Effect of micronutrient sprinkles on reducing anemia: a cluster-randomized effectiveness trial. Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement. Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trial Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings. The Effect of Deworming on Growth in One-Year-Old Children Living in a Soil-Transmitted Helminth-Endemic Area of Peru: A Randomized Controlled Trial Effect of participatory women's groups and counselling through home visits on children's linear growth in rural eastern India (CARING trial): a cluster-randomised controlled trial Home- and community-based growth monitoring to reduce early life growth faltering: an open-label, cluster-randomized controlled trial Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. Nutrition, hygiene, and stimulation education to improve growth, cognitive, language, and motor development among infants in Uganda: A cluster‐randomized trial Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. Multiple micronutrient supplementation increases the growth of Mexican infants. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial Impact of anti-Giardia and anthelminthic treatment on infant growth and intestinal permeability in rural Bangladesh: a randomised double-blind controlled study. Effects of animal source food and micronutrient fortification in complementary food products on body composition, iron status, and linear growth: a randomized trial in Cambodia. The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants Effectiveness of facility-based personalized maternal nutrition counseling in improving child growth and morbidity up to 18 months: A cluster-randomized controlled trial in rural Burkina Faso Impact of Maternal Education about Complementary Feeding on Their Infants' Nutritional Outcomes in Low- and Middle-income Households: A Community-based Randomized Interventional Study in Karachi, Pakistan Adding multiple micronutrient powders to a homestead food production programme yields marginally significant benefit on anaemia reduction among young children in Nepal. 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. Mineral- and vitamin-enhanced micronutrient powder reduces stunting in full-term low-birth-weight infants receiving nutrition, health, and hygiene education: a 2 × 2 factorial, cluster-randomized trial in Bangladesh. Lipid-based nutrient supplementation in the first 1000 d improves child growth in Bangladesh: a cluster-randomized effectiveness trial. Determinants of growth from birth to 12 months among breast-fed Honduran infants in relation to age of introduction of complementary foods. Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial PROCOMIDA, a Food-Assisted Maternal and Child Health and Nutrition Program, Reduces Child Stunting in Guatemala: A Cluster-Randomized Controlled Intervention Trial Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial A six-month intervention with two different types of micronutrient-fortified complementary foods had distinct short- and long-term effects on linear and ponderal growth of Vietnamese infants.
OBJECTIVE To evaluate the effectiveness of Sprinkles alongside infant and young child feeding ( IYCF ) education compared with IYCF education alone on anemia , deficiencies in iron , vitamin A , and zinc , and growth  in Cambodian infants . DESIGN Cluster-r and omized effectiveness study . SETTING Cambodian rural health district . PARTICIPANTS Among 3112 infants aged 6 months , a r and om sub sample ( n = 1350 ) was surveyed at baseline and 6-month intervals to age 24 months . INTERVENTION Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months . MAIN OUTCOME MEASURES Prevalence of anemia ; iron , vitamin A , and zinc deficiencies ; and growth via biomarkers and anthropometry . RESULTS Anemia prevalence ( hemoglobin level < 11.0 g/dL [ to convert to grams per liter , multiply by 10.0 ] ) was reduced in the intervention arm compared with the control arm by 20.6 % at 12 months ( 95 % CI , 9.4 - 30.2 ; P = .001 ) , and the prevalence of moderate anemia ( hemoglobin level < 10.0 g/dL ) was reduced by 27.1 % ( 95 % CI , 21.0 - 31.8 ; P < .001 ) . At 12 and 18 months , iron deficiency prevalence was reduced by 23.5 % ( 95 % CI , 15.6 - 29.1 ; P < .001 ) and 11.6 % ( 95 % CI , 2.6 - 17.9 ; P = .02 ) , respectively . The mean serum zinc concentration was increased at 12 months ( 2.88 μg/dL [ to convert to micromoles per liter , multiply by 0.153 ] ; 95 % CI , 0.26 - 5.42 ; P = .03 ) . There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time . CONCLUSIONS Sprinkles reduced anemia and iron deficiency and increased the  mean serum zinc concentration in Cambodian infants . Anemia and zinc effects did not persist beyond the intervention period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12608000069358 BACKGROUND Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas . Stunting affects 1 in 5 young children . OBJECTIVE We aim ed to test the efficacy of a daily lipid-based nutrient supplement ( LNS ) for increased linear growth in  young children . DESIGN Healthy , singleton infants aged 6 - 11 mo ( n = 589 ) were recruited from an urban slum of Cap Haitien and r and omly assigned to receive : 1 ) a control ; 2 ) a 3-mo LNS ; or 3 ) a 6-mo LNS . The LNS provided 108 kcal and other nutrients including vitamin A , vitamin B-12 , iron , and zinc at ≥80 % of