Community-Based Child Food Interventions/Supplements for the Prevention of Wasting in Children Up to 5 Years at Risk of Wasting and Nutritional Oedema: A Systematic Review and Meta-Analysis

Context Malnutrition poses a significant threat to child health, with millions of children worldwide affected by wasting, which increases the risk of morbidity and mortality. Objective In this study we sought to evaluate the effectiveness of community-based infant/child food interventions and supplements for preventing wasting among children up to 5 years at risk of wasting and nutritional oedema. The World Health Organization commissioned this review to update their guidelines on wasting due to malnutrition in children. Data sources Nine databases were searched from inception until July 2021 and an updated search was carried out on MEDLINE and Ovid MEDLINE until April 13, 2023, and included 24 studies (98 articles) evaluating the impact of community-based infant/child food interventions/supplements for the prevention of wasting among children up to 5 years. Data extraction Two review authors independently extracted data and assessed the quality of included studies using the Cochrane Risk of Bias Tool 2.0. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to assess the quality of evidence. Data analysis This review included 19 cluster-randomized controlled trials (cRCTs) and 5 RCTs evaluating the impact of community-based infant/child food interventions/supplements including fortified blended foods (FBFs), small-quantity (SQ), medium-quantity (MQ), or large-quantity (LQ) lipid-based nutrient supplements (LNS), and multiple micronutrient powder (MNP) for the prevention of wasting among children up to 5 years of age. The analysis showed that infants/children given supplementation with LNS (either SQ, MQ, or LQ) had significantly reduced wasting and significant improvements in weight-for-age z-score, mid-upper-arm circumference (MUAC), and underweight prevalence, along with significant reductions in mortality. The MNP supplementation had little or no impact on wasting but was associated with increased incidences of rapid breathing/chest indrawing and diarrhea morbidity. Overall, the studies were judged to have raised some concerns for the outcomes of wasting and adverse anthropometric indices. However, the GRADE analysis suggested low-to-moderate certainty of outcomes. Conclusions The findings of this review highlight the effectiveness of SQ-LNS and MQ/LQ-LNS supplementation in decreasing rates of wasting, underweight, and mortality and increasing MUAC and weight-for-age z-scores. Methodological limitations in most studies emphasize the need for future trials with direct comparisons of various dietary supplementation strategies.