Mikhail Shady, Chattopadhyay Lily, DiBona Melissa, Steppling Charlotte, Kwadjo Dede, Ramamonjisoa Anjaramamy, Gallardo Wendy, Almendarez Fatima, Sylvester Beau, Rosales Samanta, Nthalika Ibrahim, Collier Zachary J, Magee William, Auslander Allyn
Operation Smile, Inc, 3641 Faculty Blvd, Virginia Beach, VA, 23453, USA.
Children's Hospital Los Angeles, Los Angeles, CA, USA.
BMC Nutr. 2023 Mar 14;9(1):47. doi: 10.1186/s40795-023-00704-1.
Children with orofacial clefts are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to receive safe surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for malnutrition; however, the effectiveness has not been demonstrated in this patient population prior to surgery. We studied the effectiveness of short-term RUTF use in transitioning children with malnutrition, who were initially ineligible for surgery, into surgical candidates.
A cohort of patients from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela enrolled in a nutrition program were followed by Operation Smile from June 2017 to January 2020. Age, weight, and length/height were tracked at each visit. Patients were included until they were sufficiently nourished (Z > = -1) with a secondary outcome of receiving surgery. The study was part of a collaborative program between Operation Smile (NGO), Birdsong Peanuts (peanut shellers and distributors), and MANA Nutrition (RUTF producer).
A total of 556 patients were recruited between June 2017 and January 2020. At baseline 28.2% (n = 157) of patients were diagnosed with severe, 21.0% (n = 117) moderate, and 50.7% (n = 282) mild malnutrition. 324 (58.3%) presented for at least one return visit. Of those, 207 (63.7%) reached optimal nutrition status. By visit two, the mean z-score increased from -2.5 (moderate) to -1.7 (mild) (p < 0·001). The mean time to attain optimal nutrition was 6 weeks. There was a significant difference in the proportion of patients who improved by country(p < 0.001).
Malnutrition prevents many children with orofacial clefts in low- and middle-income countries from receiving surgical care even when provided for free. This creates an even larger disparity in access to surgery. In an average of 6 weeks with an approximate cost of $25 USD per patient, RUTF transitioned over 60% of patients into nutritionally eligible surgical candidates, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, the expansion of cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired orofacial clefts receive timely and safe surgical care.
患有口面部裂隙的儿童极易营养不良，严重营养不良会限制他们接受安全手术的资格。即食治疗性食品（RUTF）是治疗营养不良的有效方法；然而，此前尚未在该患者群体的术前阶段证明其有效性。我们研究了短期使用RUTF对将最初不符合手术条件的营养不良儿童转变为手术候选者的有效性。
2017年6月至2020年1月，“微笑行动”对来自加纳、洪都拉斯、马拉维、马达加斯加、尼加拉瓜和委内瑞拉参加营养项目的一组患者进行了跟踪。每次就诊时记录年龄、体重和身长/身高。纳入患者直至其营养状况充足（Z≥ -1），次要结果是接受手术。该研究是“微笑行动”（非政府组织）、鸟鸣花生公司（花生脱壳和经销商）和MANA营养公司（RUTF生产商）之间合作项目的一部分。
2017年6月至2020年1月共招募了556名患者。基线时，28.2%（n = 157）的患者被诊断为重度营养不良，21.0%（n = 117）为中度营养不良，50.7%（n = 282）为轻度营养不良。324名（58.3%）患者至少复诊了一次。其中，207名（63.7%）达到了最佳营养状态。到第二次就诊时，平均Z评分从-2.5（中度）升至-1.7（轻度）（p < 0.001）。达到最佳营养状态的平均时间为6周。不同国家患者改善比例存在显著差异（p < 0.001）。
营养不良使许多低收入和中等收入国家患有口面部裂隙的儿童即使在免费提供手术的情况下也无法接受手术治疗。这在手术可及性方面造成了更大的差距。平均6周时间，每位患者花费约25美元，RUTF使超过60%的患者转变为符合营养条件的手术候选者，使其成为一种有效的短期术前营养干预措施。通过独特的伙伴关系，扩大具有成本效益的大规模营养项目可在确保那些面临未修复口面部裂隙风险最高的人获得及时和安全的手术治疗方面发挥关键作用。
