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Title: Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians

Author
item PHUKA, JOHN - UNIV MALAWI
item MALETA, KENNETH - UNIV MALAWI
item THAKWALAKWA, CHRISSIE - UNIV MALAWI
item CHEUNG, YIN - LONDON SCH HYG TROP MED
item BRIEND, ANDRE - WORLD HEALTH ORGANIZATION
item Manary, Mark
item ASHORN, PER - UNIV TAMPERE MED SCHOOL

Submitted to: Archives of Pediatrics and Adolescent Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/1/2008
Publication Date: 7/1/2008
Citation: Phuka, J.C., Maleta, K., Thakwalakwa, C., Cheung, Y.B., Briend, A., Manary, M.J., Ashorn, P. 2008. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Archives of Pediatrics and Adolescent Medicine. 162(7):619-626.

Interpretive Summary: Stunting, or short stature as a result of inadequate food intake in young childhood, has been identified as one of the most child important nutrition problems worldwide. Giving these children foods with more energy and micronutrients is thought to be part of the solution. This study compared children receiving a peanut butter-based paste with milk powder as a daily food to children receiving a standard corn porridge for 1 year. Those children receiving the paste were less likely to be severely stunted. The peanut paste with milk powder may well be an infant food that can be used to prevent stunting.

Technical Abstract: The objective of this study was to compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread (FS) or micronutrient-fortified maize-soy flour (likuni phala [LP]). A total of 182 6-month-old infants in rural Malawi were randomized in a controlled, single-blind trial to receive 1 year of daily supplementation with 71 g of LP (282 kcal), 50 g of FS (FS50) (256 kcal), or 25 g of FS (FS25) (127 kcal). Outcome measures were weight and length gains and the incidences of severe stunting, underweight, and wasting. We found that mean weight and length gains in the LP, FS50, and FS25 groups were 2.37, 2.47, and 2.37 kg (P = .66) and 12.7, 13.5, and 13.2 cm (P = .23), respectively. In the same groups, the cumulative 12-month incidence of severe stunting was 13.3%, 0.0%, and 3.5% (P = .01), of severe underweight was 15.0%, 22.5%, and 16.9% (P = .71), and of severe wasting was 1.8%, 1.9%, and 1.8% (P > .99). Compared with LP-supplemented infants, those given FS50 gained a mean of 100 g more weight and 0.8 cm more length. There was a significant interaction between baseline length and intervention (P = .04); in children with below-median length at enrollment, those given FS50 gained a mean of 1.9 cm more than individuals receiving LP. We concluded that 1-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants, but it is likely to boost linear growth in the most disadvantaged individuals and, hence, decrease the incidence of severe stunting.