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Research Finding

Category: Moderate Malnutrition — Returned 36 results

Thakwalakwa, C., Ashorn, P., Phuka, J., Cheung, YB., Briend, A., Puumalainen, T., Maleta, K. and
A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6- to 18-month old moderately underweight children in rural Malawi
J Nutrition. 2010 Nov; 140(11):2008-13

 
Annotation

In this study, children between 65-<110 cm (or 6-59 months) with moderate acute malnutrition and newly admitted to supplementary feeding centers (SFCs) were randomly assigned to receive either ready-to-use therapeutic foods (RUTF) or a traditional corn-soy blend (CSB) pre-mix at. The primary goal of this study was to compare the weight gain and recovery weight among the two groups over the 6 month trial period. Children were followed weekly up to recovery. Results of the study demonstrated a 79.1% overall recovery rate in the children receiving the RUTF, and a 64.4% recovery rate in those receiving the CSB. Moreover, the RUTF facilitated higher weight gain, higher recovery rate, shorter length of stay at the SFCs and a lower transfer to inpatient therapeutic feeding centers compared to CSB.

Click here to view the abstract

 
 

Lagrone, L. N., Trehan, I., Meuli, G. J., Wang, R. J., Thakwalakwa, C., Maleta, K. and Manary, M. J.
A novel fortified blended flour, corn-soy blend "plus-plus" is not inferior to lipid based ready to use supplementary foods for the treatment of moderate acute malnutrition in Malawian children
American Journal of Clinical Nutrition. 2012; 2012 Jan; Vol. 95, 212-219

 
Annotation

This prospective, randomized, controlled trial looked at 2,712 children aged 6-59 months with moderate acute malnutrition (MAM) in southern Malawi. They compared the recovery (WHZ>-2) of the children on three different treatments: 1. A corn soy blend plus plus (CSB++) which was a corn soy blend fortified with oil and dry skim milk. 2. A locally produced ready to use supplement food (RUSF). 3. A commercially available soy/whey RUSF, Plumpynut. Children were followed for a total of 7 visits, including baseline analysis with findings that children on CSB++ took an average two days longer to recover than the other two treatment groups which had an average recovery time of 23 days.  CSB++ requires a large amount of water for preparation so the child would have to consume eight times the mass of food per day when compared to the RUSF treatment.  Results showed that RUSF improved weight gain but soy/whey RUSF was superior in imporoving Mid-upper arm circumference (MUAC) when compared to just soy RUSF.  This was the first study to show that CSB++ may have similar effects on improvement in MAM as RUSF products.

Click here to view the abstract.

 
 

Phuka, J., Ashorn, U., Ashorn, P., Zeilani, M., Cheung, Y.B., Dewey, K.G., Manary, M., Maleta, K. and
Acceptability of three novel lipid-based nutrient supplements among Malawian infants and their caregivers
Maternal and child Nutrition. 2011; 2011 April;DOI:10.1111/j.1740-8709.2011.00297.x

 
Annotation

In this study, the researchers tested the acceptability of three new lipid-based nutrient supplements (LNSs) among 18 Malawian children aged 8-12-months. The trial was conducted in two independent phases. In the first phase, the three new LNSs were compared to an LNS already determined to be acceptable (Nutribitter®). Each day one of the new LNS products was introduced for comparison until all three products had been tested for acceptability. In the second phase, infants were randomly provided with one of the novel supplements for a 2-week home trial. Results demonstrated that all supplements were rated highly acceptable by most caregivers during both phases. Some infants preferred the new LNS products over the traditional complementary food.

Click here to view the abstract

 
 

Hoppe C., Udam, T.R., Lauritzen, L., Mølgaard, C., Juul, A. and Michaelsen, K.F.
Animal protein intake, serum insulin-like growth factor I, and growth in healthy 2.5-y-old Danish children.
American Journal of Clinical Nutrition. 2004 Aug; 80(2): 447-52.

