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Severe Acute MalnutritionNCT05015257

Effectiveness of Four Transition Dietary Regimens in the Hospital Management of Children With Kwashiorkor.

A study testing Standard F100, Standard F75 + Plumpynut and Alternative F75 with CMV + Plumpynut in people with Severe Acute Malnutrition and Kwashiorkor, run by University Ghent at 1 site in Burkina Faso.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In Burkina Faso the number of severely acute malnourished (SAM) children successfully treated has increased since the implementation of community-based management of acute malnutrition. SAM children with oedema have a higher risk of dying than SAM without oedema; they require inpatient care. Read more about this study

Who is it for?
Ages 6 to 59 months
What is being tested?
Standard F100, Standard F75 + Plumpynut and Alternative F75 with CMV + Plumpynut
Could I receive a placebo?
No, everyone receives an active treatment
How many people
32 participants
Where
1 siteBurkina Faso
Study dates
15 Sep 2021to 31 Aug 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 to 59 months
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Severe acute malnutrition defined as the presence of edema
  • Who are admitted and treated in the refeeding center (CREN) of the CHUSS
  • Aged between 6 and 59 Months
  • Parental Signed informed consent form
  • Recruited in the first phase of the treatment and successfully admitted to the transition phase

Who cannot join

  • SAM without edema
  • Moderate acute malnutrition (MAM)
  • Did not improve during the stabilization phase

Trial locations and contacts

1 site in 1 country.

Burkina Faso1 site
  • Centre Hospitalier Universitaire Souro

    Bobo-Dioulasso, Bobo Dioulasso

Other trials in Burkina Faso

About this study

Official title: The Underlying Causes Affecting the Response to Dietary Rehabilitation in Severely Acutely Malnourished Children at the Center Hôspitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso

In Burkina Faso the number of severely acute malnourished (SAM) children successfully treated has increased since the implementation of community-based management of acute malnutrition. SAM children with oedema have a higher risk of dying than SAM without oedema; they require inpatient care. Several theories have been proposed to explain the pathophysiology of oedema in SAM, but its etiology remains unclear. Knowledge on the nutritional adequacy of therapeutic regimens in kwashiorkor is limited. The World Health Organization (WHO) recommends to use in the treatment of complicated SAM a therapeutic milk 'F75' in the stabilization phase; F75+ready-to-use therapeutic foods (RUTF) or F100 at the transition phase. Alternatively the local formulas (maize flour, milk powder, oil, sugar, mineral-vitamin complex CMV) can be used in case of shortage or intolerance.

At the Nutritional Rehabilitation and Education Center of the University Hospital of Bobo Dioulasso it was found that some SAM children whose oedema resolved under F75 in the stabilization phase, re-developed oedema as they entered the transition phase with RUTF. RUTF has the same nutritional value as F100 but contains iron unlike F100 (<0.07 mg/100 mL). It was observed that RUTF in some cases may be associated with higher mortality, probably due to high iron content (10-14 mg/100 g), which may increase the risk of infections and the formation of free radicals, thereby increasing damage to the body's cells. Clinical trials evaluating the current guidelines for the treatment of SAM with oedema are scarce. A better understanding of the risk factors affecting the effectiveness of the nutritional therapeutic protocol for children with Kwashiorkor will be useful to improve their care.

The main objective of this study is to determine whether the use of transition phase diets (Plumpy-Nut®+F75 or F100 or alternative F75+/- CMV+ Plumpy-Nut®) affect oedema resolving in Kwashiorkor children and to investigate the underlying factors for the relapse or non-responsiveness to the therapeutic treatment.

Read the detailed description

Severe acute malnutrition (SAM) is a life threatening condition that requires urgent attention and appropriate management to reduce mortality and promote recovery among children. SAM is defined by 1) a weight-for-height Z-score more than three standard deviations (SD) below the median based on the 2006 WHO growth standards, 2) a mid-upper arm circumference (MUAC) of less than 115 mm or 3) by the presence of nutritional edema. Signs such as edema, mucocutaneous changes, hepatomegaly, lethargy, anorexia, anemia, severe immune deficiency and rapid progression to mortality characterize a state commonly coined as "complicated SAM". Kwashiorkor (SAM with edema) is one of the forms of complicated SAM commonly distinguished by the unmistakable presence of bipedal edema. Kwashiorkor is characterized by the following clinical signs: 1) edemas symmetrical, painless, soft, bilateral, ascending, pitting; 2) lesions of the skin and integuments; 3) ulcerations and depigmentation; 4) alopecia; 5) constant weight loss marked by edema; 6) hepatomegaly; 7) clinical anemia; 8) intestinal transit disorders: persistent diarrhea, vomiting; 9) anorexia and behavioral disorders (apathy).

