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Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour^1,2,3,4

¹ From the College of Medicine, University of Malawi, Blantyre, Malawi (JCP, KM, and CT); the Department of International Health, University of Tampere Medical School, Finland (JCP, YBC, and PA); the Clinical Trials and Epidemiology Research Unit, Singapore (YBC), the Department of Child Health and Development, World Health Organization, Geneva, Switzerland, and IRD, Département Sociétés et Santé, Paris, France (AB) ⁵Washington University School of Medicine, St Louis, MO (MJM); and the Department of Paediatrics, Tampere University Hospital, Tampere, Finland (PA).

² AB is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication, which do not necessarily represent the decisions or the stated policy of the World Health Organization. The funders of this trial had no role in its implementation, analysis, or reporting.

³ Supported by the Academy of Finland (grants 200720 and 109796), the Foundation for Paediatric Research in Finland, and the Medical Research Fund of Tampere University Hospital. The micronutrient mixture used in the production of fortified spread was provided free of charge by Nutriset Inc (Malaunay, France). JCP and CT received personal stipends from the Nestle Foundation.

⁴ Reprints not available. Address correspondence to J Phuka, College of Medicine, University of Malawi, PO Box 431, Mangochi, Malawi. E-mail: johnphuka{at}malawi.net.

ABSTRACT

Background: Therapeutic feeding with micronutrient-fortified lipid-based nutrient supplements (LNSs) has proven useful in the rehabilitation of severely malnourished children. We recently reported that complementary feeding of 6–18-mo-old infants with an LNS known as FS50 was associated with improved linear growth and a reduction in the incidence of severe stunting during the supplementation period.

Objective: Our objective was to assess whether a reduction in stunting seen with 12-mo LNS supplementation was sustained over a subsequent 2-y nonintervention period.

Design: One hundred eighty-two 6-mo-old healthy rural Malawian infants were randomly assigned to receive daily supplementation for 12 mo with 71 g of maize-soy flour [likuni phala (LP); control group, 282 kcal] or either 50 g of FS50 (264 kcal; main intervention group), or 25 g of FS25 (130 kcal). Main outcome measures were incidence of severe stunting and mean changes in weight-for-age, length-for-age, and weight-for-length during a 36-mo follow-up period.

Results: The cumulative 36-mo incidence of severe stunting was 19.6% in LP, 3.6% in FS50, and 10.3% in FS25 groups (P = 0.03). Mean weight-for-age changes were –1.09, –0.76, and –1.22 (P = 0.04); mean length-for-age changes were –0.47, –0.37, and –0.71 (P = 0.10); and mean weight-for-length changes were –1.52, –1.18, and –1.48 (P = 0.27). All differences were more marked among individuals with baseline length-for-age below the median. Differences in length developed during the intervention at age 10–18 mo, whereas weight differences continued to increase after the intervention.

Conclusions: Twelve-month-long complementary feeding with 50 g/d FS50 is likely to have a positive and sustained impact on the incidence of severe stunting in rural Malawi. Half-dose intervention may not have the same effect. This trial was registered at clinicaltrials.gov as NCT00131209.

Received for publication June 3, 2008. Accepted for publication October 27, 2008.

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