PLOS Med:膳食补充剂无助改善儿童营养不良

比利时根特大学等机构的研究人员近日在美国《科学公共图书馆—医学》杂志上报告说，在家庭食物里加入高能量的膳食补充剂，对改善儿童营养不良状况几乎没有效果。

在一些紧急情势下，国际救援组织会为受影响人们，特别对营养不良的儿童，提供食品或膳食补充剂，如可即食的含补充剂食品（RUSF）等。

根特大学Lieven Huybregts领导的研究小组以年龄为6～36个月的1038个儿童为对象，分析他们食用RUSF的效果。这些儿童来自非洲食物短缺的国家，他们的体重与身高比偏低，处于营养不良状态。

最后统计发现，在家庭食物基础上补充RUSF数月，他们的营养状况指标——体重与身高比并没有降低，但是他们身高和体内血红蛋白水平却略有升高。

对此作者表示，此项研究没有证据表明RUSF能够有效改善儿童营养不良状况。其他种类替代品是否有效还有待进一步研究。

doi:10.1371/journal.pmed.1001313

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The Effect of Adding Ready-to-Use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-Randomized Controlled Trial

Lieven Huybregts, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, Patrick Kolsteren

Background Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program. Methods and Findings We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p<0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (?29.3%; 95% CI: 20.5, 37.2; p<0.001) and fever episodes (?22.5%; 95% CI: 14.0, 30.2; p<0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions. Conclusions Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity.