A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response

Schlossman, Nina; Brown, Carrie; Batra, Payal; Sa, Augusto Braima de; Balan, Ionela; Balan, Adrian; Gamache, Madeleine G; Wood, Lauren V.; Pruzensky, William; Saltzman, Edward; Roberts, Susan B.; Balé, Carlitos

doi:10.1177/0379572117700754

Cited by 16 publications

(20 citation statements)

References 19 publications

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“…The authors speculated that 14 days of supplementation was not long enough to reduce incidence of SAM. The other study that saw no benefit from a food intervention, compared with no intervention, was conducted by Schlossman et al in Guinea Bissau using “at risk” infants and children (Schlossman et al, ). This was defined as children aged 6–59 months with either WHZ < 2 or WAZ < 1 or HAZ < 2.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of the treatment of moderate acute malnutrition using food products

Lelijveld

Beedle

Farhikhtah

et al. 2019

Maternal & Child Nutrition

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There is currently a lack of international guidance on the most appropriate treatment for moderate acute malnutrition (MAM), and discrepancies in national treatment guidelines exist. We aimed to explore whether food interventions are effective for MAM children 6-59 months old and whether they result in better outcomes compared with no treatment or management with nutrition counselling. A systematic literature search was conducted in October 2018, identifying studies that compared treating MAM children with food products versus management with counselling or no intervention. A total of 673 abstracts were screened, 101 full texts were read, and one study was identified that met our inclusion criteria. After broadening the criteria to include micronutrients in the control group and enrolment based on outdated anthropometric criteria, 11 studies were identified for inclusion. Seven of these found food products to be superior for anthropometric outcomes compared with counselling and/or micronutrient supplementation; two of the studies found no significant benefit of a food product intervention; and two studies were inconclusive.Hence, the majority of studies in this review found that food products resulted in greater anthropometric gains than counselling or micronutrient interventions. This was especially true if the supplementary food provided was of suitable quality and provided for an adequate duration. Improving quality of and adherence to counselling may improve its effectiveness, particularly in food secure contexts. There is currently a paucity of comparable studies on this topic as well as a lack of studies that include important functional outcomes beyond anthropometric proxies.

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Section: Resultsmentioning

confidence: 99%

Systematic review of the treatment of moderate acute malnutrition using food products

Lelijveld

Beedle

Farhikhtah

et al. 2019

Maternal & Child Nutrition

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“…Regardless of the relative importance of the underlying mechanisms, improving nutritional status of pregnant women could be an important intervention beside strategies that focus on mothers and their infants between 0 and 6 months of age. A study in Guinea Bissau showed that 3-month provision of ready-to-use supplementary foods to mothers significantly increased MUAC by on average 0.6 cm (Schlossman et al, 2017). The impact of a ready-to-use supplementary foods given to pregnant Cambodian women on MUAC needs to be established.…”

Section: Discussionmentioning

confidence: 99%

Maternal mid‐upper arm circumference during pregnancy and linear growth among Cambodian infants during the first months of life

Kpewou¹,

Poirot²,

Berger

et al. 2020

Maternal & Child Nutrition

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Stunting prevalence among children under 5 years remains high in Cambodia, affecting about one‐third of children. In most low‐ and middle‐income countries, linear growth faltering of young children starts in the womb. The 1,000‐days window of opportunity to improve child nutritional status includes pregnancy, as maternal nutritional status is an important determinant of birthweight and child development. In Cambodia, nutritional status of pregnant women is poor, with some studies reporting >20% of pregnant women having a low mid‐upper arm circumference (MUAC < 23 cm). Few studies have investigated associations between maternal nutritional status during pregnancy and neonatal growth. Using data from a Cambodian cohort study conducted from 2016 through 2018 in selected districts of Phnom Penh, Kratie, and Ratanakiri provinces, we investigated associations between maternal MUAC during pregnancy as indicator of maternal nutritional status and their offspring linear growth during early life. Multivariate regression models were used to assess the associations between maternal MUAC during the last trimester of pregnancy and infant's length‐for‐age z‐scores during the first 3.5 months of life. Maternal MUAC was significantly associated with infant's length‐for‐age z‐scores (regression coefficient 0.06, 95% CI [0.03, 0.09]). Infants born from mothers with a low MUAC during pregnancy had a 1.6 times higher risk (odds ratio 1.621, 95% CI [0.998, 2.636]) of being stunted during the first 3.5 months of life compared with infants born from mothers with a MUAC >23 cm. This study underlines the importance of optimum maternal MUAC during pregnancy for optimal infant growth. Interventions that aim to tackle stunting in infants should integrate improving maternal MUAC during pregnancy.

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“…The control meal, which replicated a traditional breakfast for children, was imported white rice cooked with water, a small amount of soybean oil and salt, which contained an average of 1% of the recommended daily micronutrients. We provided the control meal to maximize intervention fidelity, and because our previous work in Guinea-Bissau indicated that not giving a control meal could result in compensation in home food 69…”

Section: Methodsmentioning

confidence: 99%

“…We provided the control meal to maximize intervention fidelity, and because our previous work in Guinea-Bissau indicated that not giving a control meal could result in compensation in home food. 69 …”

Section: Methodsmentioning

confidence: 99%

Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial

Roberts

Franceschini

Silver

et al. 2020

BMJ

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ObjectiveTo assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition.DesignRandomized controlled trial.Setting10 villages in Guinea-Bissau.Participants1059 children aged 15 months to 7 years; children younger than 4 were the primary population.InterventionsSupervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast).Main outcome measurementsThe primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models.ResultsAmong children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (−0.23, −0.43 to −0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (−5.82 cm2, −11.28 to −0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10−8, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03).ConclusionsChildhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups.Trial registrationClinicalTrials.gov NCT03017209.

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A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response

Cited by 16 publications

References 19 publications

Systematic review of the treatment of moderate acute malnutrition using food products

Systematic review of the treatment of moderate acute malnutrition using food products

Maternal mid‐upper arm circumference during pregnancy and linear growth among Cambodian infants during the first months of life

Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial

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