Maleta, K. et al. Supplementary feeding of underweight, stunted Malawian children with a ready-to-use food. J. Pediatr. Gastroenterol. Nutr. 38, 152-158
ABSTRACT Maize and soy flour mixes are often used in the treatment of moderate malnutrition in Malawi. Their efficacy has not been formally evaluated. A recently developed ready-to-use food (RTUF) effectively promotes growth among severely malnourished children. The authors compared the effect of maize and soy flour with that of RTUF in the home treatment of moderately malnourished children.
Sixty-one underweight, stunted children 42 to 60 months of age were recruited in rural Malawi, in southeastern Africa. They received either RTUF or maize and soy flour for 12 weeks. Both supplements provided 2 MJ (500Kcal) of energy daily but had different energy and nutrient densities. Outcome variables were weight and height gain and dietary intake.
Before intervention, the mean dietary intake and weight and height gain were similar in the two groups. During the supplementation phase, the consumption of staple food fell among children receiving maize and soy flour but not among those receiving RTUF. There was thus higher intake of energy, fat, iron, and zinc in the RTUF group. Both supplements resulted in modest weight gain, but the effect lasted longer after RTUF supplementation. Height gain was not affected in either group. Periodic 24-hour dietary recalls suggested that the children received only 30% and 43%, respectively, of the supplementary RTUF and maize and soy flour provided.
RTUF is an acceptable alternative to maize and soy flour for dietary supplementation of moderately malnourished children. Approaches aimed at increasing the consumption of supplementary food by the selected recipients are needed.
- SourceAvailable from: Valerie L Flax
[Show abstract] [Hide abstract]
- "LNS increased concentrations of haemoglobin in African children (Kuusipalo et al. 2006; Adu-Afarwuah et al. 2008) and vitamin B12 and folate in the present study in Honduran children (Siega-Riz et al. 2014). Observational and quantitative studies in Africa indicate that LNS are consumed in addition to usual foods and increase macroand micronutrient intakes (Maleta et al. 2004; Adu-Afarwuah et al. 2007; Flax et al. 2008; Hemsworth et al. 2013; Thakwalakwa et al. 2014), but it should be noted that some of these studies assumed that participants consumed LNS as intended and measured overall dietary intake without quantifying the amount of LNS eaten. Food cultures, diet quality and levels of food insecurity vary greatly between and within countries and regions, making it important to understand how products, such as LNS, affect dietary intakes in different locations. "
ABSTRACT: Inadequate energy intake and poor diet quality are important causes of chronic child undernutrition. Strategies for improving diet quality using lipid-based nutrient supplements (LNS) are currently being tested in several countries. To date, information on children's dietary intakes during LNS use is available only from Africa. In this study, we collected 24-h dietary recalls at baseline, 3, 6, 9 and 12 months on Honduran children (n = 298) participating in a cluster-randomised trial of LNS. Generalised estimating equations were used to examine differences in number of servings of 12 food groups in the LNS and control arms, and multi-level mixed effects models were used to compare macro- and micronutrient intakes. Models accounted for clustering and adjusted for child's age, season and breastfeeding status. Mean daily servings of 12 food groups did not differ by study arm at baseline and remained similar throughout the study with the exception of groups that were partially or entirely supplied by LNS (nuts and nut butters, fats, and sweets). Baseline intakes of energy, fat, carbohydrates, protein, folate and vitamin A, but not vitamin B12, iron and zinc were lower in the LNS than control arm. The change in all macro- and micronutrients from baseline to each study visit was larger for the LNS arm than the control, except for carbohydrates from baseline to 9 months. These findings indicate that LNS improved the macro- and micronutrient intakes of young non-malnourished Honduran children without replacing other foods in their diet. © 2015 John Wiley & Sons Ltd.Maternal and Child Nutrition 04/2015; DOI:10.1111/mcn.12182 · 2.97 Impact Factor
[Show abstract] [Hide abstract]
- "Studies using RUF give a mixed picture with regard to sharing. Those studies that used weekly interviews indicated that there is very little sharing of the supplementary food (Lin et al. 2008; Phuka et al. 2008, 2009; Matilsky et al. 2009), whereas those that collected data through dietary recalls and direct observation found that the quantities of RUF eaten by participants was small (Maleta et al. 2004), and that there was direct and indirect sharing (Flax et al. 2010). "
ABSTRACT: Poor complementary feeding practices and low-quality complementary foods are significant causes of growth faltering and child mortality throughout the developing world. Ready-to-use foods (RUF) are energy-dense, lipid-based products that do not require cooking or refrigeration that have been used to prevent and treat malnutrition among vulnerable children. The effectiveness of these products in improving child nutritional status depends on household use by caregivers. To identify the key facilitators and barriers that influence appropriate in-home RUF consumption by supplemental feeding program beneficiaries, we conducted individual interviews among caregivers (n = 80), RUF producers (n = 8) and program staff (n = 10) involved in the Byokulia Bisemeye mu Bantu supplemental feeding program in Bundibugyo, Uganda. By documenting caregiver perceptions and feeding practices related to RUF, we developed a conceptual framework of factors that affect appropriate feeding with RUF. Findings suggest that locally produced RUF is well received by caregivers and children, and is perceived by caregivers and the community to be a healthy supplemental food for malnourished children. However, child feeding practices, including sharing of RUF within households, compromise the nutrient delivery to the intended child. Interventions and educational messages informed by this study can help to improve RUF delivery to targeted beneficiaries.Maternal and Child Nutrition 01/2012; 8(1):115-29. DOI:10.1111/j.1740-8709.2010.00260.x · 2.97 Impact Factor
[Show abstract] [Hide abstract]
- "Fortified lipid-based products have been successfully used for rehabilitation of malnourished children (Diop el et al. 2003; Maleta et al. 2004; Manary et al. 2004; Ciliberto et al. 2005; Ndekha et al. 2005; Patel et al. 2005), but only two studies have assessed their use for home fortification of complementary foods (Kuusipalo et al. 2006; Adu-Afarwuah et al. 2007, 2008). These studies have used products containing peanut paste and soy or milk, plus additional vegetable oil, and were consumed in quantities ranging from 5 to 75 g day "
ABSTRACT: We reviewed the efficacy and effectiveness of home fortification of complementary foods with micronutrient powders (e.g. Sprinkles®), crushable tablets and lipid-based or soy-based products. Sixteen studies (5 anaemia treatment trials, 11 prevention trials) met the inclusion criteria. The treatment trials indicate that Sprinkles were as effective as iron drops, and were better accepted and had fewer side effects. In the prevention trials, the risk of anaemia was cut in half. The effect of home fortification with multiple micronutrients on plasma zinc and vitamin A levels was mixed. The impact on child growth of home fortification using only micronutrients was not significant. However, with products containing both micronutrients and a small amount of energy (including fat and protein), the pooled data from two efficacy trials in Africa suggest an effect size of ∼0.4 for both weight and height. Home fortification with products that include some energy also showed positive effects on indices of child development in two studies. There was a beneficial impact of home fortification on morbidity in high-risk populations in some studies, but most showed no significant impact. Acceptability of home fortification by caregivers and young children is high, and side effects are rare. The safety of home fortification using ‘bolus’ doses of iron, particularly in malarial areas, needs further investigation. In one study of Sprinkles in a low-income country, the estimates of cost per disability-adjusted life year regained compared favourably with other approaches, but more data on operational and cost considerations for the various home fortification products are needed.Maternal and Child Nutrition 05/2009; 5(4):283 - 321. DOI:10.1111/j.1740-8709.2009.00190.x · 2.97 Impact Factor