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Abstract
Purpose of review This review focuses on recent data highlighting the interactions between intestinal pathogens, enteropathy and malnutrition in developing countries, which drive morbidity and mortality and hinder the long-term developmental potential of children. Recent findings Diarrhoea remains the second commonest cause of death in children below 5 years, and malnutrition underlies 45% of all child deaths. Even in the absence of diarrhoea, subclinical pathogen carriage and enteropathy are almost universal in developing countries. Here, we review recent studies addressing the causes and consequences of diarrhoea; emerging data on environmental influences that govern postnatal development of the gut and microbiota; current concepts of environmental enteric dysfunction; and recent intervention trials in the field. We highlight the interactions between these processes, whereby intestinal pathogens drive a cycle of gut damage, malabsorption, chronic inflammation and failed mucosal regeneration, leading to malnutrition and susceptibility to further enteric infections. Summary Efforts to improve child survival and long-term developmental potential need to address the overlapping and interacting effects of diarrhoea, enteropathy and malnutrition. Recent insights from human and animal studies suggest potential targets for intervention.
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Adu-Afarwuah S, Lartey A, Dewey KG. Meeting nutritional needs in the first 1000 days: a place for small-quantity lipid-based nutrient supplements. Ann N Y Acad Sci 2017; 1392:18-29. [PMID: 28319655 DOI: 10.1111/nyas.13328] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/28/2017] [Accepted: 02/06/2017] [Indexed: 02/06/2023]
Abstract
The first 1000 days of life is marked by intense metabolic activity and tissue deposition. The increased nutritional needs during this period, and the challenges to meeting them, are often not understood or appreciated. Here, we describe the nutritional needs during the first 1000 days, highlight the challenges to meeting these needs in developing countries, outline intervention strategies, and examine the consumption of small-quantity lipid-based nutrient supplements (SQ-LNS) as a promising strategy. In low-income settings, the challenge to meeting nutritional needs during the first 1000 days is worsened by overreliance on cereal-based diets of low nutrient density and high prevalence of infections and infestations. Dietary diversification is the ideal long-term solution to nutritional deficiencies, but difficulties with obtaining adequate amounts of iron, zinc, and certain vitamins may still remain. Several other interventions are available, but applying them is often fraught with challenges, including cost and contextual factors limiting efficacy. Evidence suggests that SQ-LNS supplementation may help reduce inadequate gestational weight gain and promote fetal and child growth and development in some populations. More research is needed to evaluate the effectiveness of SQ-LNS and other fortified products in different contexts and within integrated programs that address other determinants of maternal and child undernutrition.
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Affiliation(s)
- Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Anna Lartey
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California
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Hess SY, Peerson JM, Becquey E, Abbeddou S, Ouédraogo CT, Somé JW, Yakes Jimenez E, Ouédraogo JB, Vosti SA, Rouamba N, Brown KH. Differing growth responses to nutritional supplements in neighboring health districts of Burkina Faso are likely due to benefits of small-quantity lipid-based nutrient supplements (LNS). PLoS One 2017; 12:e0181770. [PMID: 28771493 PMCID: PMC5542440 DOI: 10.1371/journal.pone.0181770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/28/2017] [Indexed: 12/18/2022] Open
Abstract
Background Of two community-based trials among young children in neighboring health districts of Burkina Faso, one found that small-quantity lipid-based nutrient supplements (LNS) increased child growth compared with a non-intervention control group, but zinc supplementation did not in the second study. Objectives We explored whether the disparate growth outcomes were associated with differences in intervention components, household demographic variables, and/or children’s morbidity. Methods Children in the LNS study received 20g LNS daily containing different amounts of zinc (LNS). Children in the zinc supplementation study received different zinc supplementation regimens (Z-Suppl). Children in both studies were visited weekly for morbidity surveillance. Free malaria and diarrhea treatment was provided by the field worker in the LNS study, and by a village-based community-health worker in the zinc study. Anthropometric assessments were repeated every 13–16 weeks. For the present analyses, study intervals of the two studies were matched by child age and month of enrollment. The changes in length-for-age z-score (LAZ) per interval were compared between LNS and Z-Suppl groups using mixed model ANOVA or ANCOVA. Covariates were added to the model in blocks, and adjusted differences between group means were estimated. Results Mean ages at enrollment of LNS (n = 1716) and Z-Suppl (n = 1720) were 9.4±0.4 and 10.1±2.7 months, respectively. The age-adjusted change in mean LAZ per interval declined less with LNS (-0.07±0.44) versus Z-Suppl (-0.21±0.43; p<0.0001). There was a significant group by interval interaction with the greatest difference found in 9–12 month old children (p<0.0001). Adjusting for demographic characteristics and morbidity did not reduce the observed differences by type of intervention, even though the morbidity burden was greater in the LNS group. Conclusions Greater average physical growth in children who received LNS could not be explained by known cross-trial differences in baseline characteristics or morbidity burden, implying that the observed difference in growth response was partly due to LNS.