the recommended amounts . Infants were followed monthly on growth , morbidity , and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects . The Bonferroni multiple comparisons test was applied , and generalized least-squares ( GLS ) regressions with mixed effects was used to examine impacts longitudinally . RESULTS Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group . GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score ( ±SE ) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age ( P < 0.001 ) . The effects were sustained 6 mo postintervention . Morbidity and developmental outcomes did not differ by trial arm . CONCLUSION A low-energy , fortified product improved the linear growth  of young children in this urban setting . The trial was registered at clinical trials.gov as NCT01552512 Background Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition . Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid ( PUFA ) content and low n-3 PUFA , with no stipulated requirements for preformed long-chain n-3 PUFA . The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact , with and without fish oil supplementation , on children ’s PUFA status during treatment of severe acute malnutrition . Methods This r and omized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were r and omized to receive i ) RUTF with st and ard composition ; ii ) RUTF with elevated short chain n-3 PUFA ; or iii ) RUTF with elevated short chain n-3 PUFA plus fish oil capsules . Participants were followed-up for 3 months . The primary outcome was erythrocyte PUFA composition . Results Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil . Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or st and ard RUTF alone : 3 months after enrolment , DHA content was 6.3 % ( interquartile range 6.0–7.3 ) , 4.5 % ( 3.9–4.9 ) , and 3.9 % ( 2.4–5.7 ) of total erythrocyte fatty acids ( P < 0.001 ) , respectively , while eicosapentaenoic acid ( EPA ) content was 2.0 % ( 1.5–2.6 ) , 0.7 % ( 0.6–0.8 ) , and 0.4 % ( 0.3–0.5 ) ( P < 0.001 ) . RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes . Conclusions PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA . Clinical and growth implication s of revised formulations need to be addressed in large clinical trials . Trial registration Clinical trials.gov NCT01593969 . Registered 4 May 2012 BACKGROUND Improved complementary feeding is cited as a critical factor for reducing stunting . Consumption of meats has been advocated , but its efficacy in low-re source setting s has not been tested . OBJECTIVE The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal . DESIGN This was a cluster r and omized efficacy trial conducted in the Democratic Republic of Congo , Zambia , Guatemala , and Pakistan . Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants . Blood tests were obtained at trial completion . RESULTS A total of 532 ( 86.1 % ) and 530 ( 85.8 % ) participants from the meat and cereal arms , respectively , completed the study .  Linear growth velocity did not differ between treatment groups : 1.00 ( 95 % CI : 0.99 , 1.02 ) and 1.02 ( 95 % CI : 1.00 , 1.04 ) cm/mo for the meat and cereal groups , respectively ( P = 0.39 ) . From baseline to 18 mo , stunting [ length-for-age z score ( LAZ ) < -2.0 ] rates increased from ~33 % to nearly 50 % . Years of maternal education and maternal height were positively associated with linear growth velocity ( P = 0.0006 and 0.003 , respectively ) ; LAZ at 6 mo was negatively associated ( P < 0.0001 ) . Anemia rates did not differ by group ; iron deficiency was significantly lower in the cereal group . CONCLUSION The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods Background Appropriate health and nutrition interventions to prevent long-term adverse effects in children are necessary before two years of age . One such intervention may include population -based deworming , recommended as of 12 months of age by the World Health Organization in soil-transmitted helminth (STH)-endemic areas ; however , the benefit of deworming has been understudied in early preschool-age children . Methodology /Principal Findings A r and omized , double-blind , placebo-controlled trial was conducted to determine the effect of  deworming ( 500 mg single-dose crushed mebendazole tablet ) on growth in one-year-old children in Iquitos , Peru . Children were enrolled during their routine 12-month growth and development clinic visit and followed up at their 18 and 24-month visits . Children were r and omly allocated to : Group 1 : deworming at 12 months and placebo at 18 months ; Group 2 : placebo at 12 months and deworming at 18 months ; Group 3 : deworming at both 12 and 18 months ; or Group 4 : placebo at both 12 and 18 months ( i.e. control group ) . The primary outcome was weight gain at the 24-month visit . An intention-to-treat approach was used . A total of 1760 children were enrolled between September 2011 and June 2012 . Follow-up of 1563 children ( 88.8 % ) was completed by July 2013 . STH infection was of low prevalence and predominantly light intensity in the study population . All groups gained between 1.93 and 2.05 kg on average over 12 months ; the average difference in weight gain ( kg ) compared to placebo was : 0.05 ( 95 % CI : -0.05 , 0.17 ) in Group 1 ; -0.07 ( 95%CI : -0.17 , 0.04 ) in Group 2 ; and 0.04 ( 95%CI : -0.06 , 0.14 ) in Group 3 . There