Fortified blended flour supplements displace plain cereals in feeding of young children

Abstract

Lipid-based nutritional supplements (LNS) and fortified blended flours (FBF) are widely used to increase the nutrient density of children's diets and improve their health, but their effectiveness could be modified by displacement of other foods. We reanalysed data from a cost-effectiveness trial comparing impacts on anthropometry of three FBFs (Corn Soy Blend Plus [CSB+], Corn Soy Whey Blend [CSWB], SuperCereal Plus [SC+]) and one LNS (Ready-to-use Supplementary Food [RUSF]) among infants aged 7-23 months in Burkina Faso. Using dietary diversity data from a single 24-h recall period (n = 1,591 children, observed once over 18-month study period), we fit logistic regression models to estimate differences in intake of each food group making up the infant and young child minimum dietary diversity score and linear models to test for differences in dietary diversity score among children in each supplement arm. We tested for differences in breastfeeding time using the subsample for which breastfeeding was observed (n = 176). Children who consumed one of the three FBFs had lower odds of consuming household grains, roots and tubers compared with the LNS consumers (odds ratios [ORs] = 0.35-0.47; 95% confidence intervals [CIs]: 0.20-1.05). Consumption of other foods, dietary diversity and breastfeeding did not differ significantly at the 5% significance level. FBFs displaced the household's own cereals more than LNS, with no difference in the child's consumption of other more nutrient-rich family foods. Given limited stomach capacity and feeding time, providing fortified cereals may help improve children's overall diet quality in settings where children would otherwise be fed nutrient-poor root crops or cereal grains.

Keywords: Burkina Faso; complementary feeding; displacement; fortified food; infants and young children; substitution; supplementary feeding.

FIGURE 1

Caregiver report of household food group consumption by supplementary food type among children 7–23 months participating in a blanket supplementary feeding program, Burkina Faso 2014–2016. CSB+ = Corn Soy Blend Plus; CSWB = Corn Soy Whey Blend; SC+ = Super Cereal Plus; RUSF = Ready‐to‐use Supplementary Food. ^* p < 0.05, ^** p < 0.01, ^*** p < 0.001

FIGURE 2

Odds ratios and 95% confidence intervals for displacement of household food groups by consumption of different supplementary food types among children 7–23 months in Burkina Faso, 2014–2016. Models adjust for child sex, age (category), total illness (2 weeks prior to each anthropometric visit) reported over study period, twin status; household food security, wealth quintile, number children <5