Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings123

https://doi.org/10.3945/ajcn.112.041962Get rights and content
Under an Elsevier user license
open archive

Background: Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested.

Objective: The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal.

Design: This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion.

Results: A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-for-age z score (LAZ) <−2.0] rates increased from ∼33% to nearly 50%. Years of maternal education and maternal height were positively associated with linear growth velocity (P = 0.0006 and 0.003, respectively); LAZ at 6 mo was negatively associated (P < 0.0001). Anemia rates did not differ by group; iron deficiency was significantly lower in the cereal group.

Conclusion: The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods. This trial was registered at http://clinicaltrials.gov as NCT01084109.

Abbreviations:

GN
Global Network for Women’s and Children’s Health Research
LAZ
length-for-age z score
SES
socioeconomic status
WLZ
weight-for-length z score

Cited by (0)

1

Fromthe Department of Pediatrics, Section of Nutrition, University of Colorado Denver, Aurora, CO (NFK, KMH, and JW); Institute for Nutrition of Central America and Panama/Foundation for Food and Nutrition of Central America and Panama (INCAP/FANCAP), Guatemala City, Guatemala (MM and AG); the University Teaching Hospital, Lusaka, Zambia (EC, AM, and EI); Aga Khan University, Karachi, Pakistan (NS and OP); the Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (AT and AL); the University of Alabama, Birmingham, AL (WAC); Drexel University College of Medicine, Philadelphia, PA (RLG); the University of North Carolina, Chapel Hill, NC (CLB); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville,MD (LLWand MK-T); and RTI International, Research Triangle Park, NC (NG, EMM, MK, and TDH).

2

Supported by grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development [HD040657 (UCD), HD043464 (UAB), HD040607 (Drexel), HD043475 (UNC), HD040636 (RTI)], Office of Dietary Supplements, and National Institute of Diabetes and Digestive and Kidney Diseases 9K24 DK083772. The National Cattlemen’s Beef Association partially supported the analyses of the biomarkers for this project and had no input into the study design, implementation, analysis, or interpretation of the data.

3

Address correspondence to NF Krebs, 12700 East 19th Avenue, Box C225, University of Colorado Denver, Aurora, CO 80045. E-mail: [email protected].