Local Food Interventions for the Management of Moderate Acute Malnutrition (MAM) among Children Aged 6 to 59 Months: A Systematic Review and Non-inferiority Meta-Analysis

Abstract

ABSTRACT Moderate acute malnutrition (MAM) remains a major public health challenge among children aged 6 to 59 mo. Specialized nutritious foods (SNFs) are the standard intervention for the management of MAM; however, their use is constrained by supply chain disruptions, high costs, limited local production, and sustainability challenges, highlighting the need for context-specific alternatives. We conducted a systematic review and non-inferiority meta-analysis to compare local food interventions with SNFs for recovery rate and weight gain among children with MAM. We searched Medical Literature Analysis and Retrieval System On Line, Excerpta Medica dataBASE, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest, and grey literature sources. Randomized controlled trials and quasi-experimental studies comparing local food interventions with SNFs were included. Local food interventions were categorized into the following 2 groups: locally available foods (LAFs), prepared from local ingredients using household or community methods, and locally processed foods (LPFs), produced from locally sourced ingredients through processing and fortification. To demonstrate non-inferiority, the predefined non-inferiority margins were set at 10% for recovery rate and 1.2 g/kg/d for weight gain. Non-inferiority was established when the lower bound of the 95% confidence interval (CI) remained above the corresponding margin. A network meta-analysis was performed to compare the relative effectiveness of LAFs, LPFs, fortified blended food, and ready-to-use supplementary food. Twenty-one studies met the eligibility criteria, and 13 were included in the meta-analyses. For recovery rate, LAFs were inferior to SNFs [risk difference (RD): −0.21; 95% CI: −0.33, −0.08], whereas LPFs were non-inferior (RD: −0.03; 95% CI: −0.09, 0.03). For weight gain, both LAFs [mean difference (MD): −0.33; 95% CI: −0.56, −0.11] and LPFs (MD: −0.32; 95% CI: −0.43, −0.21) resulted in lower weight gain than SNFs but met the predefined non-inferiority criterion. In conclusion, LPFs can serve as effective alternatives to SNFs for managing MAM. Further research is needed to optimize the formulation and effectiveness of LAFs for MAM management. This review was registered at PROSPERO as CRD42024566607.