Location: Children's Nutrition Research CenterTitle: Complementary feeding with cowpea reduces growth faltering in rural Malawian infants: A blind, randomized controlled clinical trial
|STEPHENSON, KEVIN - Washington University|
|AGAPOVA, SOPHIA - Washington University|
|DIVALA, OSCAR - University Of Malawi|
|KAIMILA, YANKHO - University Of Malawi|
|MALETA, KENNETH - University Of Malawi|
|THAKWALAKWA, CHRISSIE - University Of Malawi|
|ORDIZ, M - Washington University|
|TREHAN, INDI - Washington University|
|MANARY, MARK - Children'S Nutrition Research Center (CNRC)|
Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/4/2017
Publication Date: 11/1/2017
Citation: Stephenson, K.B., Agapova, S.E., Divala, O., Kaimila, Y., Maleta, K.M., Thakwalakwa, C., Ordiz, M.I., Trehan, I., Manary, M.J. 2017. Complementary feeding with cowpea reduces growth faltering in rural Malawian infants: A blind, randomized controlled clinical trial. American Journal of Clinical Nutrition. 106(6):1500-1507. https://doi.org/10.3945/ajcn.117.160986.
Interpretive Summary: Poor growth is common in rural African children and is related to poor diet and gut health. Six-month-old rural Malawian children received a daily feeding of either cowpea, common bean, or corn-soy flour for 6 months. The addition of cowpea to complementary feeding in Malawian infants resulted in less growth failure than children on the other foods.
Technical Abstract: Growth faltering is common in rural African children and is attributed to inadequate dietary intake and environmental enteric dysfunction (EED). We tested the hypothesis that complementary feeding with cowpea or common bean flour would reduce growth faltering and EED in 6-mo-old rural Malawians compared with the control group receiving a corn-soy blend. A prospective, double-blind, randomized controlled clinical trial was conducted in which children received daily feeding for 6 mo (200 kcal/d when 6-9 mo old and 300 kcal/d when 10-12 mo old). The primary outcomes were change in length-for-age z score (LAZ) and improvements in EED, as measured by percentage of lactulose excretion (%L). %L <0.2% was considered normal. Anthropometric measurements and %L through urine were compared between each legume group and the control group with Student's t test. Of the 355 infants enrolled, 291 infants completed the trial, and 288 were breastfed throughout the duration of the study. Cowpea and common bean added 4.6-5.2 g protein/d and 4-5 g indigestible carbohydrate/d to the diet. LAZ and weight-for-height z score were reduced in all 3 groups from 6 to 12 mo of age. The changes in LAZ [mean (95% CI)] for the cowpea, common bean, and control groups from 6 to 9 mo were -0.14 (-0.24, -0.04), -0.27 (-0.38, -0.16), and -0.27 (-0.35, -0.19), respectively. LAZ was reduced less in infants receiving cowpea than in those receiving control food from 6 to 9 mo (P = 0.048). The absolute value of %L did not differ between the dietary groups at 9 mo of age (mean +/- SD: 0.30 +/- 0.43, 0.23 +/- 0.21, and 0.26 +/- 0.31 for cowpea, common bean, and control, respectively), nor did the change in %L from 6 to 9 mo. Addition of cowpea to complementary feeding in Malawian infants resulted in less linear growth faltering.