New formulations for fortified‐blended foods: the MFFAPP Tanzania efficacy trial

Abstract

BackgroundFortified‐blended foods (FBFs) are micronutrient fortified, partially precooked blends of cereals and pulses that are the most commonly distributed micronutrient‐fortified food aid globally. Along with reformulation to improve FBF quality, it has been suggested that alternative commodities like sorghum and cowpea be considered for FBF formulation due to their drought tolerance, and local and regional availability in food aid receiving regions.ObjectivesOur primary objective was to determine whether newly formulated, extruded corn, soy, sorghum and cowpea‐based FBFs would result in equivalent or better hemoglobin and anemia outcomes compared with CSB+, the most commonly distributed FBF by the United States Agency for International Development. Secondary outcomes included evaluation of anthropometric and z‐score changes in height, weight, and mid‐upper arm circumference among groups.MethodsTwenty‐week, partially randomized cluster control trial located in the Mara region of Tanzania between February and July 2016. White sorghum cowpea (WSC‐1, WSC‐2), red sorghum‐cowpea (RSC), white sorghum‐soy (WSS), extruded corn‐soy blend (CSB14), or CSB+ were provided to 2186 children divided into two age groups (6–23 and 24–53 months) in seven clusters. A negative control received no FBF until study end. At 0, 10, and 20 weeks, health questionnaires, hemoglobin, and anthropometric measurements were collected. Anemia prevalence, height, weight, MUAC, WAZ, LAZ, and WHZ were calculated for each cluster at each time point. Differences in baseline socioeconomic factors, food intake and unadjusted outcomes were analyzed with SAS. Absolute anemia risk reduction was calculated for all FBFs and control compared to CSB+. Improvement and deterioration in HAZ and LAZ were also analyzed.ResultsNewly formulated FBFs were non‐inferior, or superior, to CSB+ in all outcome measures. At end line, there were significant absolute anemia risk reductions in all newly formulated FBFs compared to CSB+ in at least one age group; CSB14 and WSC‐1 anemia prevalence was significantly reduced in both age groups. In both groups, there were significant improvements in control, WSC‐2, and WSS consuming groups' HAZ scores from baseline to end line, and more children's HAZ scores improved than deteriorated compared to control in all FBFs groups.ConclusionResults suggest that sorghum and cowpea may be suitable alternatives to corn‐soy based FBFs. Socioeconomic and health factors will be analyzed in adjusted models for all outcomes.Support or Funding InformationUnited States Department of Agriculture (USDA) Foreign Agricultural Service under the Micronutrient Fortified Food Aid Products Pilot (MFFAPP) program, contract number #FFE‐621‐2012/033‐00.