was no statistically significant difference in weight gain in any of the deworming intervention groups compared to the control group . Conclusions Overall , with one year of follow-up , no effect of deworming on growth could be detected in this population of preschool-age children . Low baseline STH prevalence and intensity and /or access to deworming drugs outside of the trial may have diluted the potential effect of the intervention . Additional research is required to overcome these challenges and to contribute to strengthening the evidence base on deworming . Trial Registration Clinical Trials.gov ( NCT01314937 Summary Background Around 30 % of the world 's stunted children live in India . The Government of India has proposed a new cadre of community-based workers to improve nutrition in 200 districts . We aim ed to find out the effect of such a worker carrying out home visits and participatory group meetings on children 's linear growth . Methods We did a cluster-r and omised controlled trial in two adjoining districts of Jharkh and and Odisha , India . 120 clusters ( around 1000 people each ) were r and omly allocated to intervention or control using a lottery . R and omisation took place in July , 2013 , and was stratified by district and number of hamlets per cluster ( 0 , 1–2 , or ≥3 ) , result ing in six strata . In each intervention cluster , a worker carried out one home visit in the third trimester of pregnancy , monthly visits to children younger than 2 years to support feeding , hygiene , care , and stimulation , as well as monthly women 's group meetings to promote individual and community action for nutrition . Participants were pregnant women identified and recruited in the study clusters and their children . We excluded stillbirths and neonatal deaths , infants whose mothers died , those with congenital abnormalities , multiple births , and mother and infant pairs who migrated out of the study area permanently during the trial period . Data collectors visited each woman in pregnancy , within 72 h of her baby 's birth , and at 3 , 6 , 9 , 12 , and 18 months after birth . The primary outcome was children 's length-for-age Z score at 18 months of age . Analyses were by intention to treat . Due to the nature of the intervention , participants and the intervention team were not masked to allocation . Data collectors and the data manager were masked to allocation . The trial is registered as ISCRTN ( 51505201 ) and with the Clinical Trials Registry of India ( number 2014/06/004664 ) . Results Between Oct 1 , 2013 , and Dec 31 , 2015 , we recruited 5781 pregnant women . 3001 infants were born to pregnant women recruited between Oct 1 , 2013 , and Feb 10 , 2015 , and were therefore eligible for follow-up ( 1460 assigned to intervention ; 1541 assigned to control ) . Three groups of children could not be included in the final analysis : 147 migrated out of the study area ( 67 in intervention clusters ; 80 in control clusters ) , 77 died after the neonatal period and before 18 months ( 31 in intervention clusters ; 46 in control clusters ) , and seven had implausible length-for-age Z scores ( < –5 SD ; one in intervention cluster ; six in control clusters ) . We measured 1253 ( 92 % ) of 1362 eligible children at 18 months in intervention clusters , and 1308 ( 92 % ) of 1415 eligible children in control clusters . Mean length-for-age Z score at 18 months was −2·31 ( SD 1·12 ) in intervention clusters and −2·40 ( SD 1·10 ) in control clusters ( adjusted difference 0·107 , 95 % CI −0·011 to 0·226 , p=0·08 ) . The intervention did not significantly affect exclusive breastfeeding , timely introduction of complementary foods , morbidity , appropriate home care or care-seeking during childhood illnesses . In intervention clusters , more pregnant women and children attained minimum dietary diversity ( adjusted odds ratio [ aOR ] for women 1·39 , 95 % CI 1·03–1·90 ; for children 1·47 , 1·07–2·02 ) , more mothers washed their h and s before feeding children ( 5·23 , 2·61–10·5 ) , fewer children were underweight at 18 months ( 0·81 , 0·66–0·99 ) , and fewer infants died ( 0·63 , 0·39–1·00 ) . Interpretation Introduction of a new worker in areas with a high burden of undernutrition in rural eastern India did not significantly increase children 's length . However , certain secondary outcomes such as self-reported dietary diversity and h and washing , as well as infant survival were improved . The interventions tested in this trial can be further optimised for use at scale , but substantial improvements in growth will require investment in nutrition-sensitive interventions , including clean water , sanitation , family planning , girls ' education , and social safety nets . Funding UK Medical Research Council , Wellcome Trust , UK Department for International Development ( DFID ) Background : Despite the continued high prevalence of faltering growth , height monitoring remains limited in many low- and middle-income countries . Objective : The objective of this study was to test whether providing parents with information on their child ’s height can improve children ’s height and developmental outcomes . Design : Villages in Chipata District , Zambia ( n = 127 ) , were r and omly assigned with equal probability to 1 of 3 groups : home-based growth monitoring ( HBGM ) , community-based growth monitoring including nutritional supplementation for children with stunted growth ( CBGM+NS ) , and control . Primary study outcomes were individual height-for-age z score ( HAZ ) and overall child development assessed with the International Fetal and Newborn Growth Consortium for the 21st Century Neurodevelopment Assessment tool . Secondary outcomes were weight-for-age z score ( WAZ ) , protein consumption , breastfeeding , and general dietary diversity . Results : We enrolled a total of 547 children with a median age of 13 mo at baseline .  