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Title: Trial of ready-to-use supplemental food and corn-soy blend in pregnant Malawian women with moderate malnutrition: A randomized controlled clinical trial

Author
item CALLAGHAN-GILLESPIE, MEGHAN - Washington University
item SCHAFFNER, ANDREW - California Polytechnic State University
item GARCIA, PATSY - California Polytechnic State University
item FRY, JOCELYN - California Polytechnic State University
item ECKERT, RACHAEL - California Polytechnic State University
item MALEK, SHIRIN - California Polytechnic State University
item TREHAN, INDI - Washington University
item THAKWALAKWA, CHRISSIE - University Of Malawi
item MALETA, KENNETH - University Of Malawi
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)
item PAPATHAKIS, PEGGY - California Polytechnic State University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/14/2017
Publication Date: 8/9/2017
Citation: Callaghan-Gillespie, M., Schaffner, A.A., Garcia, P., Fry, J., Eckert, R., Malek, S., Trehan, I., Thakwalakwa, C., Maleta, K.M., Manary, M.J., Papathakis, P.C. 2017. Trial of ready-to-use supplemental food and corn-soy blend in pregnant Malawian women with moderate malnutrition: A randomized controlled clinical trial. American Journal of Clinical Nutrition. 106(4):1062-1069. https://doi.org/10.3945/ajcn.117.157198.
DOI: https://doi.org/10.3945/ajcn.117.157198

Interpretive Summary: Malnutrition during pregnancy in sub-Saharan Africa is associated with poor birth outcomes. Pregnant Malawian women with moderate malnutrition were given one of three pregnancy supplements. This study found that despite the large amount of food given, the overall low effect on newborn growth suggests that infant stunting is unlikely to be reduced by supplemental food alone.

Technical Abstract: Malnutrition during pregnancy in sub-Saharan Africa is associated with poor birth outcomes. This study compared maternal and offspring anthropometry for moderately malnourished pregnant women receiving ready-to-use supplemental food (RUSF), a fortified corn-soy blend (CSB+) with a daily multiple micronutrient antenatal supplement [United Nations International Multiple Micronutrient Preparation (UNIMMAP)], or standard of care comprising CSB+ and iron and folic acid (IFA). A single-blind randomized controlled clinical trial was conducted in southern Malawi among 1828 pregnant women with moderate malnutrition, defined as a midupper arm circumference (MUAC) >=20.6 and <=23.0 cm. Women received 1 of 3 dietary treatment regimens that provided approximately 900 kcal/d and 33-36 g protein/d. Maternal and infant anthropometry were followed until the child was 3 mo old. Newborns had a mean length-for-age z score of -1.3 +/- 1.2 and 22% were stunted at birth. Mothers receiving RUSF had the highest weight gain during supplementation (3.4 +/- 2.6, 3.0 +/- 2.2, and 3.2 +/- 2.4 kg for the RUSF, CSB+ with UNIMMAP, and CSB+ with IFA groups, respectively; P = 0.03). Newborn birth weights and lengths were similar across intervention groups, but the incidence of newborns with a birth weight <2.4 kg (weight-for-age z score <-2) was higher in the CSB+ with UNIMMAP group than the other groups (17%, 18%, and 24% for the CSB+ with IFA, RUSF, and CSB+ with UNIMMAP groups, respectively; P = 0.02). At birth, HIV-exposed newborns had a similar length and weight as newborns without HIV exposure, but their head circumference was smaller (34.0 +/- 1.5 and 34.3 +/- 1.6 cm, respectively; P = 0.02). At 3 mo of age, HIV-exposed infants had smaller weights, lengths, and head and arm circumferences than infants without HIV exposure. RUSF improved maternal weight gain compared with CSB+ with UNIMMAP. The large amount of food given and the modest effect on linear growth in newborns suggests that stunting in utero is unlikely to be reduced by supplemental food alone.