Providing energy dense food supplements within a general household food distribution has little effect on the weight of children at risk of malnutrition
Giving energy dense food supplements— Ready-to-Use Supplementary Food (RUSF), a lipid-based nutrient supplement—to young children in addition to a general food distribution in a country with food shortages (Chad) did not reduce levels of wasting (low weight for height, a sign of acute undernutrition) but slightly increased their height and haemoglobin levels according to a study conducted by the international non-governmental organization Action Against Hunger-France (ACF-France) in collaboration with European researchers published in this week's PLOS Medicine.
In emergency situations, international aid organizations support affected populations by distributing food and sometimes by also providing nutritional supplements such as RUSF, to children at risk of malnutrition. In a cluster randomized controlled trial, researchers from Belgium and France, led by Lieven Huybregts from Ghent University in Belgium, investigated the effect of a targeted daily dose of RUSF in 6-month old children by randomly assigning fourteen household clusters in the city of Abeche, Chad, into an intervention or control arm. All the households received a general food distribution that included staple foods but eligible children in the intervention households were also given a daily RUSF ration.
At the end of the study period, the researchers found that the addition of RUSF to the household food rations had little effect on the incidence of wasting. However, compared to the children in the control group, those in the intervention group had a greater gain in height-for-age, slightly higher hemoglobin levels, and lower rates of diarrhea and fever, as reported by the child's parents.
The authors say: "Adding child-targeted RUSF supplementation to a general food distribution resulted in increased hemoglobin status and linear growth, accompanied by a reduction in diarrhea and fever episodes. However, we could not find clear evidence that adding RUSF to a household food ration distribution of staple foods was more effective in preventing acute malnutrition."
The authors continue: "Other context-specific alternatives for preventing acute malnutrition should therefore be investigated."
And in an accompanying Perspective article, Kathryn Dewey and Mary Arimond from the University of California in the USA (uninvolved in the study), say: "There is clearly a need for additional research to understand the potential growth-promoting effect of certain ingredients in Lipid-based Nutritional supplements (e.g., milk powder, essential fatty acids). The new study by Huybregts et al. is an important contribution to the evidence base."
Dewey and Arimond add: "High-quality programmatic studies can help provide urgently needed information on the cost and comparative cost effectiveness of different integrated strategies for filling nutrient gaps and promoting healthy growth."
Funding: This study was funded by Action Contre la Faim-France. ACF-France reviewed the final study protocol, contributed to the conception of the study and to the study design, conducted the data collection, contributed to the analysis and interpretation of the data and preparation of the manuscript. World Food Programme donated the food used to compile the food rations. WFP had no role in the study design, implementation, analysis, interpretation and preparation of the manuscript. ACF-France and World Food Programme had no role in the decision to publish the results.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Huybregts L, Houngbe´ F, Salpe´teur C, Brown R, Roberfroid D, et al. (2012) The Effect of Adding Ready-to-Use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-Randomized Controlled Trial. PLoS Med 9(9): e1001313. doi:10.1371/journal.pmed.1001313
Department of Food Safety and Food Quality
Funding: Neither author received any funding to write this piece.
Competing Interests: Neither author has a competing financial interest. Kathryn Dewey is Principal Investigator and Mary Arimond is Project Manager for the International Lipid-Based Nutrient Supplements Project (http://www.iLiNS.org), an on-going series of efficacy trials using ''small-quantity'' LNS. The supplements used in these trials were developed in collaboration with Nutriset and are purchased from Nutriset for the trials. A representative from Nutriset serves on the iLiNS Project Steering Committee, but the company had no role in study design and will have no role in analysis of results. The iLiNS Project is funded by the Bill & Melinda Gates Foundation.
Citation: Dewey KG, Arimond M (2012) Lipid-Based Nutrient Supplements: How Can They Combat Child Malnutrition? PLoS Med 9(9): e1001314. doi:10.1371/journal.pmed.1001314
Kathryn G. Dewey
University of California, Davis,
Davis, California, United States of America
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