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Affiliation(s)
- Sonja Y. Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, CA, United States of America
- * E-mail:
| | - Janet M. Peerson
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, CA, United States of America
| | - Elodie Becquey
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Souheila Abbeddou
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, CA, United States of America
| | - Césaire T. Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, CA, United States of America
- Direction Régionale de l'Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Jérôme W. Somé
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, CA, United States of America
- Direction Régionale de l'Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Elizabeth Yakes Jimenez
- Center for Education Policy Research and Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
| | - Jean-Bosco Ouédraogo
- Direction Régionale de l'Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Stephen A. Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA, United States of America
| | - Noël Rouamba
- Direction Régionale de l'Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Kenneth H. Brown
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, CA, United States of America
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Unger SA, Drammeh S, Hasan J, Ceesay K, Sinjanka E, Beyai S, Sonko B, Dondeh BL, Fulford AJ, Moore SE, Prentice AM. Impact of fortified versus unfortified lipid-based supplements on morbidity and nutritional status: A randomised double-blind placebo-controlled trial in ill Gambian children. PLoS Med 2017; 14:e1002377. [PMID: 28809926 PMCID: PMC5557358 DOI: 10.1371/journal.pmed.1002377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multiple micronutrients (MMN) are commonly prescribed in pediatric primary healthcare in sub-Saharan Africa to improve nutritional status and appetite without evidence for their effectiveness or international clinical guidelines. Community-wide MMN supplementation has shown limited and heterogeneous impact on growth and morbidity. Short-term ready-to-use therapeutic foods in acutely sick children in a hospital setting also had limited efficacy regarding subsequent growth. The effectiveness of MMN in improving morbidity or growth in sick children presenting for primary care has not been assessed. METHODS AND FINDINGS We undertook a double-blind randomised controlled trial of small-quantity lipid-based nutrient supplements (SQ-LNS) fortified with 23 micronutrients in children aged 6 months (mo) to 5 years (y) presenting with an illness at a rural primary healthcare centre in The Gambia. Primary outcomes were repeat clinic presentations and growth over 24 wk. Participants were randomly assigned to receive 1 of 3 interventions: (1) supplementation with micronutrient-fortified SQ-LNS for 12 wk (MMN-12), (2) supplementation with micronutrient-fortified SQ-LNS for 6 wk followed by unfortified SQ-LNS for 6 wk (MMN-6), or (3) supplementation with unfortified SQ-LNS for 12 wk (MMN-0) to be consumed in daily portions. Treatment masking used 16 letters per 6-wk block in the randomisation process. Blinded intention-to-treat analysis based on a prespecified statistical analysis plan included all participants eligible and correctly enrolled. Between December 2009 and June 2011, 1,101 children (age 6-60 mo, mean 25.5 mo) were enrolled, and 1,085 were assessed (MMN-0 = 361, MMN-6 = 362, MMN-12 = 362). MMN supplementation was associated with a small increase in height-for-age z-scores 24 wk after recruitment (effect size for MMN groups combined: 0.084 SD/24 wk, 95% CI: 0.005, 0.168; p = 0.037; equivalent to 2-5 mm depending on age). No significant difference in frequency of morbidity measured by the number of visits to the clinic within 24 wk follow-up was detected with 0.09 presentations per wk for all groups (MMN-0 versus MMN-6: adjusted incidence rate ratio [IRR] 1.03, 95% CI: 0.92, 1.16; MMN-0 versus MMN-12: 1.05, 95% CI: 0.93, 1.18). In post hoc analysis, clinic visits significantly increased by 43% over the first 3 wk of fortified versus unfortified SQ-LNS (adjusted IRR 1.43; 95% CI: 1.07, 1.92; p = 0.016), with respiratory presentations increasing by 52% with fortified SQ-LNS (adjusted IRR 1.52; 95% CI: 1.01, 2.30; p = 0.046). The number of severe adverse events during supplementation were similar between groups (MMN-0 = 20 [1 death]; MMN-6 = 21 [1 death]; MMN-12 = 20 [0 death]). No participant withdrew due to adverse effects. Study limitations included the lack of supervision of daily supplementation. CONCLUSION Prescribing micronutrient-fortified SQ-LNS to ill children presenting for primary care in rural Gambia had a very small effect on linear growth and did not reduce morbidity compared to unfortified SQ-LNS. An early increase in repeat visits indicates a need for the establishment of evidence-based guidelines and caution with systematic prescribing of MMN. Future research should be directed at understanding the mechanisms behind the lack of effect of MMN supplementation on morbidity measures and limited effect on growth. TRIAL REGISTRATION ISRCTN 73571031.
