Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children

Abstract

Moderate childhood wasting is defined as having a weight-for-height Z-score (WHZ) < -2, but > or = -3. These children are typically given fortified corn/soy blended flour (CSB), but this intervention has shown limited effectiveness. Fortified spreads (FS) can be used as supplementary foods instead; they are energy-dense, lipid-based pastes with added powdered micronutrients. In this randomized clinical effectiveness trial, the recovery rates were compared among children with moderate wasting who received either milk/peanut FS, soy/peanut FS, or CSB. Children received isoenergetic quantities of food, 314 kJ x kg(-1) x d(-1), for up to 8 wk with biweekly follow-up. The primary outcome was recovery, defined as having a WHZ > -2. Time-event analysis was used to compare the recovery rate. A total of 1362 children were enrolled in the study. Children receiving soy/peanut FS had a similar recovery rate to those receiving milk/peanut FS and children in either FS group were more likely to recover than those receiving CSB (80% in both FS groups vs. 72% in the CSB group; P < 0.01). The rate of weight gain in the first 2 wk was greater among children receiving milk/peanut FS (2.6 g x kg(-1) x d(-1), n = 465) or children receiving soy/peanut FS (2.4 g x kg(-1) x d(-1), n = 450) than among children receiving CSB (2.0 g x kg(-1) x d(-1), n = 447; P < 0.05). Rates of length gain did not differ among the 3 groups. A total of 8% of children in each feeding group developed edema, indicative of severe malnutrition, while receiving supplemental feeding. We conclude that FS are superior supplementary foods to CSB for moderately wasted Malawian children.

FIGURE 1

Subject enrollment flow chart.

FIGURE 2

Recovery rates for moderately wasted Malawian children who received milk/peanut FS, soy/peanut FS, or a CSB as a supplementary food for up to 8 wk. Recovery was defined as reaching WHZ > −2. *CSB differs from both FS, P < 0.01 (time event analyses at each 2-wk interval).

FIGURE 3

Rates of gain in stature (A), MUAC (B), and weight (C) for moderately wasted Malawian children who received milk/peanut FS, soy/peanut FS, or CSB as a supplementary food for up to 8 wk. Values are means, whiskers are 95% CI, n = 1362. Rates of weight gain and MUAC gain were greater (P < 0.05) for children who received either FS compared with children who received the CSB, except children who received the soy/peanut FS at 6 wk. Growth rates at each 2-wk interval compared by ANOVA.