Patterns and predictors of growth in HIV‐exposed 24–48‐weekold Malawians receiving lipid‐based nutrient supplements as a breastmilk replacement: results of the BAN study

Abstract

Lipid‐based nutrient supplements (LNS) could be used to limit morbidity and maintain growth in HIV‐exposed infants weaned early. This study examined growth in 1617 HIV‐exposed infants weaned from exclusive breastfeeding at 24–28 wks and provided with LNS as a breastmilk replacement to 48 wks. Weight, length, and BMI at 6 time points were estimated in sex‐stratified longitudinal random effects models controlling for birth measurement and maternal age, height, parity and education. Predictors included season and current and lagged fever, diarrhea and cough. From 24–48 wks, weight and length Z‐scores declined steadily (mean WAZ −0.42 to −0.76 and LAZ −0.93 to −1.56), BMI Z‐score remained >0 (mean 0.17), and proportion stunted increased (15.8% to 34.2%). Fever and diarrhea increased from 24–32 wks then leveled off; cough was stable. In boys, negative associations were observed with weight (season, fever and diarrhea), length (diarrhea), and BMI (fever and diarrhea). In girls, cough was also negatively associated with weight and BMI; diarrhea was not associated with length. To put these results in context, despite adverse effects of morbidity, HIV‐exposed infants given LNS as a breastmilk replacement had comparable growth to infants in the Malawi Demographic and Health Surveys. Support: CDC (U48 DP000059 01), Bill & Melinda Gates Foundation (OPP53107), Carolina Pop Ctr (NICHD 5 R24 HD050924).