DesignFactorsforFoodSupplementationand NutritionEducationInterventionsThatLimit ConclusionsaboutEffectivenessforWasting Prevention:AScopingReviewofPeer-Reviewed Literature

Abstract

Weconductedascopingreview to characterizethe evidence base forthe effectiveness of foodsupplementation (FS),nutritioneducation(NE), or FS/NE interventions to prevent wasting among children aged 6 to 59 mo. We aimed to identify gaps in peer-reviewed literature and to develop recommendations for strengthening study designs. We identified 56 unique studies (FS = 21, NE = 19, FS/NE = 16) for which we assessed interventiondesignfactors,implementationcontext,evaluationmethods,andwastingimpact.Comparedwithstudiesfocusedonstunting,fewer wasting-focusedstudiesreportedweight-for-heightzscore(WHZ).Midupperarmcircumference(MUAC)wasmorecommonlyreportedinwastingfocusedstudies(71.4%)thanthosefocusedonstunting(36.8%)orwastingandstunting(30.4%).FSstudiesmeasuredanthropometry(mean,95% CI) more frequently at every 11.3 (7.8, 14.8) wk than NE interventions at 36.3 (8.8, 62.1) wk (P = 0.036), but not FS/NE interventions at 25.8 (5.6, 49.1) wk (P = 0.138). NE interventions tended to be of longer duration than FS or FS/NE interventions. Only 6 studies followed and measured children after the intervention period ended. Across all studies, 45% reported a significant effect on wasting; these included FS, NE, and FS/NE interventions.Thelackofcomparabilityacrossstudieslimitsconclusionsabouttheeffectivenessofspecifictypesofinterventions.Tobuildamore unifiedevidencebaseforwastingpreventionwerecommendthatfuturestudies1)reportonaconsistentsetofmetrics,includingMUAC;2)attempt to measure change in wasting incidence using more frequent measures; 3) measure wasting prevalence among the general population; 4) follow children postintervention to assess relapse; 5) measure food insecurity and diet quality; and 6) use harmonized protocols across multiple settings. Sucheffortstoimprovestudycomparabilitywillstrengthentheevidencebase,mayhelpunitedivergentprofessionalcommunities,andultimately accelerateprogresstowardeliminatingchildundernutrition