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An Atole Fortified with 21 Vitamins and Minerals Improves Nutritional Status of 6 to 72 Month‐Old Children in 6 Nurseries in Guatemala City
The FASEB Journal
Abstract
Chispuditos® is a corn/soy atole fortified with 21 vitamins and minerals designed to reduce micronutrient deficiency of Central American children. A portion of atole (18.75g) was provided for 5 days/week to 6‐72 month‐old children. Seven hundred and forty seven children completed 1 year of the nutritional intervention. Hemoglobin, anthropometry and incidence of respiratory tract infections and diarrhea were analyzed at baseline, six months and one year. Repeated measures ANOVA indicated an increase in hemoglobin from baseline=11.76±1.17g/dL to endline=12.39±1.05 g/dL, p<0.001. HAZ scores increased from ‐1.25±1.02 to ‐1.07±0.96, p<0.001 over the time course of the intervention. Furthermore, there was a 57.1% reduction in respiratory tract infections, p<0.001 after 12 months. No changes in the incidence of diarrhea from baseline to one year were observed. Overall, children in this study had an improvement in HAZ scores, hemoglobin concentrations and respiratory tract infections after 12 months of intervention, while previous studies in comparable settings took approximately 24 months for HAZ scores to improve.
Funded by The Mathile Institute for the Advancement of Human Nutrition.
... In order to increase the acceptability and thus compliance with supplementation programmes, a drink-based supplement (Chispuditos ® ) was developed, which was fortified with high levels of zinc iron and other vitamins and minerals, thought to be important for longitudinal growth. This novel food was administered in two different longitudinal cohorts of toddlers attending nurseries in Guatemala city over a period of 2.5 and 4 years with pre-and postmeasurements of growth and findings suggesting small but promising improvements in stunting and iron status (Villanueva et al., 2015;Villanueva & Reinhart, 2013). Thus, the aim of this study was to test in a randomised control trial (RCT) the hypothesis that providing extra micronutrients via this culturally acceptable liquid food over an extended period would reduce stunting, improve zinc and iron status and reduce morbidity compared to an energy/protein-matched milk with no added micronutrients. ...
... This trial found that 18 months' use of a liquid food supplement fortified with micronutrients had no impact on either the growth or the micronutrient status of rural Guatemalan infants and preschool children, compared with an isoenergetic lactose-free milk. This is disappointing, as reduction in the rates of stunting and IDA was observed when the same atole + MN (Chispuditos ® ) was given as a supplement to urban toddlers in an uncontrolled study in nurseries in Guatemala City (Villanueva et al., 2015;Villanueva & Reinhart, 2013). ...
Micronutrient supplementation is widely used to prevent stunting in children under 5 years in low- and middle-income countries (LMIC), but the impact of treatment has been disappointing, possibly due to non-compliance. Our aim was to deliver long-term micronutrient supplementation via a novel, culturally acceptable liquid food to improve linear growth in a high stunting prevalence region.
In a randomised control trial, 971 children aged 6–72 months received either ‘Chispuditos®’ (n = 681), a hot drink (atole) fortified with micronutrients (atole + MN) (9 mg/zinc, 12.5 mg/iron), or lactose-free milk (n = 290) for 18 months. Primary outcomes were changes in length/height-for-age (HAZ) score and the prevalence of stunting at 18-month follow-up. Adherence was monitored monthly, and 73% children in atole + MN group consumed at least half their daily zinc and iron requirement. At 18 months, there was no difference between the treatments in growth [mean change in HAZ −0.02 (95% CI −0.12, 0.08)] or stunting [atole + MN 41%, milk 41%; RR 0.99 (95% CI 0.84, 1.19)]. There were no differences in haemoglobin (HB), ferritin or zinc. No children had iron deficiency anaemia (IDA) at outcome, but zinc deficiency remained equally prevalent in both groups: atole + MN 35%, milk 35% [RR 1.02 (95% CI 0.83, 1.24)]. There was no difference in morbidity between the groups, and micronutrient status was unrelated to HAZ. Long-term micronutrient supplementation via a culturally acceptable food had no impact on stunting or morbidity, raising the question of whether large-scale micronutrient supplementation is worthwhile.
... In order to increase the acceptability and thus compliance with supplementation programmes, a drink-based supplement (Chispuditos ® ) was developed, which was fortified with high levels of zinc iron and other vitamins and minerals, thought to be important for longitudinal growth. This novel food was administered in two different longitudinal cohorts of toddlers attending nurseries in Guatemala city over a period of 2.5 and 4 years with pre-and postmeasurements of growth and findings suggesting small but promising improvements in stunting and iron status (Villanueva et al., 2015;Villanueva & Reinhart, 2013). Thus, the aim of this study was to test in a randomised control trial (RCT) the hypothesis that providing extra micronutrients via this culturally acceptable liquid food over an extended period would reduce stunting, improve zinc and iron status and reduce morbidity compared to an energy/protein-matched milk with no added micronutrients. ...
... This trial found that 18 months' use of a liquid food supplement fortified with micronutrients had no impact on either the growth or the micronutrient status of rural Guatemalan infants and preschool children, compared with an isoenergetic lactose-free milk. This is disappointing, as reduction in the rates of stunting and IDA was observed when the same atole + MN (Chispuditos ® ) was given as a supplement to urban toddlers in an uncontrolled study in nurseries in Guatemala City (Villanueva et al., 2015;Villanueva & Reinhart, 2013). ...
Objectives
To determine the long-term impact of a micronutrient fortified supplement on stunting rates and micronutrient status in young children living in rural Guatemala, which has the highest stunting prevalence in Latin America.
Methods
A parallel, open label randomised control trial in rural children aged 6–72 months (Registration NCT01643187). After growth screening, all children < 1SD for either weight for height (WHZ), height for age (HAZ), or weight for age (WAZ) were randomly allocated using 7:3 ratio, stratified by locality and age to receive either the test drink, Chispuditos®, a corn/soy beverage fortified with 21 vitamins or de-lactosed milk (control). Both drinks were isoproteic (4g/drink) and had similar energy content (test drink 147 kcal, milk 117 kcal) but the tst
drink had higher micronutrient content (e.g., 9 mg zinc, 12.5 mg iron vs 1.5 mg zinc, 1.9 mg iron in control). They were supplied for 18 months and monthly visits were conducted to test for adherence.
Results
A total of 1238 children were screened, 971 met the criteria and 681 were allocated to test drink and 290 to control. At baseline, malnutrition prevalence of stunting (HAZ < -2SD), for test vs control was 48.4% vs 47.9%, 5.5% vs 6.7% for wasting (WHZ < -2SD) and 19.9% vs 18.7% for underweight (WAZ < -2SD). 73% of children reported to consume at least half of allocated drinks/day. After 18 months of intervention, the prevalence and relative risks [RR (95% CI)] for stunting in the test: control were 40.6:40.7% [RR 0.99 (0.84, 1.19)]; similarly, no differences were seen in WAZ, WHZ nor micronutrient status.
Conclusions
In this trial in rural Guatemalan children, long term supplementation with a micronutrient enriched drink had no impact on either stunting or micronutrient status. These results differ form long-term studies in urban Guatemalan nurseries. The present study suggest that fortified foods alone are not enough to reduce stunting rates in this setting when fed during an 18 month period.
Funding Sources
The Mathile Institute for the Advancement of Human Nutrition funded this study.
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