Submitted to: American Journal of Clinical Nutrition
Publication Type: Peer reviewed journal
Publication Acceptance Date: 10/27/2008
Publication Date: 1/1/2009
Citation: Phuka, J.C., Maleta, K., Thakwalakwa, C., Cheung, Y.B., Briend, A., Manary, M.J., Ashorn, P. 2009. Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. American Journal of Clinical Nutrition. 89(1):382-390. Interpretive Summary: Stunting affects approximately 170 million children less than 5 years old and it has a prevalence of 40% in southern Asia and 50% in sub-Saharan Africa. Therapeutic feeding with nutrient supplements of 6-18 month-old infants improves growth and replaces the incidence of severe stunting. The purpose of this study was to determine whether decreased stunting seen with 12-mo supplementation was sustained over a subsequent 2-y period without supplementation. Differences in length were evident during the intervention at age 10-18 months while, weight differences continued to increase following the conclusion of the intervention. The results support the notion that supplementation affected the timing of the infancy-to-childhood growth spurt. Such research findings provide evidence of possible measures to prevent stunting in malnourished populations and to improve overall nutrition.
Technical Abstract: 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 to 18-mo-old infants with LNS known as FS50, was associated with improved linear growth and a reduction in the incidence of severe stunting during the supplementation period. 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. 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 z score changes in weight-for-age, length-for-age, and weight-for-length during a 36-mo follow-up period. 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. 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.