 
Annotation

This study examined associations between protein intake, serum insulin-like growth factor (IFG)-1, and height in healthy 2.5 year old children.  Multiple forms of protein were compared, including milk, meat, and vegetable protein.  Height was positively associated with milk intake but not meat or vegetable protein.  IGF-1 was positively associated with milk intake but not meat or vegetable protein.  An increase in milk intake from 200 to 600 mL/d corresponded to a 30% increase in circulating IGF-I. This suggests that milk compounds have a stimulating effect on IGF-I concentrations and, thereby, on growth.

Click here to view the abstract.

 
 

Ferguson, E.L., Briend, A. and Darmon, N.
Can optimal combinations of local foods achieve the nutrient density of the F100 catch-up diet for severe malnutrition?
Journal of Pediatric Gastroenterology and Nutrition. 2008 April; 46(4): 447-52.

 
Annotation

The study aimed to assess whether optimal combinations of local foods in Ghana, Bangladesh, and Latin America could achieve the nutrient density levels of F100 (a milk-based therapeutic food to treat severe acute malnutrition) and, if that was unachievable, to identify the key limiting nutrients. For vitamin E, riboflavin, zinc, and copper, fewer than 5 foods achieved the nutrient density of F100. The study concluded that optimal combinations of local foods are unlikely to achieve the nutrient density of F100, especially for vitamin E, riboflavin, thiamin, niacin, zinc, calcium, and copper. Before home-prepared rehabilitation diets with nutrient densities lower than those of F100 are promoted, it is important to establish their clinical efficacy.

Please click here to view this abstract.

 
 

Phuka, J.C., Maleta, K., Thakwalakwa, C., Cheung, Y.B., Briend, A., Manary, M.J. and Ashorn, P.
Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians.
Archives of Pediatrics and Adolescent Medicine. 2008; 162(7): 619-25.

 
Annotation

The study compared growth and incidence of malnutrition in 6-month old infants receiving 12 months of daily dietary supplementation with either ready-to-use fortified spread with 10 g of milk (FS50) or micronutrient-fortified maize-soy flour (LP). Compared with LP-supplemented infants, those given FS50 gained a mean of 100 g more weight and 0.8 cm more length. There was a significant interaction between baseline length and intervention: children with below-median length at enrollment, presumed to be the most disadvantaged, were most likely to boost linear growth.

Please click here to view this abstract.

 
 

Michaelsen, K. F., Nielsen, A. L., Roos, N., Friis, H. and Molgaard, C.
Cow's milk in treatment of moderate and severe undernutrition in low-income countries
Nestle Nutrition Workshop Series Pediatric Program. 2011 February; Vol. 67, 99-111

 
Annotation

The aim of this review article was to look at the outcome of treating undernutrition with cow's milk in children under 5-years old in developing countries. This paper discusses how milk is effective in treating undernutrition due to its protein, sugar, mineral composition. In addition, it examines other effects milk has on nutritional status, products used to treat undernutrition, and potential limitations for using cow's milk to treat. Authors from this review generally recommend that other factors such as linear growth, body composition, and cognitive development should be assessed in addition to weight gain when looking at recovery from undernutrition. The authors also believe that children with severe wasting should be treated with a product with a high milk content.

click here to view abstract.

 
 

Hoppe, C., Molgaard, C. and Michaelsen, K.F.
Cow’s Milk and Linear Growth in Industrialized and Developing Countries.
Annual Review of Nutrition. 2006; 26: 131-73.

 
Annotation

This review of scientific literature concludes that adding cow's milk to the diet of stunted children is likely to improve linear growth and thereby reduce morbidity. In well-nourished children, the long-term consequences of an increased consumption of cow's milk, which may lead to higher levels of insulin-like growth factor (IGF)-I in circulation or an increase in the velocity of linear growth, are likely to be both positive and negative.

Please click here to view this abstract.

 
 

Espo, M., Kulmala, T., Maleta, K., Cullinan, T., Salin, M.L. and Ashorn, P.
Determinants of linear growth and predictors of severe stunting during infancy in rural Malawi.
Acta Paediatr. 2002; 91(12): 1364-70.