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Affiliation(s)
- Stefan A. Unger
- MRC Unit The Gambia, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- University of Edinburgh, Department of Child Life and Health, Edinburgh, United Kingdom
- * E-mail:
| | | | | | | | | | | | | | | | - Anthony J. Fulford
- MRC Unit The Gambia, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sophie E. Moore
- MRC Unit The Gambia, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Division of Women’s Health, King’s College London, London, United Kingdom
| | - Andrew M. Prentice
- MRC Unit The Gambia, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Assessment of the effectiveness of a small quantity lipid-based nutrient supplement on reducing anaemia and stunting in refugee populations in the Horn of Africa: Secondary data analysis. PLoS One 2017; 12:e0177556. [PMID: 28591166 PMCID: PMC5462343 DOI: 10.1371/journal.pone.0177556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/29/2017] [Indexed: 01/05/2023] Open
Abstract
Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and its partner organisations implement blanket supplementary feeding programmes using a range of special nutritional products as one approach to address these issues. The evidence base for the efficacy and effectiveness of a small quantity lipid-based nutrient supplement, Nutributter®, in reducing stunting and anaemia is limited. Secondary data analysis was used to assess the effectiveness of Nutributter® distribution on anaemia and stunting in children aged 6–23 months (programme target group) and 6–59 months (the standard age group sampled in routine nutrition surveys). Analysis was conducted using routine pre and post-intervention cross-sectional nutrition survey data collected between 2008–2011 in five refugee camps in Kenya and Djibouti. Changes in total anaemia (Haemoglobin<110g/L), anaemia categories (mild, moderate and severe), and stunting (height-for-age z-score <-2) were explored using available data on the Nutributter® programme and contextual factors. A significant reduction in the prevalence of anaemia in children aged 6–23 months and 6–59 months was seen in four of five, and in all five camps, respectively (p<0.05). Reductions ranged from 12.4 to 23.0, and 18.3 to 29.3 percentage points in each age group. Improvements were largely due to reductions in moderate and severe anaemia and occurred where the prevalence of acute malnutrition was stable or increasing. No change in stunting was observed in four of five camps. The replicability of findings across five sites strongly suggests that Nutributter® distribution was associated with a reduction in anaemia, but not stunting, among refugee children in the Horn of Africa. Benefits were not restricted to the 6–23 month target group targeted by the nutrition programme. However, even following this intervention anaemia remained a serious public health problem and additional work to define and evaluate an effective intervention package is warranted.
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Effect of 12-month intervention with lipid-based nutrient supplement on the physical activity of Malawian toddlers: a randomised, controlled trial. Br J Nutr 2017; 117:511-518. [PMID: 28382892 PMCID: PMC5426340 DOI: 10.1017/s0007114517000290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Physical activity is beneficial for children’s well-being. The effect of dietary
supplementation on children’s physical activity in food-insecure areas remains little
studied. We examined the effects of a lipid-based nutrient supplement (LNS) on children’s
objectively measured physical activity in a randomised, controlled,
outcome-assessor-blinded trial. Mothers of the children received one capsule daily of
Fe-folic acid (IFA), one capsule containing eighteen micronutrients (MMN) or one 20 g
sachet of LNS (containing twenty-two MMN, protein, carbohydrates, essential fatty acids
and 494 kJ (118 kcal)) during pregnancy and for 6 months thereafter. Children in the IFA
and MMN groups received no supplementation, and these groups were collapsed into a single
control group; children in the LNS group received 20 g LNS from 6 to 18 months. We
measured physical activity with accelerometers over 1 week at 18 months. The main outcome
was mean vector magnitude counts/15 s. Of the 728 children at the beginning of child
intervention at 6 months, 570 (78 %) provided sufficient data for analysis. The mean
accelerometer counts for the 190 children in the LNS group and for the 380 children in the
control group were 303 (sd 59) and 301 (sd 56), respectively (Pfor difference=0·65). LNS, given to mothers during pregnancy and 6 months
postpartum and to their infants from 6 to 18 months of age, did not increase physical
activity among 18-month-old children.