Estimated mean difference ( β ) in HAZ was 0.127 ( 95 % CI : −0.107 , 0.361 ) for HBGM and −0.152 ( 95 % CI : −0.341 , 0.036 ) for CBGM+NS . HBGM had no impact on child development [ β : −0.017 ( 95 % CI : −0.133 , 0.098 ) ] ; CBGM+NS reduced overall child development scores by −0.118 SD ( 95 % CI : −0.230 , −0.006 SD ) . Both interventions had larger positive effects among children with stunted growth at baseline , with estimated interaction effects of 0.503 ( 95 % CI : 0.160 , 0.846 ) and 0.582 ( 95 % CI : 0.134 , 1.030 ) for CBGM+NS and HBGM , respectively . HBGM increased mean WAZ [ β = 0.183 ( 95 % CI : 0.037 , 0.328 ) ] . Both interventions improved parental reports of children ’s protein intake . Conclusions : The results from this trial suggest that growth monitoring has a limited effect on children ’s height and development , despite improvements in self-reported feeding practice s. HBGM had modest positive effects on children with stunted growth . Given its relatively low cost , this intervention may be a cost-effective tool for increasing parental efforts toward reducing children ’s physical growth deficits . This trial was registered at clinical trials.gov as NCT02242539 BACKGROUND Therapeutic feeding with micronutrient-fortified lipid-based nutrient supplements ( LNSs ) has proven useful in the rehabilitation of severely malnourished children . We recently reported that complementary feeding of 6 - 18-mo-old infants with an LNS known as FS50 was associated with improved linear growth and a reduction in the incidence of severe stunting during the supplementation period . OBJECTIVE Our objective was to assess whether a reduction in stunting seen with 12-mo LNS supplementation was sustained over a subsequent 2-y nonintervention period . DESIGN One hundred eighty-two 6-mo-old healthy rural Malawian infants were r and omly assigned to receive daily supplementation for 12 mo with 71 g of maize-soy flour [ likuni phala ( LP ) ; control group , 282 kcal ] or either 50 g of FS50 ( 264 kcal ; main intervention group ) , or 25 g of FS25 ( 130 kcal ) . Main outcome measures were incidence of severe stunting and mean z score changes in weight-for-age , length-for-age , and weight-for-length during a 36-mo follow-up period . RESULTS The cumulative 36-mo incidence of severe stunting was 19.6 % in LP , 3.6 % in FS50 , and 10.3 % in FS25 groups ( P = 0.03 ) . Mean weight-for-age changes were -1.09 , -0.76 , and -1.22 ( P = 0.04 ) ; mean length-for-age changes were -0.47 , -0.37 , and -0.71 ( P = 0.10 ) ; and mean weight-for-length changes were -1.52 , -1.18 , and -1.48 ( P = 0.27 ) . All differences were more marked among individuals with baseline length-for-age below the median . Differences in length developed during the intervention at age 10 - 18 mo , whereas weight differences continued to increase after the intervention . CONCLUSIONS Twelve-month-long complementary feeding with 50 g/d FS50 is likely to have a positive and sustained impact on the incidence of severe stunting in rural Malawi . Half-dose intervention may not have the same effect . This trial was registered at ( clinical trials.gov ) as NCT00131209 Stunting is associated with impaired cognitive and motor function . The effect of an education intervention including nutrition , stimulation , sanitation , and hygiene on child growth and cognitive/ language /motor development , delivered to impoverished mothers in Ug and a , was assessed . In a community-based , open cluster-r and omized trial , 511 mother/children dyads aged 6 - 8 months were enrolled to an intervention ( n = 263 ) or control ( n = 248 ) group . The primary outcome was change in length-for-age z-score at age 20 - 24 months . Secondary outcomes included anthropometry and scores on the 2 developmental scales : Bayley Scales of Infant and Toddler Development-III and the Ages and Stages Question naire . There was no evidence of a difference in mean length-for-age z-score at 20 - 24 months between the 2 study groups : 0.10 , 95 % CI [ -0.17 , 0.36 ] , p = .49 . The intervention group had higher mean composite development scores than the controls on Bayley Scales of Infant and Toddler Development-III , the mean difference being 15.6 , 95 % CI [ 10.9 , 20.2 ] , p = .0001 ; 9.9 , 95 % CI [ 6.4 , 13.2 ] , p = .0001 ; and 14.6 , 95 % CI [ 10.9 , 18.2 ] , p = .0001 , for cognitive , language , and motor composite scores , respectively . The mean difference in scores from the Ages and Stages Question naire were 7.0 , 95 % CI [ 2.9 , 11.3 ] , p = .001 ; 5.9 , 95 % CI [ 1.2 , 10.3 ] , p = .01 ; 4.2 , 95 % CI [ 1.7 , 6.7 ] , p = .001 ; 8.9 , 95 % CI [ 5.3 , 12.3 ] , p = .0001 ; and 4.4 , 95 % CI [ 0.0 , 8.8 ] , p = .05 , for communication , gross motor , fine motor , problem solving , and personal-social development , respectively . The intervention education delivered to mothers promoted