 
Annotation

This study analyzed typical growth and stunting among rural Malawian infants, focusing particularly on the impact of birth size, adherence to feeding guidelines and morbidity in the development of severe stunting during infancy. 613 newborns were followed for twelve months through monthly home visits. At one year of age, 71% of the infants were at least moderately and 31% severely stunted. The strongest predictor of severe stunting at 12 months of age was small birth size. Other variables independently associated with this outcome included inappropriate complementary feeding, high morbidity, maternal short stature, male gender, and home delivery. Faltering of linear growth started soon after birth and continued throughout infancy.

Please click here to view this abstract.

 
 

Hoddinott, J., Maluccio, J. A., Behrman, J. A., Flores, R. and Martorell, R.
Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults
Lancet. 2008; Vol. 371, 411-416

 
Annotation

This rare 25 year follow up study looked at 1,424 Guatemalan individuals who were enrolled in a nutrition intervention study between 1969 and 1977. Two different supplements were given, a nutritious supplement - atole which is made from a vegetable protein mix, dry skimmed milk, and sugar and fresco which is made from sugar and contains no protein. Over 25 years later,  questionnaires were given out to assess income information and education. Results showed that subjects who took atole had a higher annual income and worked fewer hours than those on the fresco supplement but the results were not statistically significant.  Also, they found that women who recieved atole were educated longer than those receiving fresco. Overall findings show that improving the nutrition of children at risk is a long-term of economic growth.

Click here to view the abstract.

 
 

Nackers, F., Broillet, F., Oumarou, D., Gaboulaud, V., Guerin, P., Rusch, B., Grais, R. and Captier, V.
Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger
J Trop Pediatr.. 2010 Dec; 56(6):407-13.

 
Annotation

In this study, children between 65-<110 cm (or 6-59 months) with moderate acute malnutrition and newly admitted to supplementary feeding centers (SFCs) were randomly assigned to receive either ready-to-use therapeutic foods (RUTF) or a traditional corn-soy blend (CSB) pre-mix at. The primary goal of this study was to compare the weight gain and recovery weight among the two groups over the 6 month trial period. Children were followed weekly up to recovery. Results of the study demonstrated a 79.1% overall recovery rate in the children receiving the RUTF, and a 64.4% recovery rate in those receiving the CSB. Moreover, the RUTF facilitated higher weight gain, higher recovery rate, shorter length of stay at the SFCs and a lower transfer to inpatient therapeutic feeding centers compared to CSB.

Click here to view the abstract

 
 

Allen, L.H., Dror, D.K.,
Effects of animal source foods, with emphasis on milk, in the diet of children in low-income countries
Nestle Nutr Workshop Ser Pediatr Program.. 2011; 2011;67:113-30

 
Annotation

Studies have demonstrated that higher intakes of animal-source foods in children in developing countries can lead to better growth and is associated with superior micronutrient status, increased cognitive performance, motor function and activity. This review paper highlights the findings of the completed observational and interventional studies to date. Though study designs have limited the ability to fully display efficacy and effectiveness of consumption of animal-source foods, data suggests that increased consumption – particularly of milk and meat – may play a significant role in improving nutritional status, including growth, superior micronutrient profiles, improved cognitive function, and reduced prevalence of anemia in children.

Click here to view the abstract

 
 

Isanaka, S., Nombela, N., Djibo, A., Poupard, M., Van Beckhoven, D., Gaboulaud, V., Guerin, P.J. and Grais, R.F.
Effects of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial.
Journal of the American Medical Association. 2009 Jan 21; 301(3): 277-85.

 
Annotation

Three-month supplementation of non-malnourished children under age five with RUTF reduced the incidence of wasting and severe wasting over eight months. The intervention resulted in a 36% reduction in the incidence of wasting and a 58% reduction in the incidence of severe wasting.

Please click here to view this abstract.

