TABLE 3.
GRADE evidence profile for outcomes of this systematic review of RUTF containing low or no dairy for children with severe acute malnutrition1
| Quality assessment | Number of participants | Effect | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | RUTF <50%2 | Standard RUTF | Relative (95% CI) | Absolute | Quality |
| Weight gain (better indicated by higher values) | |||||||||||
| 6 | RCTs and cluster-RCTs | No serious risk of bias | No serious inconsistency | No serious indirectness | No serious imprecision | None | 2366 | 2185 | — | SMD 0.20 lower (0.26 to 0.15 lower) | ⊕⊕⊕⊕ High |
| Recovery | |||||||||||
| 4 | RCTs and cluster-RCTs | No serious risk of bias | No serious inconsistency | Serious3 | No serious imprecision | None | 1941/2597 (74.7%) | 1811/2328 (77.8%) | RR 0.93 (0.87 to 1.00) | 54 fewer per 1000 (from 101 fewer to 0 fewer) | ⊕⊕⊕Ο Moderate |
| Time to recovery (better indicated by lower values) | |||||||||||
| 4 | RCTs and cluster-RCTs | Serious4 | Serious5 | Serious3 | Serious6 | None | 1292 | 1129 | — | SMD 0.20 higher (0.01 lower to 0.41 higher) | ⊕ΟΟΟ Very low |
| Mortality | |||||||||||
| 5 | RCTs and cluster-RCTs | Serious4 | No serious inconsistency | No serious indirectness | Serious6 | None | 111/2635 (4.2%) | 108/2369 (4.6%) | RR 1.11 (0.85 to 1.44) | 5 more per 1000 (from 6 fewer to 20 more) | ⊕⊕ΟΟ Low |
| Default | |||||||||||
| 3 | RCTs and cluster-RCTs | Serious4 | No serious inconsistency | No serious indirectness | Serious6 | None | 307/1668 (18.4%) | 240/1384 (17.3%) | RR 1.16 (0.99 to 1.35) | 28 more per 1000 (from 2 fewer to 61 more) | ⊕⊕ΟΟ Low |
| Nonresponse | |||||||||||
| 4 | RCTs and cluster-RCTs | No serious risk of bias | No serious inconsistency | No serious indirectness | Serious6 | None | 151/2633 (5.7%) | 108/2332 (4.6%) | RR 1.36 (0.95 to 1.94) | 17 more per 1000 (from 24 fewer to 44 more) | ⊕⊕⊕Ο Moderate |
| Weight-for-height z scores (better indicated by higher values) | |||||||||||
| 4 | RCTs | Serious4 | No serious inconsistency | No serious indirectness | Serious6 | None | 1099 | 1117 | — | MD 0.01 higher (0.12 lower to 0.14 higher) | ⊕⊕ΟΟ Low |
| Midupper arm circumference (better indicated by higher values) | |||||||||||
| 4 | RCTs | No serious risk of bias | Serious5 | Serious7 | No serious imprecision | None | 1099 | 1117 | — | MD 0.06 lower (0.25 lower to 0.13 higher) | ⊕⊕ΟΟ Low |
| Weight-for-age z scores (better indicated by higher values) | |||||||||||
| 3 | RCTs | No serious risk of bias | No serious inconsistency | No serious indirectness | Serious6 | None | 1063 | 1079 | — | MD 0.10 lower (0.20 lower to 0 higher) | ⊕⊕⊕Ο Moderate |
| Height-for-age z scores (better indicated by higher values) | |||||||||||
| 4 | RCTs | No serious risk of bias | No serious inconsistency | No serious indirectness | Serious6 | None | 1099 | 1117 | — | MD 0.02 lower (0.10 lower to 0.05 higher) | ⊕⊕⊕Ο Moderate |
1
GRADE, Grading of Recommendations Assessment, Development and Evaluation; MD, mean difference; RCT, randomized controlled trial; RR, risk ratio; RUTF, ready-to-use therapeutic food; SMD, standardized mean difference.
2
Definition of recovery varies between studies.
3
The amount of data from studies with a high risk of bias may affect the interpretation of results.
4
Substantial unexplained statistical heterogeneity.
5
Wide CI around the estimate of the effect.
6
Differences in outcome measurement (change over time and absolute values).
7
RUTF <50% represents RUTF with <50% of protein coming from dairy products.