Effectiveness of a locally produced ready-to-use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial.

Bindi Borg,Mark Griffin,Nanna Roos,Chhoun Chamnan,Seema Mihrshahi,Daream Sok,Jacques Berger,Frank T Wieringa,Arnaud Laillou

doi:10.1111/mcn.12896

Abstract

This cluster randomised controlled trial tested the effectiveness of a locally produced, fish‐based, ready‐to‐use supplementary food (RUSF) to prevent growth faltering (decline in z‐scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn‐Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight‐for‐age z‐scores (WAZ; ‐0.02, 95%CI = ‐0.03 ‐ ‐0.01, P= 0.001) and height‐for‐age z‐scores (HAZ; ‐0.07, 95%CI = ‐0.09 ‐ ‐0.05, P < 0.001), and increased mid‐upper arm‐circumference (MUAC; 0.02cm, 95%CI = 0.01 ‐ 0.04, P = 0.010), but no statistically significant change in weight‐for‐height z‐scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 ‐ 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01‐0.06, P = 0.006; 0.04, 95%CI = 0.01‐0.08, P = 0.026; and 0.05cm, 95%CI = 0.02‐0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.

Highlights

BACKGROUND AND RATIONALEUndernutrition contributes to almost half of all deaths in children under 5 years (Black et al, 2013)
Loss to follow up ranged from 24.5% in the micronutrient powders (MNP) group to 52.0% in the CSB++ group
Nor did CSB++ and MNP prevent growth faltering, or slow it to any clinically significant extent. This is consistent with studies elsewhere and in Cambodia, which have demonstrated the difficulty in preventing undernutrition in a representative population with moderately acutely malnourished (MAM) and non-MAM children using specialised products

Summary

Introduction

Undernutrition contributes to almost half of all deaths in children under 5 years (Black et al, 2013). In Cambodia, despite impressive economic growth, high rates of undernutrition persist (NIS et al, 2015). Borbor (white rice porridge, the traditional weaning food in Cambodia) has inadequate energy and micronutrient nutrient density to sustain adequate growth velocity in the first 2 years of life (Black et al, 2008; Ferguson et al, 2018). Nutrient dense specialised foods can be used to prevent growth faltering and promote improved linear growth and weight gain among children (Bhutta et al, 2013; Pee & Bloem, 2009; Golden, 2009)

Methods

Results

Discussion

Conclusion