 
 

Benedikte Grenov, Anne-Louise Hother Nielsen, Christian Molgaaard and Kim Michaelsen
Evaluation of whey permeate in the treatment of moderate malnutrition
2012;

 
Annotation

This report evaluates the potential use of whey permeate in the treatment of MAM.  Adding lactose to the diets of moderately malnourished children would increase energy density and possibly the palatability while reducing cariogenic activity and having a potential prebiotic benefit. Research has previously shown that RUSF containing milk powder produces higher recovery rates and anthropometric improvements however the minimum amount of milk necessary to produce those results is unknown.  One of the biggest problems with using milk powder is it is costly and prices fluctuate. However, whey permeate has a more stable price and might be effective.  Variolac is a whey permeate product and might be effective for SAM treatment.  This report also discusses lactose intolerance, lactose and dental health, mineral content of Variolac, as well as other potential health benefits of whey permeate.    Some research using weanling piglets showed that the addition of whey permeate to their diets increased average daily feed intake and average daily weight gain.  Researchers believe that whey permeate may be a good replacement for some of the sugar in food aid products while also benefiting the child.  Comparing CSB, CSB++ and a CSB made with 20% permeate showed that CSB with permeate is a much less expensive product than CSB++ but may still benefit the child more than CSB.  Permeate may be effective in supplements for MAM.

 
 

Flax, V.L., Phuka, J., Cheung, Y.B., Ashorn, U., Maleta, K.,, Ashorn, P.,
Feeding patterns and behaviors during home supplementation of underweight Malawian children with lipid-based nutrient supplements or corn-soy blend
Apetite. 2010 Jun; 54(3):504-11

 
Annotation

The primary aim of this 12-week interventional trial was to compare child food patterns and caregiver and child feeding behaviors between 6-14 month olds supplemented with lipid-based nutrient supplements (LNS) or corn-soy blend supplements (CSB). The children observed in this study were moderately to severely malnourished, and supplements were delivered to the home weekly. Observational data was collected during one 11-hour home visit for each participant and differences were assessed by study group and mode of serving LNS. Results showed no significant differences between CSB and LNS in number of feeding episodes per day or mean daily feeding time. In fact, mean number of supplement episodes was higher with LNS, while the mail daily time spent feeding was higher in CSB. However, there were significantly more CSB leftovers than LNS mixed with porridge or plain LNS, indicating additional instructions should be provided to caregivers to minimize leftovers and maximize growth potential during supplementation periods.

Click here to view the abstract

 
 

Kuusipalo, H, Maleta, K., Briend, A., Manary, M. and Ashorn, P.
Growth and change in blood haemoglobin concentration among underweight Malawian infants receiving fortified spreads for 12 weeks: a preliminary trial.
Journal of Pediatric Gastroenterology and Nutrition. 2006; 43: 525-32.

 
Annotation

This study examined acceptability, growth and change in blood haemoglobin (Hb) concentration among moderately underweight infants age 6-17 months treated with eight food supplementation schemes over a 12-week period.  Four dairy-fortified spreads were tested at the level of 5, 25, 50, or 75 g/day. Three soy-fortified spreads were tested at the level of 25, 50, or 75 g/day.  All were compared to a zero supplement baseline.  Average weight, length, and Hb concentration gains were highest among infants receiving 50 g of supplementation.  Milk- and soy-based outcomes were comparable. The study concluded that supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anemia among moderately malnourished infants.

Please click here to view this abstract.

 
 

Hoppe, C., Mølgaard, C., Juul, A. and Michaelsen, K.F.
High intakes of skimmed milk, but not meat, increase serum IGF-I and IGFBP-3 in eight-year-old boys.
European Journal of Clinical Nutrition. 2004 Sept; 58(9): 1211-16.

 
Annotation

This study examined whether a high protein intake (PI) from either milk or meat could increase IGF-I and IGF-I/IGFBP-3 in healthy, prepubertal children. IGF-I levels are positively associated with growth velocity in children.  The study found that high intake of milk and not meat, increased concentrations of IGF-I and IGF-I/IGFBP-3 significantly. The conclusion is that compounds in milk and not a high PI as such seem to stimulate IGF-I.

Please click here to view this abstract.

 
 

Ndekha, M.J., Manary, M.J., Ashorn, P. and Briend, A.
Home-based therapy with ready-to-use therapeutic food is of benefit to malnourished, HIV-infected Malawian children.
Acta Paediatrica. 2005 Feb; 94(2): 222-25.

