Location: Children's Nutrition Research CenterTitle: Lactoferrin and lysozyme to reduce environmental enteric dysfunction and stunting in Malawian children: Study protocol for a randomized controlled trial
|CHENG, WILLIAM - Washington University|
|WOLD, KARL - Washington University|
|BENZONI, NICOLE - Washington University|
|THAKWALAKWA, CHRISSIE - University Of Malawi|
|MALETA, KENNETH - University Of Malawi|
|MANARY, MARK - Children'S Nutrition Research Center (CNRC)|
|TREHAN, INDI - Washington University|
Submitted to: Trials
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/25/2017
Publication Date: 11/6/2017
Citation: Cheng, W.D., Wold, K.J., Benzoni, N.S., Thakwalakwa, C., Maleta, K.M., Manary, M.J., Trehan, I. 2017. Lactoferrin and lysozyme to reduce environmental enteric dysfunction and stunting in Malawian children: Study protocol for a randomized controlled trial. Trials. 18(1):523. https://doi.org/10.1186/s13063-017-2278-8.
Interpretive Summary: Poor gut health significantly relates to stunting, which remains a barrier to healthy growth and development in children. A study will assess two important proteins found in breastmilk as dietary supplements for children at high risk for poor gut health. If proven effective, these safe proteins may reduce the burden of childhood malnutrition and improve survival.
Technical Abstract: Chronic childhood malnutrition, as manifested by stunted linear growth, remains a persistent barrier to optimal child growth and societal development. Environmental enteric dysfunction (EED) is a significant underlying factor in the causal pathway to stunting, delayed cognitive development, and ultimately morbidity and mortality. Effective therapies against EED and stunting are lacking and further clinical trials are warranted to effectively identify and operationalize interventions. A prospective randomized placebo-controlled parallel-group randomized controlled trial will be conducted to determine if a daily supplement of lactoferrin and lysozyme, two important proteins found in breast milk, can decrease the burden of EED and stunting in rural Malawian children aged 12-23 months old. The intervention and control groups will have a sample size of 86 subjects each. All field and laboratory researchers will be blinded to the assigned intervention group, as will the subjects and their caregivers. The percentage of ingested lactulose excreted in the urine (delta%L) after 4 h will be used as the biomarker for EED and linear growth as the measure of chronic malnutrition (stunting). The primary outcomes of interest will be change in delta%L from baseline to 8 weeks and to 16 weeks. Intention-to-treat analyses will be used. A rigorous clinical trial design will be used to assess the biologically plausible use of lactoferrin and lysozyme as dietary supplements for children at high risk for EED. If proven effective, these safe proteins may serve to markedly reduce the burden of childhood malnutrition and improve survival.