Severe acute malnutrition results in high mortality rates of up to half a million child deaths annually. Undernourished children are at higher risk of mortality ranging from three-times more risk among children with moderate malnutrition to 10-times in SAM children compared to well-nourished children.

The objective of this study is to determine whether the use of different transition phase diets affect oedema resolving in Kwashiorkor children and to investigate the underlying factors for the relapse or non-responsiveness to the therapeutic treatment.

Hypotheses to be tested

  • The first hypothesis is that RUTF (Plumpy-Nut®) because of its content in iron may compromise the effectiveness of the transition phase in children with kwashiorkor
  • The second hypothesis is that underlying factors including co-morbidities and epigenetics may explain a difference in response to therapeutic regimens

This is an open label randomized controlled trial to test the effectiveness of four used transition phase diets in Kwashiorkor children in their transition to the rehabilitation phase. The four dietary regimens that will be tested are:

  1. F100;
  2. RUTF+F75;
  3. RUTF+alternative F75 with complex mineral-vitamin (CMV); and
  4. RUTF+alternative F75 without CMV.

When it is decided to move to the transition phase, the child will be assigned to one of the treatments depending on the treatment received during the stabilization phase and the results of the appetite test. That is a child who accepts the Plumpy Nut will receive it in combination with their regimen they had during the stabilization phase. If a child does not accept Plumpy Nut, then they will received F100 regardless of their initial therapeutic food regimen.

  • For those who received F75 in the stabilization phase, they will receive standard F75 + Plumpy Nut
  • For those who received alternative F75 with CMV in the stabilization phase, they will receive alternative F75 with CMV + Plumpy Nut®
  • For those who received alternative F75 without CMV in the stabilization phase, they will receive alternative F75 without CMV + Plumpy Nut®.
Being tested
Standard F100, Standard F75 + Plumpynut, Alternative F75 with CMV + Plumpynut, Alternative F75 without CMV + Plumpynut
Keywords
Severe acute malnutrition, Nutritional rehabilitation, F100, Transition phase, Therapeutic complex of vitamins and minerals (CMV), Kwashiorkor, Ready-to-use Therapeutic Food
Medical subject headings
Severe Acute Malnutrition, Kwashiorkor

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Standard F100Dietary supplement

    100 kcal and 3 g protein per 100 ml

  • Standard F75 + PlumpynutDietary supplement

    Standard F75 with ready to-use therapeutic food (Plumpynut)

  • Alternative F75 with CMV + PlumpynutDietary supplement

    Alternative F75 containing CMV with ready to-use therapeutic food (Plumpynut)

  • Alternative F75 without CMV + PlumpynutDietary supplement

    Alternative F75 with no CMV with ready to-use therapeutic food (Plumpynut)

Study groups in NCT05015257
Study groupRoleWhat they receive
Standard F100Active comparatorIf the test of appetite at the end of the stabilization phase is negative (the child does not accept the Plumpynut)
Receives: Dietary Supplement: Standard F100
Standard F75+PlumpynutExperimentalIf the test of appetite at the end of the stabilization phase is positive (the child accepts the Plumpynut) and the child received Standard F75 during the stabilization phase
Receives: Dietary Supplement: Standard F75 + Plumpynut
Alternative F75 with CMV +PlumpynutExperimentalIf the test of appetite at the end of the stabilization phase is positive (the child accepts the Plumpynut) and the child received Alternative F75 with CMV during the stabilization phase
Receives: Dietary Supplement: Alternative F75 with CMV + Plumpynut
Alternative F75 without CMV +PlumpynutExperimentalIf the test of appetite at the end of the stabilization phase is positive (the child accepts the Plumpynut) and the child received Alternative F75 without CMV during the stabilization phase
Receives: Dietary Supplement: Alternative F75 without CMV + Plumpynut