 
Annotation

The study followed 93 HIV-infected children who were discharged from the hospital and instructed to continue home-based nutritional supplementation. None were receiving antiretroviral therapy. More than half of the children benefited from home-based nutritional supplementation: 56% of children reached 100% weight-for-height. The children receiving RUTF gained weight more rapidly and were more likely to reach 100% weight-for-height than the other two dietary groups.

Please click here to view this abstract.

 
 

Ana B. Perez-Exposito and Barbara P. Klein
Impact of fortified blended food aid products on nutritional status of infants and young children in developing countries
Nutrition Reviews. 2012 Apr; vol. 67, no. 12

 
Annotation

This review study evaluated the effectiveness of fortified blended foods (FBFs) on improving the nutrition and health status of children and infants with moderate malnutrition, or who are at risk of undernutrition in developing countries. FBFs have been previously used in humanitarian relief programs but their effectiveness needs to be evaluated more rigorously.  Eleven studies were reviewed that took place in 8 different countries.  The studies included in this review compared a FBFs group to a corn soy blend (CSB) control group. This review found an average 76% recovery from moderate acute malnutrition (weight-for-height Z-score (WHZ) <-2) in subjects on CSB. Positive outcomes were seen in subjects using FBFs as food aid supplements but moderate acute malnutrition subjects on RUTF had higher rates of recovery.  The limited research that has been completed has found inconclusive findings so currently no causal relationship can be established.  Several constraints and regulations such as national budget, producers' profits, and food production are major factors that affect FBFs.  Overall, the review did not find definite conclusions and more research is desired on FBFs to come to a position where economic, social, and political factors are all taken into consideration. For full abstract, please visit the following site.

 
 

Flax, VL., Thakwalakwa, C., Phuka, J., Ashorn, U., Cheung, Y.B., Maleta, K.,, Ashorn, P.,
Malawian mothers' attitudes towards the use of two supplementary foods for moderately malnourished children
Apetite. 2009; 2009: Vol. 53, No. 2, 195-202.

 
Annotation

This study assessed the attitudes of Malawian mothers towards the use of lipid-based nutrient supplements (LNS) versus corn-soy blends (CSB) for supplementing nutritional intake in their moderately malnourished children. In this study, 504 Malawian mothers were interviewed at the end of each of three 12-week trials. Results demonstrated that their attitudes were similarly positive towards LNS and CSB. Both supplements were highly acceptable and the mothers were willing to purchase them again, though the mothers expressed a willingness to pay more for a one-week supply of LNS than CSB.

Click here to view the abstract

 
 

Victora, C.G., Adair, L., Fall, C., Hallal, P.C., Martorell, R., Richter, L. and Sachdev, H.S. (for the Maternal and Child Undernutrition Study Group)
Maternal and child undernutrition: consequences for adult health and human capital.
The Lancet. 2008 Jan 26; 371(9609): 340-57.

 
Annotation

This study undertook systematic review of findings from low-income and middle-income countries including cohort studies in Brazil, Guatemala, India, Philippines, and South Africa. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and—for women—lower offspring birthweight. Height-for-age at 2 years was the best predictor of human capital and undernutrition is associated with lower human capital. We conclude that damage suffered in early life leads to permanent impairment.

Please click here to view this abstract.

 
 

Rogers, I., Emmett, P., Gunnell, D., Dunger, D., Holly, J. and ALSPAC Study Team
Milk as a food for growth? The insulin-like growth factors link.
Public Health Nutrition. 2006 May; 9(3): 359-68.

 
Annotation

The study examined the association between early diet, in particular the intake of cows' milk and dairy products, and height, leg length and IGF-I levels at age 7-8 years. Data on both diet and height were available for 744 children (404 boys, 340 girls) and on diet and IGF for 538 children (295 boys, 243 girls). In boys only, dairy product intake was positively associated with leg length.

Please click here to view this abstract.