early development domains in cognitive , language , and motor development but not linear growth of small children in impoverished rural communities in Ug and a. Our study showed that child development may be improved with a relatively low cost intervention strategy . This trial was registered at Clinical Trials.gov as NCT02098031 Undernutrition in infancy and early childhood is thought to adversely affect cognitive development , although evidence of lasting effects is not well established . With the use of data from the Cebu Longitudinal Health and Nutrition Study , we assesshere the relationship between stunting in the first 2 y of life and later cognitive development , focusing on the significance of severity , timing and persistence of early stunting . The sample included > 2000 Filipino children administered a cognitive ability test at ages 8 and 11 y.  Stunting status was determined on the basis of anthropometric data collected prospect ively between birth and age 2 y. Children stunted between birth and age 2 y had significantly lower test scores than nonstunted children , especially when stunting was severe . The shortfall in test scores among children stunted in the first 2 y was strongly related to reduced schooling , which was the result of a substantial delay in initial enrollment as well as higher absenteeism and repetition of school years among stunted children . Interactions between stunting and schooling were not significant , indicating that stunted and nonstunted children benefitted similarly from additional schooling . After multivariate adjustment , severe stunting at age 2 y remained significantly associated with later deficits in cognitive ability . The timing of stunting was also related to test performance , largely because children stunted very early also tended to be severely stunted ( chi(2 ) P = 0.000 ) . Deficits in children 's scores were smaller at age 11 y than at age 8 y , suggesting that adverse effects may decline over time . Results emphasize the need to prevent early stunting and to provide adequate schooling to disadvantaged children BACKGROUND Koko , a fermented maize porridge used as the primary complementary food in Ghana , has been implicated in the high prevalence of child malnutrition . Weanimix , a cereal-legume blend developed by the United Nations Children 's Fund and the Ghanaian government , has been promoted as an alternative . OBJECTIVE We evaluated the effect of feeding Weanimix and 3 other locally formulated , central ly processed complementary foods on the nutritional status of 208 breast-fed infants . DESIGN Infants were r and omly assigned to receive 1 of 4 foods from 6 to 12 mo of age : Weanimix ( W ) , Weanimix plus vitamins and minerals ( WM ) , Weanimix plus fish powder ( WF ) , and koko plus fish powder ( KF ) . Dietary and anthropometric data were collected regularly . Blood was collected at 6 and 12 mo of age to assess iron , zinc , vitamin A , and riboflavin status . Before and after the intervention , cross-sectional data on the anthropometric status of infants not included in the intervention ( NI ; n = 464 ) were collected . RESULTS There were no significant differences between intervention groups in weight or length gain or in hemoglobin , hematocrit , transferrin saturation , plasma zinc , or erythrocyte riboflavin values between 6 and 12 mo of age . From 9 to 12 mo of age , z scores were lower in NI infants than in the combined intervention groups [ at 12 mo : -1.71 + /- 0.90 compared with -1.19 + /- 0.93 for weight and -1.27 + /- 1.02 compared with -0.63 + /- 0.84 for length ( P < 0.001 for both ) , respectively ] . The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W , WF , and KF but not in group WM . Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined ( 0.14 + /- 0.3 compared with -0.04 + /- 0.3 micromol/L , P = 0 . 003 ) . CONCLUSIONS All 4 foods improved growth relative to the NI group . Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods BACKGROUND The role of single micronutrient deficiencies in the etiology of growth retardation has recently gained attention . However , because multiple micronutrient deficiencies are common in children in developing countries , it is possible that more than one micronutrient may limit growth and , hence , the correction of a single deficiency may not be enough to improve growth substantially . OBJECTIVE The objective was to evaluate the effect of multiple micronutrient supplementation on the growth of children aged 8 - 14 mo whose diets were poor in several micronutrients . DESIGN Children were r and omly assigned to 1 of 2 groups . One group received a multiple micronutrient supplement containing the recommended dietary allowance ( RDA ) or 1.5 times the RDA of vitamins A , D , E , K , C , B-1 , B-6 , B-12 , riboflavin , niacin , biotin , folic acid , and pantothenic acid , and iron , zinc , iodine , copper , manganese , and selenium . The other group received a placebo . Supplements were administered 6 d/wk for an average of 12.2 mo . Body length was measured at baseline and monthly thereafter until the end of supplementation . RESULTS Supplemented infants initially aged < 12 mo had significantly greater length gains than did the placebo group , with a difference of 8.2 mm ( length-for-age z score : 0.3 ) at the end of supplementation . In contrast , differences in length gains between the