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Schlossman N, Brown C, Batra P, de Sa AB, Balan I, Balan A, Gamache MG, Wood L, Pruzensky W, Saltzman E, Roberts SB, Balé C. A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response. Food Nutr Bull 2017; 38:275-290. [PMID: 28374648 DOI: 10.1177/0379572117700754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries. OBJECTIVE We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods (RUSFs) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau. METHODS A 3-month cluster-randomized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants (6-23 months) and children (24-59 months) from 13 villages. The RUSFs contained either 478 (mothers, children) or 239 kcal/d (infants) with 15% or 33% of protein from dairy and were distributed at community health centers 5 d/wk. Controls were wait-listed to receive RUSF. Primary outcomes were mid-upper arm circumference (MUAC) in mothers, and weight-for-age and height-for-age z-scores (WAZ and HAZ) in infants and children. RESULTS There was a significant effect of the RUSF-33% on MUAC in mothers ( P = .03). The WAZ and HAZ increased substantially, by ≈1 z-score, in infants and children ( P < .01) independent of group randomization. In children, but not infants, baseline WAZ and change in maternal MUAC were associated with change in WAZ (β = .07, P = .02). CONCLUSION Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers, supporting a comparable recent finding in preschool children. In addition, supplementation of children <2 years resulted in improved growth independent of family nutritional status, whereas success in older children was associated with change in maternal nutrition, suggesting the need for community-level education about preventing malnutrition in older, as well as younger, children.
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Affiliation(s)
- Nina Schlossman
- 1 Global Food & Nutrition Inc, Washington, DC, USA.,2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Carrie Brown
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Payal Batra
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Augusto Braima de Sa
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Ionela Balan
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Adrian Balan
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Madeleine G Gamache
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Lauren Wood
- 1 Global Food & Nutrition Inc, Washington, DC, USA
| | - William Pruzensky
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Edward Saltzman
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Susan B Roberts
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Carlito Balé
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
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Dewey KG, Mridha MK, Matias SL, Arnold CD, Cummins JR, Khan MSA, Maalouf-Manasseh Z, Siddiqui Z, Ullah MB, Vosti SA. Lipid-based nutrient supplementation in the first 1000 d improves child growth in Bangladesh: a cluster-randomized effectiveness trial. Am J Clin Nutr 2017; 105:944-957. [PMID: 28275125 DOI: 10.3945/ajcn.116.147942] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/02/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Stunting in linear growth occurs mainly during the first 1000 d, from conception through 24 mo of age. Despite the recognition of this critical period, there have been few evaluations of the growth impact of interventions that cover most of this window.Objective: We evaluated home fortification approaches for preventing maternal and child undernutrition within a community-based health program. We hypothesized that small-quantity lipid-based nutrient supplements (LNSs) provided to women during pregnancy and the first 6 mo postpartum, LNSs provided to their offspring from 6 to 24 mo of age, or both would result in greater child length-for-age z score (LAZ) at 24 mo than iron and folic acid (IFA) provided to women during pregnancy and postpartum plus micronutrient powder (MNP) or no supplementation for their offspring from 6 to 24 mo.Design: We conducted a cluster-randomized effectiveness trial with 4 arms: 1) women and children both received LNSs (LNS-LNS group), 2) women received IFA and children received LNSs (IFA-LNS group), 3) women received IFA and children received MNP (IFA-MNP group), and 4) women received IFA and children received no supplements (IFA-Control group). We enrolled 4011 women at ≤20 wk of gestation within 64 clusters, each comprising the supervision area of a community health worker. Analyses were primarily performed by using ANCOVA F tests and Tukey-Kramer-corrected pairwise comparisons.Results: At 24 mo, the LNS-LNS group had significantly higher LAZ (+0.13 compared with the IFA-MNP group) and head circumference (+0.15 z score compared with the IFA-Control group); these outcomes did not differ between the other groups. Stunting prevalence (LAZ <-2) was lower in the LNS-LNS group at 18 mo than in the IFA-MNP group (OR: 0.70; 95% CI: 0.53, 0.92), but the difference diminished by 24 mo (OR: 0.81; 95% CI: 0.63, 1.04).Conclusion: Home fortification with small-quantity LNSs, but not MNP, during the first 1000 d improved child linear growth and head size in rural Bangladesh. This trial was registered at clinicaltrials.gov as NCT01715038.
