Submitted to: Journal of Nutrition
Publication Type: Peer reviewed journal
Publication Acceptance Date: 1/29/2009
Publication Date: 4/1/2009
Citation: Matilsky, D.K., Maleta, K., Castleman, T., Manary, M.J. 2009. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Journal of Nutrition. 139(4):773-778. Interpretive Summary: Malawian children that are moderately malnourished are commonly given a fortified corn/soy blended flour (CSB), but the effectiveness of this approach has been limited. Fortified spreads (FS), which are energy-dense, lipid-based pastes with supplementary micronutrients, introduce a more effective alternative to provide the nutrients needed in malnourished children. A study was conducted to see how malnourished children recovered (became nourished) under three different conditions. Children that received soy/peanut FS had a similar recovery rate to those that received milk/peanut FS. Children in both of these FS groups were more likely to gain weight more quickly than those receiving CSB. After six weeks of the study, there was no difference in weight gain amongst the three groups. From these results we demonstrate that FS are superior supplementary foods to CSB, and that FS provides a more prompt response in weight gain in this population.
Technical Abstract: Moderate childhood wasting is defined as having a weight-for-height Z-score (WHZ) < -2, but > or = -3. These children are typically given fortified corn/soy blended flour (CSB), but this intervention has shown limited effectiveness. Fortified spreads (FS) can be used as supplementary foods instead; they are energy-dense, lipid-based pastes with added powdered micronutrients. In this randomized clinical effectiveness trial, the recovery rates were compared among children with moderate wasting who received either milk/peanut FS, soy/peanut FS, or CSB. Children received isoenergetic quantities of food, 314 kJ x kg(-1) x d(-1), for up to 8 wk with biweekly follow-up. The primary outcome was recovery, defined as having a WHZ > -2. Time-event analysis was used to compare the recovery rate. A total of 1362 children were enrolled in the study. Children receiving soy/peanut FS had a similar recovery rate to those receiving milk/peanut FS and children in either FS group were more likely to recover than those receiving CSB (80% in both FS groups vs. 72% in the CSB group; P < 0.01). The rate of weight gain in the first 2 wk was greater among children receiving milk/peanut FS (2.6 g x kg(-1) x d(-1), n = 465) or children receiving soy/peanut FS (2.4 g x kg(-1) x d(-1), n = 450) than among children receiving CSB (2.0 g x kg(-1) x d(-1), n = 447; P < 0.05). Rates of length gain did not differ among the 3 groups. A total of 8% of children in each feeding group developed edema, indicative of severe malnutrition, while receiving supplemental feeding. We conclude that FS are superior supplementary foods to CSB for moderately wasted Malawian children.