O'Donovan, Grace;
Allen, Daniel;
Nkosi-Gondwe, Thandile;
Anujuo, Kenneth;
Abera, Mubarek;
Kirolos, Amir;
Olga, Laurentya;
... Kerac, Marko; + view all
(2025)
Weight gain among children under five with severe malnutrition in therapeutic feeding programmes: a systematic review and meta-analysis.
eClinicalMedicine
, 81
, Article 103083. 10.1016/j.eclinm.2025.103083.
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Abstract
Background: Globally, some 45 million children under five years of age are wasted (low weight-for-height). Although 2023 World Health Organisation guidelines on their care did not aim to identify optimal weight gain, they did mention 5–10 g/kg/day as a target, which is a change from prior guidelines that recommended 10–15 g/kg/day, when inpatient-only care was the norm. We aimed to inform future policy/programming on weight gain targets. Methods: For this systematic review and meta-analysis, we searched Embase, Global Health and Medline. The final search was on 23/02/2024. Papers were included if they reported weight gain of children aged 6–59 months with severe malnutrition during inpatient (facility-based), outpatient (home-based), and hybrid treatment (initially inpatient and progressing to outpatient treatment). Summary data were extracted, and quality was assessed using a NICE Quality Appraisal Checklist. Our primary outcome was mean rate of weight gain (g/kg/day) during treatment. We conducted random-effects meta-analysis to describe pooled mean weight gain by programme type. Meta-regression investigated potential associations of weight gain with length of stay and programme outcomes. We registered the study on PROSPERO (CRD42023266472). Findings: Our search yielded 3173 papers. We reviewed 321 full texts, identifying 126 eligible papers. Of these, 104 papers, including some 240,650 participants, reported weight gain as g/kg/day and were eligible for meta-analysis. Mean rate of weight gain was 8.8 g/kg/day (95% CI: 7.6, 9.9; I2 = 97.8%) across 18 inpatient programmes, 3.4 g/kg/day (95% CI: 2.0, 4.7; I2 = 99.4%) across 12 hybrid programmes, and 3.9 g/kg/day (95% CI: 3.4, 4.4; I2 = 99.7%) across 60 outpatient programmes. We found inconsistent evidence of an association between slower weight gain and higher mortality: there was weak evidence of association after adjusting for programme type (coefficient = −0.4; 95% CI: −0.7, −0.02; p = 0.04; n = 118 programmes). There was high heterogeneity between studies. Details of weight gain calculation methods varied. We found no evidence for publication bias when accounting for programme type (Egger's test p-value = 0.2). Interpretation: Weight gain in outpatient programmes was markedly slower than in inpatient treatment. Clearer reporting of weight gain and a better understanding of the sequelae of faster/slower recovery is important to set future weight gain targets. Our results set an important baseline for current programmes to benchmark against.
| Type: | Article |
|---|---|
| Title: | Weight gain among children under five with severe malnutrition in therapeutic feeding programmes: a systematic review and meta-analysis |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.eclinm.2025.103083 |
| Publisher version: | https://doi.org/10.1016/j.eclinm.2025.103083 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, RANDOMIZED CONTROLLED-TRIAL, HOME-BASED THERAPY, COMMUNITY-BASED MANAGEMENT, UPPER ARM CIRCUMFERENCE, AGED 6-59 MONTHS, MALNOURISHED CHILDREN, DOUBLE-BLIND, NUTRITION REHABILITATION, NOURISHED CHILDREN, TREATMENT OUTCOMES |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10206276 |
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