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To the Editor: In their randomized controlled trial, Ms Isanaka and colleagues¹ found that providing children younger than 5 years with ready-to-use therapeutic food during periods of food insecurity can prevent cases of malnutrition. However, their study presents 2 important methodological difficulties.

First, the authors used different reference distributions to define malnutrition at inclusion in the study (National Center for Health Statistics/World Health Organization [NCHS/WHO], 1978) and at inclusion in the analysis (WHO Child Growth Standards, 2006). A proportion of participants were thus excluded from the analysis on the grounds that they were already malnourished at recruitment according to the WHO reference.² This proportion was likely substantial and would be expected to consist mainly of children younger than 24 months because the 2 references yield different diagnoses principally in that age range.² Unfortunately, this age range has the highest risk of malnutrition.³ This compromises the internal validity of the study, . . . [Full Text of this Article]

Dominique Roberfroid, MD, MSc, MPhil
droberfroid@itg.be
Institute of Tropical Medicine
Antwerp, Belgium

Lieven Huybregts, MSc
Ghent University
Ghent, Belgium

Patrick Kolsteren, MD, PhD
Institute of Tropical Medicine

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Effect of Preventive Supplementation With Ready-to-Use Therapeutic Food on the Nutritional Status, Mortality, and Morbidity of Children Aged 6 to 60 Months in Niger: A Cluster Randomized Trial
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