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Affiliation(s)
| | - Malay K Mridha
- Departments of Nutrition and.,Nutrition and Clinical Science Division and
| | | | | | - Joseph R Cummins
- Department of Economics, University of California, Riverside, CA
| | - Md Showkat Ali Khan
- Initiative of Noncommunicable Disease, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh; and
| | | | | | | | - Stephen A Vosti
- Agricultural and Resource Economics, University of California, Davis, CA
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Lipid-based Nutrient Supplements Do Not Affect Gut Bifidobacterium Microbiota in Malawian Infants: A Randomized Trial. J Pediatr Gastroenterol Nutr 2017; 64:610-615. [PMID: 27403608 DOI: 10.1097/mpg.0000000000001333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of the study was to assess the effect of nutritional supplementation with lipid-based nutrient supplements (LNS) and corn-soy blend flour on Bifidobacterium and Staphylococcus aureus gut microbiota composition in Malawian infants. In addition, the microbiota changes over time were characterized in the study infants. METHODS Healthy 6-month-old Malawian infants were randomly assigned to 1 of 4 intervention schemes for a 6-month period. Infants in the control group were not provided with any supplementary food. Infants in other 3 groups received either micronutrient-fortified corn-soy blend, micronutrient-fortified LNS with milk protein base, or micronutrient-fortified LNS with soy protein base between 6 and 12 months of age. Fecal bifidobacteria and S aureus gut microbiota at 6 and 12 months of age were analyzed by quantitative real-time polymerase chain reaction method. RESULTS There was no difference in change in bacterial prevalence or counts between the intervention groups during the 6-month study period. When looking at the total study population, higher counts of total bacteria (P = 0.028), Bifidobacterium genus (P = 0.027), B catenulatum (P = 0.031), and lower counts of B infantis (P < 0.001), B lactis (P < 0.001), B longum (P < 0.001), and S aureus (P < 0.001) were detected in the children's stools at 12 months rather than at 6 months of age. CONCLUSIONS The dietary supplementation did not have an effect on the Bifidobacterium and S aureus microbiota composition of the study infants. The fecal bifidobacterial diversity of the infants, however, changed toward a more adult-like microbiota profile within the observed time.
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Provision of preventive lipid-based nutrient supplements given with complementary foods to infants and young children 6 to 23 months of age for health, nutrition, and developmental outcomes. Hippokratia 2017. [DOI: 10.1002/14651858.cd012611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
The prevalence of stunting remains high in low- and middle-income countries despite adoption of comprehensive nutrition interventions, particularly in low-income countries. In the present paper, we review current evidence on the acceptability and efficacy of small-quantity lipid-based nutrient supplements (SQ-LNS) on preventing stunting in children under 2 years, discuss the factors that affect their efficacy, highlight the implications of the current findings at pragmatic level and identify research priorities. Although the present paper is not a generic systematic review, we used a systematic approach to select relevant literature. The review showed that there is growing interest in the potential benefits of using SQ-LNS to prevent growth faltering. Acceptability studies showed that SQ-LNS are generally well accepted. However, results on the efficacy of SQ-LNS on improving linear growth or preventing growth faltering in infants and young children are still inconclusive. Factors that may affect efficacy include the duration of the trial, composition and dosage of SQ-LNS given, and baseline demographics and nutritional status of research participants. Future research should focus on controlled and long-term follow-up trials to obtain more conclusive results. In the long term, there will be need for studies to investigate how provision of SQ-LNS can be integrated with existing strategies to prevent stunting in low- and middle-income settings.
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Arimond M, Abbeddou S, Kumwenda C, Okronipa H, Hemsworth J, Jimenez EY, Ocansey E, Lartey A, Ashorn U, Adu-Afarwuah S, Vosti SA, Hess SY, Dewey KG. Impact of small quantity lipid-based nutrient supplements on infant and young child feeding practices at 18 months of age: results from four randomized controlled trials in Africa. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27910260 PMCID: PMC5516197 DOI: 10.1111/mcn.12377] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/24/2016] [Accepted: 08/10/2016] [Indexed: 01/19/2023]
Abstract
Optimal infant and young child feeding (IYCF) practices can help ensure nutrient adequacy and support healthy growth and development. Small‐quantity lipid‐based nutrient supplements (SQ‐LNS) have been proposed to help fill nutrient gaps, but little is known about the impact of provision of SQ‐LNS on breastfeeding or complementary feeding practices. In the context of four coordinated randomized controlled nutrient supplementation trials in diverse sites in Africa, we compared IYCF practices at infant age 18 months (after 9–12 months of supplementation) between those receiving and not receiving SQ‐LNS. Practices were assessed by caregiver recall. Continued breastfeeding ranged from 74% (Ghana site) to 97% (Burkina Faso site) and did not differ between groups in any site; prevalence of frequent breastfeeding also did not differ. In two sites (Burkina Faso and Malawi), infants receiving SQ‐LNS were more likely to meet the World Health Organization recommendations for frequency of feeding (percentage point differences of 12–14%, P < 0.0001 and P = 0.005, respectively; the remaining two sites did not have data for this indicator). Most indicators of infant dietary diversity did not differ between groups in any site, but in the same two sites where frequency of feeding differed, infants receiving SQ‐LNS were less likely to have low frequency of consumption of animal‐source foods in the previous week (percentage point differences of 9–19% for lowest tertile, P = .02 and P = 0.04, respectively). We conclude that provision of SQ‐LNS did not negatively impact self‐reported IYCF practices and may have positively impacted frequency of feeding.
