Abstract
A USDA‐funded cluster‐randomized controlled trial compared two RUSF containing 500 calories and either 15% or 33% of dietary protein from dairy for 3 months versus a wait‐listed control. Each RUSF was provided 5 days per week. Intention‐to‐treat analyses were conducted with changes in weight‐for‐age and height‐for‐age Z‐scores (WAZ, HAZ) as primary outcomes. Additional outcomes included mid‐upper arm circumference (MUAC), hemoglobin and retinol binding protein levels and disease incidence.Z‐scores increased significantly in all groups over baseline (P=>0.01) but there was no significant effect of the RUSFs on changes in WAZ or HAZ. There was a significant effect of supplementation on the association between baseline WAZ and WAZ gain (P<0.002). There was a significant positive effect of randomization to the 33% RUSF on change in MUAC (P<0.05). There was a significant decrease in reported rates of malaria in children randomized to either supplement.This study provides the first evidence that RUSF with 33% versus the more typical 15% of protein provided by dairy may have particular benefit for prevention of wasting. It also indicates that RUSFs demonstrate growth benefits across the range of baseline anthropometric measures. It further shows that preschools can be an effective platform for implementation of intensive programs for prevention of malnutrition in young children living in low‐income countries.
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