MSF doctors gave a third of the sick kids RUTFs, worth about 500 calories a day, for two weeks. Another third of the kids received a powder with similar nutrients but without any protein, fats, or carbohydrates—that is, no calories. The remaining kids were put in a control group that got medical treatment but no supplements.
In Uganda, at least, RUTFs worked. Six months after treatment, malnutrition rates were down about 33 percent compared to the control group—about 14 percent malnourishment compared with 21 percent in the control group—while the nutrient powder had no statistically discernible effect.
Unfortunately, RUTFs had little to no effect on malnutrition in the Nigerian children. Upwards of 50 percent of kids in the Nigerian study were malnourished at the end of six months, regardless of their treatment or lack thereof.
Perhaps that's because malnourishment and disease are already so severe in Goronyo, a situation that "probably further affects a child’s nutritional status and children’s ability to escape from the illness–malnutrition cycle," the team writes. They suggest that longer treatment periods may help, but further research will be needed to figure out how to prevent malnourishment in the regions most riddled with disease.
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