 
 

Phuka, J.C., Maleta, K., Thakwalakwa, C., Cheung, Y.B.,, Briend, A., Manary, M.J. and Ashorn, P.
Post-intervention growth of Malawian children who receive 12-month dietary complementation with a lipid-based nutritional supplement or maize-soy flour.
American Journal of Clinical Nutrition. 2009 Jan; 89(1): 382-90.

 
Annotation

Twelve-month-long complementary daily feeding with FS50 (a lipid-based nutrition supplement containing 10 g of milk) is likely to have a beneficial and sustained impact on the incidence of severe stunting in rural Malawi. Improvements in length developed during the intervention at age 10-18 mo, whereas weight differences continued to increase after the intervention. Half-dose interventions (FS25) did not show the same effect.

Click here to view the abstract.

 
 

Menon, P., Ruel, M.T., Arimond, M., Hankebo, B., Loechl, C., Maluccio, J., Mbuya, M. and Michaud, L.
Prevention or cure? Comparing preventive and recuperative approaches to targeting maternal and child health and nutrition programs in rural Haiti: executive summary of the evaluation report.
USAID Food and Nutrition Technical Assistance Project (FANTA). 2007 Dec; www.fantaproject.org

 
Annotation

This study compared the effectiveness and cost-effectiveness of a “preventive” approach, which targets all children under 2, with the traditional “recuperative” approach, which targets children under 5 years of age once they have become undernourished. In communities randomly allocated to receive a preventive approach, the prevalence of stunting, underweight and wasting respectively was 4, 6 and 4 percentage points lower after three years of operation compared to communities exposed to the recuperative program approach. When examining costs per beneficiary month, direct program costs per beneficiary-month were found to be higher in the recuperative than in the preventive approach ($21 versus $15).

Please click here to view this abstract.

 
 

Golden, M.H.
Protein-energy interactions in the management of severe malnutrition.
Clinical Nutrition. 1997 March; Supplement 1: 19-23.

 
Annotation

The three syndromes of childhood malnutrition are contrasted with respect to protein. It is concluded that stunting and wasting are the outcomes of protein deficiency, and that kwashiorkor is not due to protein deficiency, rather it is related to unopposed oxidant stress. Formulas for the energy and protein requirements are derived and contour plots of the amounts needed to sustain high rates of weight gain at different body compositions are generated. Using this approach to design a diet, high rates of weight gain are achieved under field conditions in refugee camps.

Please click here to view this abstract.

 
 

Adu-Afarwuah, S., Lartey, A., Brown, K.H., Zlotkin, S., Briend, A. and Dewey, K.G.
Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development.
American Journal of Clinical Nutrition. 2007; 86: 412–20.

 
Annotation

The study examined growth responses of Ghanian infants from 6 to 12 months of age to three forms of micronutrient dietary supplementation: Sprinkles (SP), crushable Nutritabs (NT) or lipid-based Nutributter (NB). At 12 months, after control for initial size, the NB group had significantly greater weight-for-age z and length-for-age z scores than did the NT group, and the NT and SP groups combined. All 3 supplements had positive effects on motor milestone acquisition by 12 months compared with no intervention.

Click here to view the abstract.

 
 

Fleige, L.E., Moore, W.R., Garlick, P.J., Murphy, S.P., Turner, E.H., Dunn, M.L., van Lengerich, B., Orthoefer, F.T. and Schaefer, S.E.
Recommendations for optimization of fortified and blended food aid products from the United States
Nutr Rev. 2003; 2010 May;68(5):290-315.

 
Annotation

This review provides background information regarding the history of fortified blended foods (FBFs) use in the food aid arena and highlights specific areas for improving nutritional adequacy of the FBF formulations. Finally, the authors propose a two-step strategy to optimize the nutritional quality of FBFs for food aid beneficiaries. The two main recommendations suggested include improving composition of FBFs used for general distribution in order to enhance efficiency of manufacturing and formulation to reduce costs, as well as developing new products tailor-made for specific target populations to meet their specific nutritional requirements for growth and development.

Click here to view the abstract

 
 

Patel, M., Sandige, H., Ndekha, M., Briend, A., Ashorn, P. and Manary, M.
Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition.
Journal of Health, Population and Nutrition. 2005; 23(4): 351-57.

