A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose-response effect in improving linear growth: a 12-month cluster randomised trial

Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial

Stunting is reportedly associated with low circulating levels of essential amino acids (EAAs). This study examined the effect of a macronutrient- and micronutrient-fortified complementary food supplement (KOKO Plus) on specific plasma EAA levels and stunting in infants aged 6-18 months. In a single-blind cluster-randomized controlled trial conducted in Ghana, infants were enrolled at 6 months and followed until 18 months. Thirty-eight communities were randomly assigned to receive KOKO Plus (KP, fourteen communities, n = 321), multiple-micronutrient powder (MN, thirteen communities, n = 327), or only nutritional education as control group (NE, eleven communities, n = 318), and all groups received nutrition education. Plasma amino acids (AAs) were measured at 6, 12, and 18 months (end point). Mixed-effects models were used to assess the effect of the intervention on plasma AAs, and the relationship between plasma branched-chain AAs (BCAAs) and the risk of stunting was assessed. At the end point, total BCAA concentrations (±standard error) significantly exceeded baseline in the KP (284.2 ± 4.3 μM) and NE (289.1 ± 4.4 μM) groups but not the MN group (264.4 ± 4.1 μM). After adjustment for compliance at 200 sachets, plasma BCAAs exceeded in the KP group (284.5 ± 4.2 μM) compared to the MN group (264.6 ± 4 μM). Plasma BCAAs were positively correlated with changes in length-for-age Z-score from baseline (R = 0.327, p = 0.048). In conclusion, the plasma BCAA concentrations of infants that received KP and the NE group was significantly higher compared to the MN group but there were no differences between the KP and NE group at end point. Improved plasma BCAAs may be due to improved nutrient intake by infants exposed to KP or NE. Low BCAAs were associated with stunting, replicating the previous finding. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03181178?term=NCT03181178&draw=2&rank=1, identifier: NCT03181178.

Micronutrient Supplementation and Fortification Interventions on Health and Development Outcomes among Children Under-Five in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Micronutrient deficiencies continue to be widespread among children under-five in low- and middle-income countries (LMICs), despite the fact that several effective strategies now exist to prevent them. This kind of malnutrition can have several immediate and long-term consequences, including stunted growth, a higher risk of acquiring infections, and poor development outcomes, all of which may lead to a child not achieving his or her full potential. This review systematically synthesizes the available evidence on the strategies used to prevent micronutrient malnutrition among children under-five in LMICs, including single and multiple micronutrient (MMN) supplementation, lipid-based nutrient supplementation (LNS), targeted and large-scale fortification, and point-of-use-fortification with micronutrient powders (MNPs). We searched relevant databases and grey literature, retrieving 35,924 papers. After application of eligibility criteria, we included 197 unique studies. Of note, we examined the efficacy and effectiveness of interventions. We found that certain outcomes, such as anemia, responded to several intervention types. The risk of anemia was reduced with iron alone, iron-folic acid, MMN supplementation, MNPs, targeted fortification, and large-scale fortification. Stunting and underweight, however, were improved only among children who were provided with LNS, though MMN supplementation also slightly increased length-for-age z-scores. Vitamin A supplementation likely reduced all-cause mortality, while zinc supplementation decreased the incidence of diarrhea. Importantly, many effects of LNS and MNPs held when pooling data from effectiveness studies. Taken together, this evidence further supports the importance of these strategies for reducing the burden of micronutrient malnutrition in children. Population and context should be considered when selecting one or more appropriate interventions for programming.