Inclusion of stabilised rice bran in ready-to-use therapeutic food supports growth in Indonesian children with severe and moderate acute malnutrition: solutions to enhance health with alternative treatments (SEHAT), a double-blinded, randomised clinical trial.

RUTF with rice bran produced significantly greater weight gain velocity at week 4 compared to RUTF without rice bran across all ages.

• Per protocol (PP) analysis at week 4 showed significantly greater weight gain velocity for RUTF+rice bran vs RUTF (p = 0.02) across all ages.
• The same effect was observed specifically in the 24-59 months age group (p = 0.008).
• Linear mixed models were applied across all ages and split by age groups (6-23 months and 24-59 months) at weeks 0, 4, 8, 12, and 16.
• Both intention-to-treat (ITT) and per protocol (PP) analyses were conducted.

RUTF with rice bran produced significantly greater MUAC velocity at week 4 compared to RUTF without rice bran.

• PP analysis at week 4 showed significantly greater MUAC velocity for RUTF+rice bran vs RUTF across all ages (p = 0.004).
• In the 24-59 months age group specifically, MUAC velocity was also significantly greater (p = 0.03).
• MUAC was measured as a primary outcome alongside weight and anthropometric z-scores.

There were no significant differences between treatment groups in other anthropometric outcomes beyond weight gain velocity and MUAC velocity at week 4.

• Primary outcomes included weight, MUAC, and anthropometric z-scores.
• Measurements were taken at weeks 0, 4, 8, 12, and 16.
• No significant differences between treatment groups were found at other time points in anthropometric outcomes beyond week 4.

The trial enrolled 200 children aged 6-59 months with severe or moderate acute malnutrition in Jember, Indonesia.

• Children had SAM defined as WHZ < -3.0 and/or MUAC < 115 mm or bilateral pitting oedema +/++, or approaching SAM (WHZ < -2.5).
• The study was a two-arm, double-blinded, randomised controlled trial.
• The trial compared a locally produced RUTF with rice bran to the same RUTF without rice bran.
• Children were split into two age groups (6-23 months and 24-59 months) based on expected differences in microbiome maturity.

Rice bran was incorporated into RUTF as a novel nutrient-dense and prebiotic food ingredient to support recovery from acute malnutrition.

• Rice bran is described as 'a novel nutrient-dense, prebiotic food ingredient' that 'can support healthy growth.'
• The RUTF was locally produced in Indonesia.
• The rationale for age group stratification was that children in the two age groups were expected to respond differently to treatment based on their microbiome maturity.
• Optimisation of RUTF formulations is highlighted as important to support sustained recovery from SAM.