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Affiliation(s)
- Mary Arimond
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Souheila Abbeddou
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Chiza Kumwenda
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
| | - Harriet Okronipa
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Jaimie Hemsworth
- Nutrition Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Yakes Jimenez
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA.,Center for Education Policy Research, University of New Mexico, Albuquerque, New Mexico, USA.,Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Eugenia Ocansey
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Ulla Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California Davis, Davis, California, USA
| | - Sonja Y Hess
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California Davis, Davis, California, USA
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63
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Hotz C, Pelto G, Armar-Klemesu M, Ferguson EF, Chege P, Musinguzi E. Constraints and opportunities for implementing nutrition-specific, agricultural and market-based approaches to improve nutrient intake adequacy among infants and young children in two regions of rural Kenya. MATERNAL AND CHILD NUTRITION 2016; 11 Suppl 3:39-54. [PMID: 26778801 PMCID: PMC5066664 DOI: 10.1111/mcn.12245] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/16/2015] [Accepted: 10/13/2015] [Indexed: 01/23/2023]
Abstract
Several types of interventions can be used to improve nutrient intake adequacy in infant and young child (IYC) diets, including fortified foods, home fortification, nutrition education and behaviour change communication (BCC) in addition to agricultural and market‐based strategies. However, the appropriate selection of interventions depends on the social, cultural, physical and economic context of the population. Derived from two rural Kenyan populations, this analysis combined information from: (1) a quantitative analysis to derive a set of food‐based recommendations (FBRs) to fill nutrient intake gaps in IYC diets and identify ‘problem nutrients’ for which intake gaps require solutions beyond currently available foods and dietary patterns, and (2) an ethnographic qualitative analysis to identify contextual factors posing opportunities or constraints to implementing the FBRs, including perceptions of cost, convenience, accessibility and appropriateness of the recommended foods for IYC diets and other social or physical factors that determine accessibility of those foods. Opportunities identified included BCC to increase the acceptability and utilisation of green leafy vegetables (GLV) and small fish and agronomic interventions to increase the productivity of GLV and millet. Value chains for millet, beans, GLV, milk and small fish should be studied for opportunities to increase their accessibility in local markets. Processor‐level interventions, such as partially cooked fortified dry porridge mixes or unfortified cereal mixes incorporating millet and beans, may increase the accessibility of foods that provide increased amounts of the problem nutrients. Multi‐sectoral actors and community stakeholders should be engaged to assess the feasibility of implementing these locally appropriate strategies.
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Affiliation(s)
| | - Gretel Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | | | | | | | - Enock Musinguzi
- Global Alliance for Improved Nutrition (GAIN), Naroibi, Kenya
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64
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Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Peerson JM, Arimond M, Ashorn U, Zeilani M, Vosti S, Dewey KG. Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial. Am J Clin Nutr 2016; 104:797-808. [PMID: 27534634 PMCID: PMC4997301 DOI: 10.3945/ajcn.116.134692] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/07/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life. OBJECTIVE We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age. DESIGN In this partially double-blind, individually randomized trial, 1320 women at ≤20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age. RESULTS At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for-age z score (LAZ) were 79.3 cm and -0.83, respectively, and 12% of the children were stunted (LAZ <-2). In analysis based on the intended treatment, mean ± SD length and LAZ for the LNS group (79.7 ± 2.9 cm and -0.69 ± 1.01, respectively) were significantly greater than for the IFA (79.1 ± 2.9 cm and -0.87 ± 0.99) and MMN (79.1 ± 2.9 cm and -0.91 ± 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045). CONCLUSION Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child's attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.
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Affiliation(s)
- Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana;
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Harriet Okronipa
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Per Ashorn
- Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Janet M Peerson
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Mary Arimond
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Ulla Ashorn
- Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | | | - Stephen Vosti
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and
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65
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Klevor MK, Adu-Afarwuah S, Ashorn P, Arimond M, Dewey KG, Lartey A, Maleta K, Phiri N, Pyykkö J, Zeilani M, Ashorn U. A mixed method study exploring adherence to and acceptability of small quantity lipid-based nutrient supplements (SQ-LNS) among pregnant and lactating women in Ghana and Malawi. BMC Pregnancy Childbirth 2016; 16:253. [PMID: 27577112 PMCID: PMC5004276 DOI: 10.1186/s12884-016-1039-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/11/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements (SQ-LNS) has resulted in improvements in birth outcomes in some low-income settings. In order to be effective, SQ-LNS must be consumed regularly over sustained periods. METHODS The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation. We enrolled women before 20 gestation weeks into randomized trials in Ghana (n = 1320) and Malawi (n = 869). In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation. In the control groups participants received multiple micronutrients (MMN) during pregnancy and lactation or iron and folic acid (IFA) during pregnancy and calcium during lactation. We used questionnaires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability. RESULTS The mean self-reported adherence during the supplementation period was lower in Ghana (79.9 %) than in Malawi (91.7 %) for all supplements (difference 11.8 %, P < 0.001). Over time, adherence increased in Malawi but decreased in Ghana. In both countries, adherence in the SQ-LNS group was non-inferior to that in the control groups. Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences, most of the women described incidents of non-adherence. A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy. Especially in Malawi, women reported sharing SQ-LNS with families and friends. Sustained use of SQ-LNS was attributed to expected health benefits and favorable sensory attributes. Often women compared their pregnancy to previous ones, and were of the view that SQ-LNS made a positive difference. CONCLUSION Self-reported sustained adherence to consume SQ-LNS daily was high in both sites but lower in Ghana than in Malawi. In Ghana, adherence decreased over time whereas in Malawi adherence increased. Acceptability and adherence appeared interlinked, complex and context-related. Sustained consumption of SQ-LNS may require tailoring interventions by context. TRIAL REGISTRATION The Ghana trial was registered at clinicaltrials.gov as NCT00970866 , and the Malawi trial as NCT01239693 .
