Elsevier

The Journal of Nutrition

Volume 145, Issue 8, August 2015, Pages 1909-1915
The Journal of Nutrition

Provision of 10–40 g/d Lipid-Based Nutrient Supplements from 6 to 18 Months of Age Does Not Prevent Linear Growth Faltering in Malawi1, 2, 3

https://doi.org/10.3945/jn.114.208181Get rights and content
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ABSTRACT

Background: Complementing infant diets with lipid-based nutrient supplements (LNSs) has been suggested to improve growth and reduce morbidity, but the daily quantity and the milk content of LNSs affect their cost.

Objective: We tested the hypotheses that the change in mean length-for-age z score (LAZ) for infants provided with 10–40 g LNSs/d from ages 6 to 18 mo would be greater than that for infants receiving no dietary intervention at the same age and that provision of LNSs that did not contain milk would be as good as milk-containing LNSs in promoting linear growth.

Methods: We enrolled in a randomized single-blind trial 6-mo-old infants who were allocated to 1 of 6 groups to receive 10, 20, or 40 g LNSs/d containing milk powder; 20 or 40 g milk-free LNSs/d; or no supplement until 18 mo of age. The primary outcome was change in LAZ.

Results: Of the 1932 enrolled infants, 78 (4.0%) died and 319 (16.5%) dropped out during the trial. The overall reported supplement consumption was 71.6% of days, with no difference between the groups (P = 0.26). The overall mean ± SD length and LAZ changes were 13.0 ± 2.1 cm and −0.45 ± 0.77 z score units, respectively, which did not differ between the groups (P = 0.66 for length and P = 0.74 for LAZ). The difference in mean LAZ change in the no-milk LNS group compared with the milk LNS group was −0.02 (95% CI: −0.10, 0.06; P = 0.72).

Conclusion: Our results do not support the hypothesis that LNS supplementation during infancy and childhood promotes length gain or prevents stunting between 6 and 18 mo of age in Malawi. This trial was registered at clinicaltrials.gov as NCT00945698.

KEYWORDS

LNS
infants
stunting
efficacy
randomized controlled trial
sub-Saharan Africa

Abbreviations

CSB
corn-soy blend
LAZ
length-for-age z score
LNS
lipid-based nutrient supplement
MUAC
mid-upper arm circumference
SAE
serious adverse event
WAZ
weight-for-age z score
WLZ
weight-for-length z score

Cited by (0)

1

Supported by a grant to the University of California, Davis, from the Bill & Melinda Gates Foundation.

2

Author disclosures: KM Maleta, J Phuka, L Alho, YB Cheung, KG Dewey, U Ashorn, N Phiri, TE Phiri, SA Vosti, C Kumwenda, J Bendabenda, A Pulakka, and P Ashorn, no conflicts of interest. M Zeilani works as a director of research for Nutriset S.A.S., a company that produces and sells lipid-based nutrient supplements and that also prepared the lipid-based nutrient supplements purchased for the current trial. The findings and conclusions contained within the article are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

3

Data collection and analysis, decision to publish, or preparation of the manuscript. 3 Supplemental Tables 1-3 are available from the "Online Supporting Material" link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org.