Small-quantity lipid-based nutrient supplements (SQ-LNS) are promising home fortification products, but the optimal zinc level needed to improve growth and reduce morbidity is uncertain. We aimed to assess the impact of providing SQ-LNS with varied amounts of zinc, along with illness treatment, on zinc-related outcomes compared with standard care. In a placebo-controlled, cluster-randomized trial, 34 communities were stratified to intervention (IC) or non-intervention cohorts (NIC). 2435 eligible IC children were randomly assigned to one of four groups:1) SQ-LNS without zinc, placebo tablet; 2) SQ-LNS containing 5mg zinc, placebo tablet; 3) SQ-LNS containing 10mg zinc, placebo tablet; or 4) SQ-LNS without zinc and 5mg zinc tablet from 9–18 months of age. During weekly morbidity surveillance, oral rehydration salts were provided for reported diarrhea and antimalarial therapy for confirmed malaria. Children in NIC (n = 785) did not receive SQ-LNS, tablets, illness surveillance or treatment. At 9 and 18 months, length, weight and hemoglobin were measured in all children. Reported adherence was 97±6% for SQ-LNS and tablets. Mean baseline hemoglobin was 89±15g/L. At 18 months, change in hemoglobin was greater in IC than NIC (+8 vs -1g/L, p<0.0001), but 79.1% of IC were still anemic (vs. 91.1% in NIC). Final plasma zinc concentration did not differ by group. During the 9-month observation period, the incidence of diarrhea was 1.10±1.03 and of malaria 0.54±0.50 episodes per 100 child-days, and did not differ by group. Length at 18 months was significantly greater in IC compared to NIC (77.7±3.0 vs. 76.9±3.4cm; p<0.001) and stunting prevalence was significantly lower in IC (29.3%) than NIC (39.3%; p<0.0001), but did not differ by intervention group within IC. Wasting prevalence was also significantly lower in IC (8.7%) than in NIC (13.5%; p = 0.0003). Providing SQ-LNS daily with or without zinc, along with malaria and diarrhea treatment, significantly increased growth and reduced stunting, wasting and anemia prevalence in young children.Trial RegistrationClinicalTrials.gov NCT00944281

BackgroundPrevious reviews have identified 44 risk factors for poor early child development (ECD) in low‐ and middle‐income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.MethodsWe conducted path analyses of factors associated with 18‐month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid‐Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.ResultsOut of 42 indicators of the 34 factors examined, 6 were associated with 18‐month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.ConclusionsKey elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status.

The study tested the hypothesis that certain underused forages and agro-industrial byproducts available in dry areas may positively influence fatty acid (FA) composition and antioxidative properties of milk by their contents of residual oil or phenolic compounds or both. Sixty multiparous fat-tailed Awassi ewes were allocated to 6 groups in a completely randomized block design. During 50 d, the ewes were group-fed 2.5 kg of dry matter/d per ewe 1 of 6 isonitrogenous and isoenergetic diets (forage:concentrate, 0.3:0.7). The test feeds, comprising 30% of the diets, replaced either barley straw [lentil straw, olive leaves, and Atriplex (saltbush) leaves, rich in phenolic compounds or electrolytes] or conventional concentrate ingredients (olive cake and tomato pomace; ∼10% lipids) from the control diet. The diets containing olive cake and tomato pomace were rich in oleic acid (18:1 cis-9; 27% of total dietary FA) and linoleic acid (18:2 cis-9,cis-12; 37%), respectively. Profiles of FA were determined in individual milk samples drawn on d 0 and in wk 1, 3, 5 and 7. Data was analyzed by repeated measurement analysis. No consistent treatment effects on yield and gross nutrient composition of the milk were observed, although some differences occurred. Milk resulting from the Atriplex leaf diet expressed the highest antiradical activity, which was low with control and olive leaves. Feeding the tomato pomace and olive cake diets decreased the proportions of short- and medium-chain FA, whereas oleic acid clearly increased in proportion to total FA. Olive leaves most effectively increased rumenic acid (18:2 cis-9,trans-11) and α-linolenic acid (18:3 cis-9,cis-12,cis-15) in milk fat. This also resulted in the highest α-linolenic acid transfer rate from feed to milk and suggests that olive leaves affect ruminal biohydrogenation at several steps. Several alternative feeds exist with an added value, as they enhance FA with potential health benefits and the stability of the milk with higher antioxidative activity, even though responses to test feeds differed largely. It remains to be investigated whether combinations of these feeds would be complementary in these beneficial effects.

Adherence to supplementation provided during an intervention trial can affect interpretation of study outcomes. We compared different approaches for estimating adherence to small-quantity lipid-based nutrient supplements (SQ-LNS) and dispersible tablets in a randomised clinical trial in Burkina Faso. A total of 2435 children (9-18 months) were randomly assigned to receive daily 20 g SQ-LNS with varying contents of zinc and a dispersible tablet containing 0 or 5 mg zinc. Adherence to SQ-LNS and tablets was assessed for all children through weekly caregiver interviews, and disappearance rate was calculated based on empty and unused packages returned during home visits. Additional adherence data were collected in different randomly selected subgroups of children: 12-h home observations were completed for children 11 and 16 months of age (n = 192) to assess consumption of SQ-LNS and dispersible tablets, and plasma zinc concentration was measured at baseline and 18 months (n = 310). Apparent adherence to SQ-LNS and dispersible tablets differed according to the assessment method used. Average daily caregiver-reported adherence to both SQ-LNS and dispersible tablets was 97 ± 6%. Disappearance rates showed similarly high average weekly adherence (98 ± 4%). In contrast, only 63% and 54% of children at 11 and 16 months, respectively, received SQ-LNS during the 12-h home observation periods, and fewer (32% and 27%) received a tablet. The lack of change in plasma zinc concentration after 9 months of supplementation suggests low adherence to the zinc tablet. Better methods are needed to assess adherence in community-based supplementation trials.