Abstract
Stunting is reportedly associated with low circulating levels of essential amino acids (EAAs). This study examined the effect of a macronutrient- and micronutrient-fortified complementary food supplement (KOKO Plus) on specific plasma EAA levels and stunting in infants aged 6–18 months. In a single-blind cluster-randomized controlled trial conducted in Ghana, infants were enrolled at 6 months and followed until 18 months. Thirty-eight communities were randomly assigned to receive KOKO Plus (KP, fourteen communities, n = 321), multiple-micronutrient powder (MN, thirteen communities, n = 327), or only nutritional education as control group (NE, eleven communities, n = 318), and all groups received nutrition education. Plasma amino acids (AAs) were measured at 6, 12, and 18 months (end point). Mixed-effects models were used to assess the effect of the intervention on plasma AAs, and the relationship between plasma branched-chain AAs (BCAAs) and the risk of stunting was assessed. At the end point, total BCAA concentrations (±standard error) significantly exceeded baseline in the KP (284.2 ± 4.3 μM) and NE (289.1 ± 4.4 μM) groups but not the MN group (264.4 ± 4.1 μM). After adjustment for compliance at 200 sachets, plasma BCAAs exceeded in the KP group (284.5 ± 4.2 μM) compared to the MN group (264.6 ± 4 μM). Plasma BCAAs were positively correlated with changes in length-for-age Z-score from baseline (R = 0.327, p = 0.048). In conclusion, the plasma BCAA concentrations of infants that received KP and the NE group was significantly higher compared to the MN group but there were no differences between the KP and NE group at end point. Improved plasma BCAAs may be due to improved nutrient intake by infants exposed to KP or NE. Low BCAAs were associated with stunting, replicating the previous finding.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03181178?term=NCT03181178&draw=2&rank=1, identifier: NCT03181178.
Highlights
Malnutrition is a global nutrition issue; a total of 155 million children under age 5 suffer from stunting due to malnutrition [1, 2]
This secondary analysis embedded in a cluster-randomized single-blind intervention study in Ghana aimed to better understand the effect of a complementary food supplement, KP, on plasma amino acid concentrations
We hypothesized that the complementary macronutrient and micronutrient supplement KP, compared to MN with NE or NE alone, would impact infants’ plasma branched-chain amino acids (BCAAs) concentrations
Summary
Malnutrition is a global nutrition issue; a total of 155 million children under age 5 suffer from stunting due to malnutrition [1, 2]. Recent literature points to the importance of the quality of protein in complementary foods [5] and its correlation with stunting. Analysis of Malawian children has found a strong negative correlation between all essential amino acids (EAAs), including branched-chain amino acids (BCAAs), and stunting [6]. In a recent study from Ethiopia, intake levels of tryptophan, protein, and energy as well as serum levels of insulin growth factor-1 and transthyretin were positively associated with linear growth, implying a potential role for amino acids and high-quality protein in improving linear growth [15]. We hypothesized that plasma EAA and BCAA levels would be positively correlated with LAZ in infants
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