Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial

Abstract

Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40-50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.

Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy'doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < -2), weight-for-length z-score (WLZ) and wasting (WLZ < -2) in children 6-18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.

Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02-0.04/month) in the Plumpy'doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy'doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5-6% (P ≤ 0.01) in those receiving Plumpy'doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27-0.30 cm and 0.07-0.10 (all P < 0.05), respectively, in all four food groups relative to the control.

Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.

Keywords: Bangladesh; Complementary food; growth; micronutrients; stunting; supplementation.

Figure 1.

Study participants and follow-up by complementary food supplement group.

Figure 2.

Adherence to supplementation by complementary food supplement group. Example of WSB++: 50% of children had compliance rates of 89.8% and above; 20% of children had compliance rates of 97.1% and above.

Figure 3.

Predicted length for age z-score from 6 until 18 months of age by complementary food supplement group, using a mixed-effects linear regression model with age included as a quadratic term.

Figure 4.

Relative risk and 95% CI of treatment effects on length for age z-score by complementary food supplement group relative to Plumpy’doz. Grey vertical lines indicate margin of non-inferiority of ± 0.2.