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Title: Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour

item Phuka, John - University Of Malawi
item Gladstone, Melissa - University Of Liverpool
item Maleta, Kenneth - University Of Malawi
item Thakwalakwa, Chrissie - University Of Malawi
item Cheung, Yin - Singapore Clinical Research Institute
item Briend, Andre - University Of Tampere Medical School
item Manary, Mark - Children'S Nutrition Research Center (CNRC)
item Ashorn, Per - Tampere University Hospital

Submitted to: Maternal and Child Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/22/2011
Publication Date: 4/1/2012
Citation: Phuka, J.C., Gladstone, M., Maleta, K., Thakwalakwa, C., Cheung, Y.B., Briend, A., Manary, M.J., Ashorn, P. 2012. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour. Maternal and Child Nutrition. 8(2):239-248.

Interpretive Summary: Complementary feeding has been shown in many trials to improve growth of malnourished infants, but further investigation is needed regarding its effect on mental development. This trial compared the development of Malawian infants fed lipid-based nutrient supplements (LNS) to those fed micronutrient-fortified corn-soy porridge. A total of 163 Malawian infants were supplemented with one of the two interventions for one year. Mental ages based on developmental scores were compared between the two intervention groups and found to not differ significantly. This information suggests that both supplementary foods have comparable effects on developmental growth in Malawian infants and both LNS and fortified corn-soy porridge are effective interventions. The data also reveals that length-for-age and maternal education are factors associated with developmental growth.

Technical Abstract: The major aim of this trial was to compare the development of 18-month-old infants who received complementary feeding for 1 year with either lipid-based nutrient supplements or micronutrient-fortified corn-soy porridge. Our secondary aim was to determine the socio-economic factors associated with developmental outcomes in the same population. A total of 163 six-month-old rural Malawian children were enrolled in a randomized controlled trial where the control population received daily supplementation with 71 g corn-soy flour [Likuni Phala (LP)] (282 kcal) and individuals in the intervention groups received daily either 50 g of lipid-based nutrient supplement (FS50) (264 kcal) or 25 g of lipid-based nutrient supplement (FS25) (130 kcal). The main outcome measures were Griffiths' developmental scores at 0–2 years. Independent comparison of study groups was carried out using analysis of variance (ANOVA) statistics where mean raw scores, quotients, or mental ages were compared. Association of developmental outcome with predictor variables were examined using multiple regression. At 18 months of chronological age, the mean +/- standard deviation (SD) mental ages in the LP, FS50, and FS25 groups were 17.9 +/- 1.3, 17.9 +/- 1.3, and 17.9 +/- 1.2 (P > 0.99), respectively. Likewise, the mean raw developmental scores and mean developmental quotients did not differ significantly. Length-for-age z-score gain during the intervention period, and maternal education were associated with developmental outcome at 18 months (P = 0.03 and P = 0.04; respectively). In conclusion, rural Malawian infants receiving 12-month daily supplementation of their diet with either the tested lipid-based nutrient supplements or fortified corn-soy flour have comparable development outcomes by 18 months of age.