Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement123

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ABSTRACT

Background:

Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas. Stunting affects 1 in 5 young children.

Objective:

We aimed to test the efficacy of a daily lipid-based nutrient supplement (LNS) for increased linear growth in young children.

Design:

Healthy, singleton infants aged 6–11 mo (n = 589) were recruited from an urban slum of Cap Haitien and randomly assigned to receive: 1) a control; 2) a 3-mo LNS; or 3) a 6-mo LNS. The LNS provided 108 kcal and other nutrients including vitamin A, vitamin B-12, iron, and zinc at ≥80% of the recommended amounts. Infants were followed monthly on growth, morbidity, and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects. The Bonferroni multiple comparisons test was applied, and generalized least-squares (GLS) regressions with mixed effects was used to examine impacts longitudinally.

Results:

Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group. GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score (±SE) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age (P < 0.001). The effects were sustained 6 mo postintervention. Morbidity and developmental outcomes did not differ by trial arm.

Conclusion:

A low-energy, fortified product improved the linear growth of young children in this urban setting. The trial was registered at clinicaltrials.gov as NCT01552512.

Cited by (0)

1

From the Institute for Public Health, George Warren Brown School of Social Work, Washington University, St Louis, MO (LLI, SJLD, JG, SJ, JF, M-LA, CL, and JM); the Notre Dame de la Sagesse Nursing School, Cap-Haïtien, Haiti (SJLD and SJ); Konbit Sante, Portland, ME (NMN); and Konbit Sante, Cap-Haïtien, Haiti (NMN).

2

Supported by the Bill & Melinda Gates Foundation to FHI 360 through the Alive & Thrive Small Grants Program managed by University of California Davis; The Inter-American Development Bank; The World Bank; and The United Nations World Food Program.

3

Address correspondence to L Iannotti, Washington University, Campus Box 1196, One Brookings Drive, St Louis, MO 63130-4899. E-mail: [email protected].

4

Abbreviations used: FSM, Fort Saint Michel; GLS, generalized least squares; IP, integrated package; IYCF, infant and young-child feeding; LAZ, length-for-age z score; LNS, lipid-based nutrient supplement; MSPP, Ministry of Public Health and Population; RUSF, ready-to-use supplemental food; RUTF, ready-to-use therapeutic food; SAM, severe acute malnutrition; WAZ, weight-for-age z score; WLZ, weight-for-length z score.