Additional Zinc Delivered as a Tablet and SQ‐LNS May Increase Fat Free Mass Accrual in Young Burkinabe Children

Abstract

Small‐quantity lipid‐based nutrient supplements (SQ‐LNS) provide additional energy (~120 kcal/d) and micronutrients and may affect body composition in young children. Previous analyses found that Burkinabe children who received SQ‐LNS from 9 to 18 months, along with treatment for diarrhea, malaria, and fever, gained more weight and length than those who did not, regardless of the amount of supplemental zinc; but the composition of weight gain was not reported. In the present analyses, we compare the composition of tissue gained for a subgroup of children participating in the iLiNS‐Zinc trial.Using a two‐stage cluster randomized trial design, communities were randomly assigned to the intervention cohort (IC) or non‐intervention cohort (NIC), and family compounds within the IC were randomly assigned to different zinc dose groups (SQ‐LNS without zinc+placebo tablet; SQ‐LNS with 5mg zinc+placebo tablet; SQ‐LNS with 10mg zinc+placebo tablet; or SQ‐LNS without zinc+5mg zinc tablet). All IC children received the SQ‐LNS+tablets daily from 9–18 mo along with treatment for malaria, diarrhea and fever. Body composition was assessed for IC (n=202) and NIC children (n=74) at 9 and 18 months using the deuterium dilution method. This was about 70% of the desired sample size because collection of saliva was challenging. A mixed linear model was used to examine average change in fat free mass (FFM) and % fat mass (%FM) between 9–18 mo by zinc dose group and by cohort. Analysis included a random effect of the community to account for intra‐community correlation.There was a high variability in response, but on average, children had increased FFM and decreased %FM from 9 to 18 mo. Change in FFM differed significantly between the NIC group (1.40 [mean]±0.07 [SD] kg) and the IC group (1.61±0.05 kg; p=0.005), and specifically between the NIC group and the group that received SQ‐LNS without zinc+5mg zinc tablet (1.73±0.08 kg; p=0.02). These results remained significant after controlling for baseline FFM. Patterns for change in FFM closely reflected patterns for overall weight gain. There were no significant differences in the change in %FM between NIC and IC or among the zinc dose groups.Zinc delivered in tablet form and SQ‐LNS may positively affect fat free mass accrual from 9 to 18 months of age. Zinc tablets and SQ‐LNS did not seem to affect changes in %FM from 9 to 18 months of age. Not achieving the desired sample size is a limitation for interpreting findings indicating no differences, and more work is needed to identify fast and easy methods to accurately measure young children's body composition in field settings.Support or Funding InformationFunded by the Bill & Melinda Gates Foundation