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Affiliation(s)
- Moses K. Klevor
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA USA
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Per Ashorn
- Center for Child Health Research and Department of Paediatrics, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Mary Arimond
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA USA
| | - Kathryn G. Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Nozgechi Phiri
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Juha Pyykkö
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
| | | | - Ulla Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
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66
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Prado EL, Abbeddou S, Adu-Afarwuah S, Arimond M, Ashorn P, Ashorn U, Brown KH, Hess SY, Lartey A, Maleta K, Ocansey E, Ouédraogo JB, Phuka J, Somé JW, Vosti SA, Yakes Jimenez E, Dewey KG. Linear Growth and Child Development in Burkina Faso, Ghana, and Malawi. Pediatrics 2016; 138:peds.2015-4698. [PMID: 27474016 DOI: 10.1542/peds.2015-4698] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We aimed to produce quantitative estimates of the associations between 4 domains of child development and linear growth during 3 periods: before birth, early infancy, and later infancy. We also aimed to determine whether several factors attenuated these associations. METHODS In 3700 children in Burkina Faso, Ghana, and Malawi, growth was measured several times from birth to age 18 months. At 18 months, language, motor, socioemotional, and executive function development were assessed. In Burkina Faso (n = 1111), personal-social development was assessed rather than the latter 2 domains. RESULTS Linear growth was significantly associated with language, motor, and personal-social development but not socioemotional development or executive function. For language, the pooled adjusted estimate of the association with length-for-age z score (LAZ) at 6 months was 0.13 ± 0.02 SD, and with ΔLAZ from 6 to 18 months it was 0.11 ± 0.03 SD. For motor, these estimates were 0.16 ± 0.02 SD and 0.22 ± 0.03 SD, respectively. In 1412 children measured at birth, estimates of the association with LAZ at birth were similar (0.07-0.16 SD for language and 0.09-0.18 SD for motor development). These associations were weaker or absent in certain subsets of children with high levels of developmental stimulation or mothers who received nutritional supplementation. CONCLUSIONS Growth faltering during any period from before birth to 18 months is associated with poor development of language and motor skills. Interventions to provide developmental stimulation or maternal supplementation may protect children who are faltering in growth from poor language and motor development.
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Affiliation(s)
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | | | - Per Ashorn
- Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Kenneth H Brown
- Departments of Nutrition, and Bill & Melinda Gates Foundation, Seattle, Washington
| | | | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Eugenia Ocansey
- Departments of Nutrition, and Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé/DRO, Bobo-Dioulasso, Burkina Faso; and
| | - John Phuka
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Steve A Vosti
- Agricultural and Resource Economics, University of California Davis, Davis, California
| | - Elizabeth Yakes Jimenez
- Departments of Individual, Family, and Community Education and Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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67
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Prado EL, Phuka J, Maleta K, Ashorn P, Ashorn U, Vosti SA, Dewey KG. Provision of Lipid-Based Nutrient Supplements from Age 6 to 18 Months Does Not Affect Infant Development Scores in a Randomized Trial in Malawi. Matern Child Health J 2016; 20:2199-208. [DOI: 10.1007/s10995-016-2061-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Elizabeth L Prado
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, 3253 Meyer Hall, One Shields Ave, Davis, CA, 95616, USA.
