ORIGINAL RESEARCH article

Front. Nutr.

Sec. Clinical Nutrition

Volume 12 - 2025 | doi: 10.3389/fnut.2025.1507360

This article is part of the Research TopicThe Role of Nutrition In Pediatric Chronic Diseases: A Focus On Metabolic, Genetic, And Palliative Care ChallengesView all 5 articles

Supplementation with Ready-to-Use Therapeutic Food has no effect on adverse outcomes among undernourished children aged 6-59 months with severe pneumonia

Provisionally accepted
Damalie  NalwangaDamalie Nalwanga1,2Elisa  GiallongoElisa Giallongo3Victor  MusiimeVictor Musiime4,5Sarah  KiguliSarah Kiguli4Peter  Olupot-OlupotPeter Olupot-Olupot6Florence  AlarokerFlorence Alaroker7Robert  OpokaRobert Opoka4,8Tagoola  Abner VesuviusTagoola Abner Vesuvius9Mainga  HamalubaMainga Hamaluba10Christabel  MogakaChristabel Mogaka10Eva  NabawanukaEva Nabawanuka4Charles  KaramagiCharles Karamagi11,4André  BriendAndré Briend12,13Kathryn  MaitlandKathryn Maitland10,14*
  • 1College of Health Sciences, Makerere University, Kampala, Uganda
  • 2Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
  • 3Intensive Care National Audit & Research Centre, London, United Kingdom
  • 4Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
  • 5Joint Clinical Research Centre, Kampala, Uganda
  • 6Mbale Clinical Research Institute, Mbale, Uganda, Mbale, Uganda
  • 7Soroti Regional Referral Hospital, Soroti, Uganda
  • 8Aga Khan University, Medical College East Africa, Nairobi, Kenya
  • 9Jinja Regional Referral Hospital, Jinja, Uganda
  • 10KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
  • 11Clinical Epidemiology Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
  • 12Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
  • 13Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
  • 14Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, United Kingdom

The final, formatted version of the article will be published soon.

Objectives: To investigate the effect of supplementation with ready-to-use therapeutic food (RUTF) on adverse outcomes among undernourished children aged 6 -59 months with severe pneumonia.This secondary analysis of the COAST-Nutrition (ISRCTN10829073) included children hospitalized for severe pneumonia in Uganda and Kenya. Undernutrition was defined as having either a weight-for-age z score, height-for-age z score, or weight-for-height/length z score below the median of the WHO reference population (< 0) or mid-upper arm circumference (MUAC) below 13.5 cm. Participants were randomized to receive 1 sachet of RUTF daily for 8 weeks in addition to the usual diet (intervention) or usual diet alone (control). The primary composite outcome for adverse events was any one of mortality, re-admission, or deterioration of nutritional status by day 90 of follow-up.Of 846 main trial participants, 741 (88%) met the inclusion criteria (intervention:374 versus control:367). Of 687 (93%) participants in whom the primary outcome was assessed, 370 (54%) experienced an adverse event, (intervention: 184/348(53%) versus control: 186/339(54%). There was no difference in the primary outcome between groups, aOR 0.92 (95% CI 0.68, 1.24), p= 0.572. Adverse outcome risk reduced with increasing age, aOR 0.53, (95% CI 0.45, 0.62), p<0.001.RUTF supplementation did not reduce the high frequency of adverse outcomes in children aged 6-59 months following hospital admission with severe pneumonia. Nutritional support directly targeting metabolic needs post-pneumonia should be considered in the future.

Keywords: Severe pneumonia, undernutrition, Nutritional intervention, African children, Adverse outcomes

Received: 07 Oct 2024; Accepted: 22 May 2025.

Copyright: © 2025 Nalwanga, Giallongo, Musiime, Kiguli, Olupot-Olupot, Alaroker, Opoka, Vesuvius, Hamaluba, Mogaka, Nabawanuka, Karamagi, Briend and Maitland. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Kathryn Maitland, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.