supplemented and placebo groups initially aged > or = 12 mo were not significant . CONCLUSIONS Micronutrient deficiencies limited the growth of the Mexican infants studied . Improving micronutrient intakes should be a component of interventions to promote growth in infants living in setting s where micronutrient intakes are inadequate Summary Background Diarrhoea and growth faltering in early childhood are associated with subsequent adverse outcomes . We aim ed to assess whether water quality , sanitation , and h and washing interventions alone or combined with nutrition interventions reduced diarrhoea or growth faltering . Methods The WASH Benefits Bangladesh cluster-r and omised trial enrolled pregnant women from villages in rural Bangladesh and evaluated outcomes at 1-year and 2-years ' follow-up . Pregnant women in geographically adjacent clusters were block-r and omised to one of seven clusters : chlorinated drinking water ( water ) ; up grade d sanitation ( sanitation ) ; promotion of h and washing with soap ( h and washing ) ; combined water , sanitation , and h and washing ; counselling on appropriate child nutrition plus lipid-based nutrient supplements ( nutrition ) ; combined water , sanitation , h and washing , and nutrition ; and control ( data collection only ) . Primary outcomes were caregiver-reported diarrhoea in the past 7 days among children who were in utero or younger than 3 years at enrolment and length-for-age Z score among children born to enrolled pregnant women . Masking was not possible for data collection , but analyses were masked . Analysis was by intention to treat . This trial is registered at Clinical Trials.gov , number NCC01590095 . Findings Between May 31 , 2012 , and July 7 , 2013 , 5551 pregnant women in 720 clusters were r and omly allocated to one of seven groups . 1382 women were assigned to the control group ; 698 to water ; 696 to sanitation ; 688 to h and washing ; 702 to water , sanitation , and h and washing ; 699 to nutrition ; and 686 to water , sanitation , h and washing , and nutrition .  331 ( 6 % ) women were lost to follow-up . Data on diarrhoea at year 1 or year 2 ( combined ) were available for 14 425 children ( 7331 in year 1 , 7094 in year 2 ) and data on length-for-age Z score in year 2 were available for 4584 children ( 92 % of living children were measured at year 2 ) . All interventions had high adherence . Compared with a prevalence of 5·7 % ( 200 of 3517 child weeks ) in the control group , 7-day diarrhoea prevalence was lower among index children and children under 3 years at enrolment who received sanitation ( 61 [ 3·5 % ] of 1760 ; prevalence ratio 0·61 , 95 % CI 0·46–0·81 ) , h and washing ( 62 [ 3·5 % ] of 1795 ; 0·60 , 0·45–0·80 ) , combined water , sanitation , and h and washing ( 74 [ 3·9 % ] of 1902 ; 0·69 , 0·53–0·90 ) , nutrition ( 62 [ 3·5 % ] of 1766 ; 0·64 , 0·49–0·85 ) , and combined water , sanitation , h and washing , and nutrition ( 66 [ 3·5 % ] of 1861 ; 0·62 , 0·47–0·81 ) ; diarrhoea prevalence was not significantly lower in children receiving water treatment ( 90 [ 4·9 % ] of 1824 ; 0·89 , 0·70–1·13 ) . Compared with control ( mean length-for-age Z score −1·79 ) , children were taller by year 2 in the nutrition group ( mean difference 0·25 [ 95 % CI 0·15–0·36 ] ) and in the combined water , sanitation , h and washing , and nutrition group ( 0·13 [ 0·02–0·24 ] ) . The individual water , sanitation , and h and washing groups , and combined water , sanitation , and h and washing group had no effect on linear growth . Interpretation Nutrient supplementation and counselling  modestly improved linear growth , but there was no benefit to the integration of water , sanitation , and h and washing with nutrition . Adherence was high in all groups and diarrhoea prevalence was reduced in all intervention groups except water treatment . Combined water , sanitation , and h and washing interventions provided no additive benefit over single interventions . Funding Bill & Melinda Gates Foundation In order to test the impact of Giardia and geohelminthic infection on infant growth faltering in Bangladesh , a r and omised double-blind placebo controlled intervention of 36 weeks ' duration was conducted in a rural community located 40 km northwest of Dhaka . Infants aged between 3 and 15 months were r and omly assigned to either anti-Giardia and anthelminthic treatment , anti-Giardia treatment only , or a control .  Weight and supine length were recorded every 4 weeks . Every 12 weeks intestinal permeability ( lactulose/mannitol ratio ) , haemoglobin , plasma albumin , alpha-1-acid glycoprotein , IgG and Giardia-specific IgM ( GSIgM ) and eggs of the three common geohelminths and G. intestinalis cysts were determined . Data on 222 fully compliant infants were analysed . No significant differences in intestinal permeability , biochemical or anthropometric variables were found between the intervention groups , although there were associations between improvement in small intestinal mucosal function and better weight-for-age and weight-for-height ( length ) Z-scores . GSIgM titres indicated high endemicity with rapid re-infection of Giardia among infants ; over 95 % of infants were positive throughout the study , whereas the stool examination showed very few infants with either geohelminth eggs or Giardia cysts BACKGROUND Poor nutritional quality of