| | - John Phuka
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland.,Department of Paediatrics, University of Tampere School of Medicine, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
| | - Steve A Vosti
- Department of Agricultural and Resource Economics, University of California Davis, Davis, CA, USA
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, 3253 Meyer Hall, One Shields Ave, Davis, CA, 95616, USA
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68
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The effect of providing lipid-based nutrient supplements on morbidity in rural Malawian infants and young children: a randomized controlled trial. Public Health Nutr 2016; 19:1893-903. [DOI: 10.1017/s1368980016000331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveSafety of home fortificants in children is uncertain in areas where infections are common. We tested the hypothesis that provision of lipid-based nutrient supplements (LNS) containing Fe does not increase infectious morbidity in children.DesignRandomized controlled trial. Infants were randomised to receive 10, 20 or 40 g LNS/d; or no supplement until age 18 months. All LNS contained 6 mg Fe/d. Morbidity outcomes (serious adverse events, non-scheduled visits and guardian-reported morbidity episodes) were compared between control and intervention groups using a non-inferiority margin of 20 %.SettingNamwera and Mangochi catchment areas in rural Malawi.SubjectsInfants aged 6 months (n1932).ResultsThe enrolled 1932 infants contributed 1306 child-years of follow-up. Baseline characteristics were similar across groups. Compared with the control group, the relative risk (95 % CI) of serious adverse events was 0·71 (0·48, 1·07), 0·67 (0·48, 0·95) and 0·91 (0·66, 1·25) in 10, 20 and 40 g LNS/d groups, respectively. The incidence rate ratio (95 % CI) of non-scheduled visits due to malaria was 1·10 (0·88, 1·37), 1·08 (0·89, 1·31) and 1·21 (1·00, 1·46), and of guardian-reported morbidity episodes was 1·04 (0·96, 1·11), 1·03 (0·97, 1·10) and 1·04 (0·97, 1·10), in the respective LNS groups.ConclusionsProvision of 10 and 20 g LNS/d containing 6 mg Fe/d did not increase morbidity in the children. Provision of 40 g LNS/d did not affect guardian-reported illness episodes but may have increased malaria-related non-scheduled visits.
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69
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Hemsworth J, Kumwenda C, Arimond M, Maleta K, Phuka J, Rehman AM, Vosti SA, Ashorn U, Filteau S, Dewey KG, Ashorn P, Ferguson EL. Lipid-Based Nutrient Supplements Increase Energy and Macronutrient Intakes from Complementary Food among Malawian Infants. J Nutr 2016; 146:326-34. [PMID: 26740684 DOI: 10.3945/jn.115.215327] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/30/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low intakes of good-quality complementary foods (CFs) contribute to undernutrition and consequently negatively affect health, growth, and development. Lipid-based nutrient supplements (LNSs) are designed to ensure dietary adequacy in micronutrients and essential fatty acids and to provide some energy and high-quality protein. In populations in which acute energy deficiency is rare, the dose-dependent effect of LNSs on CF intakes is unknown. OBJECTIVE The objective of this study was to evaluate the difference in energy and macronutrient intakes from CF between a control (no supplement) group and 3 groups that received 10, 20, or 40 g LNS/d. METHODS We collected repeated interactive 24-h dietary recalls from caregivers of rural Malawian 9- to 10-mo-old infants (n = 748) to estimate dietary intakes (LNS and all non-breast-milk foods) of energy and macronutrients and their dietary patterns. All infants were participating in a 12-mo randomized controlled trial to investigate the efficacy of various doses of LNS for preventing undernutrition. RESULTS Dietary energy intakes were significantly higher among infants in the LNS intervention groups than in the control group (396, 406, and 388 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d; each pairwise P < 0.05), but no significant differences were found in energy intakes between groups who were administered the different LNS doses (10 g LNS/d compared with 20 g LNS/d: P = 0.72; 10 g LNS/d compared with 40 g LNS/d: P ≥ 0.67; 20 g LNS/d compared with 40 g LNS/d: P = 0.94). Intakes of protein and fat were significantly higher in the LNS intervention groups than in the control group. No significant intergroup differences were found in median intakes of energy from non-LNS CFs (357, 347, and 296 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d in the control group; P = 0.11). CONCLUSION LNSs in doses of 10-40 g/d increase intakes of energy and macronutrients among 9- to 10-mo-old Malawian infants, without displacing locally available CFs. This trial was registered at clinicaltrials.gov as NCT00945698.
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Affiliation(s)
| | - Chiza Kumwenda
- Department for International Health, School of Medicine, and
| | - Mary Arimond
- Program in International and Community Nutrition, and
| | - Kenneth Maleta
- College of Medicine, University of Blantyre, Blantyre, Malawi
| | - John Phuka
- College of Medicine, University of Blantyre, Blantyre, Malawi
| | - Andrea M Rehman
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, CA; and
| | - Ulla Ashorn
- Department for International Health, School of Medicine, and
| | | | | | - Per Ashorn
- Department for International Health, School of Medicine, and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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