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Edema redevelopment during the transition phase

    Number of children whose edema redeveloped after it has been resolved during the stabilization phase

    Measured: Three to Seven days

  2. Severe adverse event

    Any serious severe adverse event ranging from diarrhea, vomiting, anorexia to death

    Measured: Three to Seven days

Secondary outcomes (5)
  1. Mean number of days for a complete edema resolving

    Number of days for a complete edema resolving among Kwashiorkor children, in Day

    Measured: Three to Seven days

  2. Intestinal microbiota

    16S rRNA sequencing of DNA extracts of fecal samples

    Measured: Three to Seven days

  3. Presence of acidic stools

    Measurement of stool potential Hydrogen (pH)

    Measured: Three to Seven days

  4. Soil Helminths

    Determination of intestinal parasites using Quantitative Real-Time polymerase chain reaction (qPCR)

    Measured: Three to Seven days

  5. Epigenetics

    In a subsample of children, DNA methylation is identified using Illumina Array Analysis Platform

    Measured: Three to Seven days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Aug 2021
  2. Study start15 Sep 2021
  3. Primary completion31 Aug 2023
  4. Study completion31 Aug 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is an open label randomized controlled trial to test the effectiveness of four diets in Kwashiorkor children in their transition phase. When it is decided to move to the transition phase, the child will be assigned to one of the treatments depending on the treatment received during the stabilization phase and the results of the appetite test. That is a child who accepts the Plumpy Nut will receive it in combination with their regimen they had during the stabilization phase. If a child does not accept Plumpy Nut, then they will received F100 regardless of their initial therapeutic food regimen. * For those who received F75 in the stabilization phase, they will receive standard F75 + Plumpy Nut * For those who received alternative F75 with CMV in the stabilization phase, they will receive alternative F75 with CMV + Plumpy Nut® * For those who received alternative F75 without CMV in the stabilization phase, they will receive alternative F75 without CMV + Plumpy Nut®.
Masking
None (open label)
Enrolment
32 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05015257
Sponsor's protocol ID
BC-09443-B
Status last verified
Oct 2023
First submitted
2 Aug 2021
Last updated
3 Oct 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: All the data that can affect the main or the secondary outcomes will be used in the analyses and shared as necessary

Publications

  • Gopalan C. Kwashiorkor and marasmus: evolution and distinguishing features. 1968. Natl Med J India. 1992 May-Jun;5(3):145-51. No abstract available.

    PubMed 1306670
  • Nguefack F, Adjahoung CA, Keugoung B, Kamgaing N, Dongmo R. [Hospital management of severe acute malnutrition in children with F-75 and F-100 alternative local preparations: results and challenges]. Pan Afr Med J. 2015 Aug 31;21:329. doi: 10.11604/pamj.2015.21.329.6632. eCollection 2015. French.

    PubMed 26587175
  • Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushik A, Kushwaha KP, Aguayo VM. Management of children with severe acute malnutrition: experience of Nutrition Rehabilitation Centers in Uttar Pradesh, India. Indian Pediatr. 2014 Jan;51(1):21-5. doi: 10.1007/s13312-014-0328-9. Epub 2013 Jul 5.

    PubMed 24277964
  • Smith MI, Yatsunenko T, Manary MJ, Trehan I, Mkakosya R, Cheng J, Kau AL, Rich SS, Concannon P, Mychaleckyj JC, Liu J, Houpt E, Li JV, Holmes E, Nicholson J, Knights D, Ursell LK, Knight R, Gordon JI. Gut microbiomes of Malawian twin pairs discordant for kwashiorkor. Science. 2013 Feb 1;339(6119):548-54. doi: 10.1126/science.1229000. Epub 2013 Jan 30.

    PubMed 23363771

Questions about this trial

What is this clinical trial studying?

A study testing Standard F100, Standard F75 + Plumpynut and Alternative F75 with CMV + Plumpynut in people with Severe Acute Malnutrition and Kwashiorkor, run by University Ghent at 1 site in Burkina Faso.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Burkina Faso. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Edema redevelopment during the transition phase (time frame: Three to Seven days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05015257, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Oct 2023.

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