complementary foods often limits growth . Animal source foods , such as milk or meat , are often unaffordable . Local affordable alternatives are needed . OBJECTIVE We evaluate the efficacy of 2 newly developed , rice-based complementary food products : WinFood ( WF ) with small fish and edible spiders and WinFood-Lite ( WF-L ) fortified with small fish , against 2 existing fortified corn-soy blend products , CSB+ ( purely plant based ) and CSB++ ( 8 % dried skimmed milk ) . DESIGN In total , 419 infants aged 6 mo were enrolled in this r and omized , single-blinded study for 9 mo , design ed primarily to assess increments in fat-free mass by a deuterium dilution technique and change in plasma ferritin and soluble transferrin receptor . Secondary endpoints were changes in anthropometric variables , including knee-heel length . Data were analyzed by the intention-to-treat approach . RESULTS There was no difference in fat-free mass increment in WF or WF-L compared with CSB+ [ WF : + 0.04 kg ( 95 % CI : -0.20 , 0.28 kg ) ; WF-L : + 0.14 kg ( 95 % CI : -0.10 , 0.38 kg ) ] or CSB++ [ WF : -0.03 kg ( 95 % CI : -0.27 , 0.21 kg ) ; WF-L : + 0.07 kg ( 95 % CI : -0.18 , 0.31 kg ) ] and no effect on iron status . The 1.7-mm ( 95 % CI : -0.1 , 3.5 mm ) greater increase in knee-heel length in WF-L than in CSB+ was not significant . CONCLUSIONS No difference was found between the locally produced products ( WF and WF-L ) and the CSBs . Micronutrient fortification may be necessary , and small fish may be an affordable alternative to milk to improve complementary foods . The dietary role of edible spiders needs to be further explored . This trial was registered at controlled-trials.com as IS RCT N19918531 The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status , linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape , South Africa . The study was design ed as an intervention study . In both the experimental and control groups , serum retinol concentration showed a decline over the intervention period of 6 months . The decline was less pronounced in the experimental group . This result ed in a significantly ( P<005 ) higher serum retinol concentration at 12 months in the experimental group ( 26.8±5.8 μg/dl ) compared with the control group ( 21.4±5 μg/dl ) . Serum iron concentration also declined over the intervention period . The decline was less pronounced in the experimental group . No difference was observed in haemoglobin levels between the groups at 12 months . Serum zinc concentration did not differ significantly between the two groups at follow up . Weight gain over the 6 months period did not differ significantly between the experimental ( 2.1±0.9 kg ) and control groups ( 2.1±1.2 kg ) . There was no difference in linear growth between the experimental ( 10.0±1.5 cm ) and control group ( 10.1±2.1 cm ) at the end of the follow-up period . Weight and length at 6 months significantly predicted weight and length at 12 months . No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention . Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group . No benefit was observed in serum zinc concentration , linear growth and psychomotor development The period from conception to 24 months of age is a crucial window for nutrition interventions . Personalized maternal counseling may improve childbirth outcomes , growth , and health . We assessed the effectiveness of facility-based personalized maternal nutrition counseling ( from pregnancy to 18 months after birth ) in improving child growth and health in rural Burkina Faso . We conducted a paired cluster r and omized controlled trial in a rural district of Burkina Faso with 12 primary health centers ( clusters ) . Healthcare providers in the intervention centers received patient-centered communication and nutrition counseling training .  Pregnant women in the third trimester living in the center catchment areas and intending to stay for the next 2 years were prospect ively included . We followed 2253 mother-child pairs quarterly until the child was aged 18 months . Women were interviewed about counseling experiences , dietary practice s during pregnancy , and their child ’s feeding practice s and morbidity history . Anthropometric measurements were taken at each visit using st and ardized methods . The primary outcomes were the cumulative incidence of wasting , and changes in child weight-for-height z-score ( WHZ ) . Secondary outcomes were the women ’s prenatal dietary practice s , early breastfeeding practice s , exclusive breastfeeding , timely introduction of complementary food , child ’s feeding frequency and dietary diversity , children ’s mean birth weight , endpoint prevalence of stunting , and cumulative incidence of diarrhea , fever , and acute respiratory infection . All analyses were by intention-to-treat using mixed effects models . The intervention and control arms each included six health centers . Mothers in the intervention arm had a significantly higher exposure to counseling with 11.2 % for breastfeeding techniques to 75.7 % for counseling on exclusive breastfeeding . Mothers of infants below 6 months of age in the intervention arm were more likely to exclusively breastfeed ( 54.3 % vs 42.3 % ; Difference of Proportion ( DP ) 12.8 % ; 95 % CI : 2.1 , 23.6 ; p = 0.020 ) as compared to the control arm . Between 6 and 18 months of age , more children in the