The effect of short-term preoperative nutritional intervention for cleft surgery eligibility
Abstract Background 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 demons...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
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| Series: | BMC Nutrition |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40795-023-00704-1 |
| _version_ | 1797865309581869056 |
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| author | Shady Mikhail Lily Chattopadhyay Melissa DiBona Charlotte Steppling Dede Kwadjo Anjaramamy Ramamonjisoa Wendy Gallardo Fatima Almendarez Beau Sylvester Samanta Rosales Ibrahim Nthalika Zachary J. Collier William Magee Allyn Auslander |
| author_facet | Shady Mikhail Lily Chattopadhyay Melissa DiBona Charlotte Steppling Dede Kwadjo Anjaramamy Ramamonjisoa Wendy Gallardo Fatima Almendarez Beau Sylvester Samanta Rosales Ibrahim Nthalika Zachary J. Collier William Magee Allyn Auslander |
| author_sort | Shady Mikhail |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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). Results 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). Conclusion 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. |
| first_indexed | 2024-04-09T23:07:09Z |
| format | Article |
| id | doaj.art-240ec5b3a038450dacc1ca103b07b129 |
| institution | Directory Open Access Journal |
| issn | 2055-0928 |
| language | English |
| last_indexed | 2024-04-09T23:07:09Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nutrition |
| spelling | doaj.art-240ec5b3a038450dacc1ca103b07b1292023-03-22T10:39:02ZengBMCBMC Nutrition2055-09282023-03-019111010.1186/s40795-023-00704-1The effect of short-term preoperative nutritional intervention for cleft surgery eligibilityShady Mikhail0Lily Chattopadhyay1Melissa DiBona2Charlotte Steppling3Dede Kwadjo4Anjaramamy Ramamonjisoa5Wendy Gallardo6Fatima Almendarez7Beau Sylvester8Samanta Rosales9Ibrahim Nthalika10Zachary J. Collier11William Magee12Allyn Auslander13Operation Smile, IncChildren’s Hospital Los AngelesOperation Smile, IncOperation Smile, IncOperation Smile GhanaOperation Smile MadagascarOperation Smile VenezuelaOperation Smile NicaraguaOperation Smile, IncOperation Smile HondurasOperation Smile MalawiCalifornia Division of Plastic & Reconstructive Surgery, University of SouthernOperation Smile, IncOperation Smile, IncAbstract Background 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. Methods 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). Results 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). Conclusion 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.https://doi.org/10.1186/s40795-023-00704-1Orofacial cleftsCleft lip and palatePediatricsMalnutritionLow- and middle- income countriesReady-to-use therapeutic foods |
| spellingShingle | Shady Mikhail Lily Chattopadhyay Melissa DiBona Charlotte Steppling Dede Kwadjo Anjaramamy Ramamonjisoa Wendy Gallardo Fatima Almendarez Beau Sylvester Samanta Rosales Ibrahim Nthalika Zachary J. Collier William Magee Allyn Auslander The effect of short-term preoperative nutritional intervention for cleft surgery eligibility BMC Nutrition Orofacial clefts Cleft lip and palate Pediatrics Malnutrition Low- and middle- income countries Ready-to-use therapeutic foods |
| title | The effect of short-term preoperative nutritional intervention for cleft surgery eligibility |
| title_full | The effect of short-term preoperative nutritional intervention for cleft surgery eligibility |
| title_fullStr | The effect of short-term preoperative nutritional intervention for cleft surgery eligibility |
| title_full_unstemmed | The effect of short-term preoperative nutritional intervention for cleft surgery eligibility |
| title_short | The effect of short-term preoperative nutritional intervention for cleft surgery eligibility |
| title_sort | effect of short term preoperative nutritional intervention for cleft surgery eligibility |
| topic | Orofacial clefts Cleft lip and palate Pediatrics Malnutrition Low- and middle- income countries Ready-to-use therapeutic foods |
| url | https://doi.org/10.1186/s40795-023-00704-1 |
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