 
Annotation

The study was a controlled, comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition. Children received either ready-to-use therapeutic food (RUTF) (n=331) or micronutrient-fortified corn-soy blend (n=41) for up to eight weeks. The primary outcome was recovery, defined as weight-for-height >90%, and the rate of weight gain. Children receiving RUTF were more likely to recover (58% vs 22%) and had greater rates of weight gain (3.1 g/kg/day vs 1.4 g/kg/day) than children receiving corn-soy blend.

Click here to view the abstract.

 
 

Kuittinen, J., Duggan, MB., Briend, A., Manary, M., Wales, J., Kulmala, T. and Ashorn, P.
Supplementary feeding of underweight, stunted Malawian children with a ready-to-use food
J Pediatr Gastroenterol Nutr.. 2004 Feb; 38(2): 152-8

 
Annotation

In this study, 61 underweight, stunted children received either a ready-to-use therapeutic food (RUTF) or traditional corn-soy blend (CSB) to alleviate moderate malnutrition. The protocol was presented in three-phases. The first phase was used to monitor baseline dietary intake and weight and height gain. In the second phase, children were randomly administered RUTF or CSB for 12 weeks of in-home use. Both supplements provided 500 calories daily but had different nutrient densities. The third phase consisted of 12-week post-supplementation observation. Results revealed that during the supplementation phase, the consumption of the CSB fell, while consumption of RUTF remained consistent leading to higher intake of energy, fat, iron and zinc in the RUTF group. Both supplemental groups experienced modest weight gain, but the effect lasted longer with the RUTF group. Height gain was not affected with either group. These findings suggest that RUTF is an acceptable alternative to CSB for dietary supplementation in moderately malnourished children.

Click here to view the abstract

 
 

Phuka, J.C., Maleta, K., Thakwalakwa, C, Cheung, Y.B., Briend, A., Manary, M.J. and Ashorn, P.
Supplementary feeding with fortified spread among moderately underweight 6- to 18-month-old rural Malawian children.
Maternal and Child Nutrition. 2009 April; 5(2): 159-70.

 
Annotation

In a poor food-security setting, underweight infants and children receiving supplementary feeding for 12 weeks with ready-to-use FS or maize–soy flour porridge show similar recovery from moderate wasting and underweight. Neither intervention, if limited to a 12-week duration, appears to have significant impact on the process of linear growth or stunting.

Please click here to view this abstract.

 
 

Matilsky, D., Maleta, K., Castleman, T. and Manary, M. J.
Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children.
Journal of Nutrition. 2009; Vol. 139(4): 773-78.

 
Annotation

Based on eight weeks of treatment, children receiving milk/peanut and soy/peanut nutritional spreads had similar recovery rates to moderate wasting, both significantly higher than the alternative supplementary food, corn-soy blend. Fortified spreads appear to be superior to corn-soy blend as supplementary foods for moderately wasted Malawian children.

Click here to view the abstract.

 
 

Larnkjaer, A., Hoppe, C., Mølgaard, C. and Michaelsen, K.F.
The effects of whole milk and infant formula on growth and IGF-I in late infancy.
European Journal of Clinical Nutrition. 2009 Aug; 63(8): 956-63. E-pub 2009 Jan 28.

 
Annotation

The study investigated the effects of high protein intake on growth and Insulin-like Growth Factor (IGF-I) from 9 to 12 months of age. 83 healthy infants received either whole milk (WM) or infant formula and fish oil or no fish oil (2 x 2 design). Intake of WM significantly increased the protein energy percentage (PE%), whereas there was no effect on size. The milk intervention increased IGF-I in boys but not in girls. Intake of fish oil had no effect on the outcomes. There was a significant correlation between weight and IGF-I at 12 months.  PE% was positively associated with IGF-I after adjusting for sex and breastfeeding at both 9 and 12 months.  The study concludes that results are consistent with the hypothesis that high milk intake stimulates growth.

Please click here to view this abstract.

