16. Supplementary feeding versus no supplementary feeding (control, placebo, standard care, dietary advice), outcome: death.
| Review | Target group | Intervention | Outcome | Assumed risk with comparator | Corresponding risk with intervention | Relative effect (95% CI) | Number of participants (studies) | Certainty of evidence (GRADE)a |
| Grobler 2013 | Children with HIV (aged 6–36 months) | Balancedb | Death (8 weeks) | 120 per 1000 | 163 per 1000 | RR 1.42 (0.59 to 3.40) | 169 (1) | NR |
| Death (26 weeks) | 217 per 1000 | 291 per 1000 | RR 1.48 (0.74 to 2.98) | 169 (1) | NR | |||
| Grobler 2016 | Adults with TB | Balancedc | Death (1 year follow‐up) | 3 per 100 | 1 per 100 (0 to 4) | RR 0.34 (0.10 to 1.20)d | 567 (4) | Very low |
| Lazzerini 2013 | Children with MAM (< 5 years of age) | High lipid and balancede | Death | 10 per 1000 | 4 per 1000 | RR 0.44 (0.14 to 1.36) | 1974 (1) | NR |
| Ota 2015 | Pregnant women | Balanced | Stillbirth | 30 per 1000 | 18 per 1000 (12 to 28) | RR 0.60 (0.39 to 0.94)f | 3408 (5) | Moderate |
| Neonatal death | 26 per 1000 | 18 per 1000 (11 to 28) | RR 0.68 (0.43 to 1.07) | 3381 (5) | Low | |||
| High protein | Stillbirth | 33 per 1000 | 27 per 1000 (10 to 72) | RR 0.81 (0.31 to 2.15) | 529 (1) | Low | ||
| Neonatal death | 11 per 1000 | 31 per 1000 (8 to 115) | RR 2.78 (0.75 to 10.36) | 529 (1) | Low | |||
| CI: confidence interval; MAM: moderate acute malnutrition; NR: not reported; RR: risk ratio; TB: tuberculosis. | ||||||||
aAs reported in 'Summary of findings' tables. bEnhanced diet: modified milk formula providing 150 kcal/kg/day and 15% of calories as protein. cProvided as a monthly ration. dNo subgroup differences between people who were HIV positive and people who were HIV negative. eComplementary lipid‐based nutrient supplement (Plumpy Doz) and blended foods (corn‐soy blended foods enriched) versus counselling (two subgroups, one study). fRisk of stillbirth significantly reduced in women given balanced energy and protein supplementation (biscuit (containing roasted groundnuts, rice flour, sugar, groundnut oil); supplement with sesame cake, jaggery, oil; fortified food supplement with peanut butter, soy flour, vegetable oil, sugar, micronutrients; supplement with dried skim milk, enriched bread, vegetable oil; oral supplement (beverage)).
Additional comments
- Stillbirth refers to death after 20 weeks' gestation and before birth.
- Neonatal death refers to death of a live infant within the first 28 days of life.
- 'Balanced' refer to additional energy or protein supplementation or both in 'balanced' proportions (balanced: carbohydrate: 45% to 65%; protein: 10% to 20%; fat: 25% to 35%).
- High protein refers to a protein content > 20% to 25% of total energy.
- Isocaloric balanced protein: a supplement in which the protein content is 'balanced', i.e. provides < 25% of total energy content, but the protein replaced an equal quantity of non‐protein energy in the control group.
- High lipid/fat refers to a lipid content > 35% of total energy.
- Adult mortality outcomes in the Grobler 2013 (HIV) review were reported narratively. Neither supplementary food (Sudarsanam 2011) nor daily supplement of spirulina (Yamani 2009) significantly altered the risk of death compared with no supplement or placebo in malnourished, antiretroviral therapy‐naive adults in these two studies.
- Child mortality outcomes in the Kristjansson 2015a review were reported narratively. One randomised controlled trial reported that there was no significant difference in mortality between children supplemented with ready‐to‐use therapeutic feeding (1671 children) and children who were not supplemented (1862 children; adjusted hazard ratio 0.76, 95% CI 0.51 to 1.13).