 
 

Whaley, S.E., Sigman, M., Neumann, C., Bwibo, N., Guthrie, D., Weiss, R.E., Alber, S. and Murphy, S.P.
The impact of dietary intervention on the cognitive development of Kenyan school children.
Journal of Nutrition. 2003 Nov; 133(11 Suppl 2): 3965S-3971S.

 
Annotation

Previous observational studies in developing countries have suggested that diet quality, particularly increased animal source food (ASF) consumption, is positively associated with child cognitive development. This study in rural Kenya was designed to test the impact of three different diets on the cognitive development of school children. 555 children were randomized to one of four feeding interventions (meat, milk, energy or no feeding), participated for 21 months, and took regular cognitive tests. Children receiving supplemental food with meat significantly outperformed all other children on the Raven's Progressive Matrices. Results suggest that supplementation with animal source food has positive effects on cognitive performance, but effects are not equivalent across all domains of cognitive functioning, nor did different forms of animal source foods produce the same beneficial effects.

Click here to view the abstract.

 
 

Hoppe, C., Andersen, G.S., Jacobsen, S., Mølgaard, C., Friis, H., Sangild, P.T. and Michaelsen, K.F.
The use of whey or skimmed milk powder in fortified blended foods for vulnerable groups.
Journal of Nutrition. 2008 Jan; 138(1): 145S-161S.

 
Annotation

Fortified blended foods (FBF), especially corn soy blend, are used as food aid for millions of people worldwide, especially malnourished individuals and vulnerable groups. There are only a few studies evaluating the effect of FBF on health outcomes, and the potential negative effect of antinutrients has not been examined. This paper reviews the evidence on the effects of adding whey or skimmed milk powder to FBF used for malnourished infants and young children or people living with HIV or AIDS. Adding whey or skimmed milk powder to FBF improves the protein quality, allowing a reduction in total amount of protein, which could have potential metabolic advantages. It also allows for a reduced content of soy and cereal and thereby a reduction of potential antinutrients. It is possible that adding milk could improve weight gain, linear growth, and recovery from malnutrition, but this needs to be confirmed. Bioactive factors in whey might have beneficial effects on the immune system and muscle synthesis, but evidence from vulnerable groups is lacking. Milk proteins will improve flavor, which is important for acceptability in vulnerable groups. The most important disadvantage is a considerable increase in price, which means that such a product should be used only in well-defined vulnerable groups with special needs. The potential beneficial effect of adding milk protein calls for randomized intervention studies.

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Briend, A. and Z Weise Prinzo (Editor)
WHO/UNICEF/WFP/UNHCR Consultation on the Management of Moderate Malnutrition in Children Under 5 Years of Age
Food and Nutrition Bulletin Supplement. 2009; Supplement.

 
Annotation

This is a compilation of information presented at the WHO-sponsored September 2008 meeting to improve management of moderate malnutrition by improving the quality of children's diet.  Readers will find good value in reading at least three papers in this volume which devote sections to the topic of animal-source proteins: 

  • "Choice of Foods and Ingredients for Moderately Malnourished Children 6 Months to 5 Years of Age" by Michaelsen, K., et.al. (pages S380-S383 focus exclusively on milk)
  • "Current and potential role of specially formulated foods and food supplements for preventing malnutrition among 6-23-month-old children and for treating moderate malnutrition among 6-59-month-old children," by de Pee, S., and Bloem, M.
  • "Proposed recommended nutrient densities for moderately malnourished children," by Golden, M.

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Bhutta, Z. A., Ahmed, T., Black, R.E., Cousens, S., Dewey, K., Giugliani, E., Haider, B.A., Kirkwood, B., Morris, S.S., Sachdev, H.P. and Shekar, M. (Maternal and Child Undernutrition Study Group)
What works? Interventions for maternal and child undernutrition and survival.
Lancet. 2008 Feb 2; 371(9610): 417-40.

 
Annotation

What interventions affect maternal and child undernutrition and nutrition-related outcomes? Although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding reduced stunting. Provision of food supplements (with or without education) in populations with insufficient food reduced stunting. Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55%. The authors used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that include 90% of children with stunted linear growth. The model showed that existing interventions designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%.

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