intervention arm benefited from the required feeding frequency ( 68.8 % vs 53.4 % ; DP 14.1 % ; 95 % CI : 9.0 , 19.2 ; p<0.001 ) and a larger proportion had a minimum dietary diversity ( 28.6 % vs 22.0 % ; DP 5.9 % ; 95 % CI : 2.7 , 9.2 ; p<0.001 ) . Birth weight of newborns in the intervention arm was on average 84.8 g ( p = 0.037 ) larger compared to the control arm . However , we found no significant differences in child anthropometry or morbidity between study arms . Facility-based personalized maternal nutrition counseling was associated with an improved prenatal dietary practice s , Infant and Young Child Feeding practice s , and child birth weight . Complementary strategies are warranted to obtain meaningful impact on child growth and morbidity . This includes strategies to ensure good coverage of facility-based services and effective nutrition/care practice s in early childhood ABSTRACT This cluster-r and omized interventional trial at peri-urban setting s of Karachi was conducted to evaluate the impact of maternal educational messages regarding appropriate complementary feeding ( CF ) on the nutritional status of their infants after 30 weeks of educational interventions delivered by trained community health workers . Mothers in the intervention group received three education modules about breastfeeding ( BF ) and appropriate CF at a baseline visit and two subsequent visits 10 weeks apart . The control group received advice about BF according to national guidelines .  Infants ' growth [ weight , length , and mid-upper arm-circumference ( MUAC ) , stunting , wasting , and underweight ] were measured at four time points . At the end of the study , infants in the intervention group had a higher mean weight of 350 g ( p=0.001 ) ; length of 0.66 cm ( p=0.001 ) , and MUAC of 0.46 cm ( p=0.002 ) compared to the controls ; proportionate reduction of stunting and underweight were 10 % ( 84 % vs 74 % ; ORadj 8.36 ( 5.6 - 12.42 ) and 5 % ( 25 % vs 20 % ; ORadj 0.75 ( 0.4 - 1.79 ) in the intervention compared to the control group . For relatively food-secure population s , educational interventions about appropriate CF to mothers had a direct positive impact on linear growth of their infants Anaemia affects 46 % of preschool-aged children in Nepal . A cluster-r and omised study was conducted in rural Nepal to test whether providing micronutrient powders ( MNP ) in addition to enhanced homestead food production ( EHFP ) programme , consisting of home gardens , poultry and nutrition education , could lead to a higher reduction in anaemia compared with providing only EHFP . This sub- study enrolled 335 children aged 6 - 9 months into one of three groups : ( 1 ) EHFP + MNP ; ( 2 ) EHFP ; or ( 3 ) control . The EHFP + MNP group received 60 sachets of MNP for flexible consumption at the start and 6 months later for a total supplementation period of 11 months . The MNP contained 15 micronutrients including iron ( 10 mg encapsulated ferrous fumarate ) . Haemoglobin and anthropometry were measured at baseline and post-MNP supplementation . Mean ± SE haemoglobin concentration increased significantly in all groups , with a slightly higher but non-significant increase in the EHFP + MNP and EHFP compared with control ( difference-in-differences : 4.1 g L(-1 ) for EHFP + MNP vs. control ; 3.6 g L(-1 ) for EHFP vs. control ; 0.5 g L(-1 ) for EHFP + MNP vs. EHFP ) . Anaemia decreased at a slightly higher magnitude in the EHFP + MNP [ 51.5 percentage points ( PP ) ] than the EHFP ( 48.6 PP ) and control ( 39.6 PP ) , with adjusted odds ratios ( 95 % CI ) at post-supplementation of 0.52 ( 0.25 - 1.12 ) for EHFP + MNP and 0.69 ( 0.35 - 1.36 ) for EHFP , compared with control . There was no impact on child growth . Combining EHFP and MNP programmes yielded a marginally significant reduction in anaemia among children Although widely used , there is little information concerning the efficacy of corn-soy blend ( CSB ) supplementation in the treatment of moderate underweight in African children .  Lipid-based nutrient supplements ( LNS ) , which have proven to be beneficial treatment for severely wasted children , could offer benefits to less severely affected individuals . We conducted a clinical r and omized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children . A total of 182 underweight [ weight-for-age Z-score ( WAZ ) < -2 ] 6- to 15-mo-old children were r and omized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB , providing 1189 and 921 kJ , respectively , or no supplementation ( control ) . The primary outcome was weight change ; secondary outcomes included changes in anthropometric indices , hemoglobin levels , and morbidity . The body weight increases ( mean ± SD ) did not differ and were 620 ± 470 , 510 ± 350 , and 470 ± 350 g in the LNS , CSB , and control groups , respectively ( P = 0.11 ) . Compared with controls , infants and children in the LNS group gained more weight [ mean ( 95 % CI ) = 150 g ( 0 - 300 g ) ; P = 0.05 ] and had a greater increase in WAZ [ 0.33 ( -0.02 - 0.65 ) ; P = 0.04 ] . Weight and WAZ changes did not differ between the control and CSB groups . In exploratory stratified analysis , the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [ 250 g ( 60 - 430 g ; P = 0.01 ] . Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ BACKGROUND The causes of stunting are complex but likely include prenatal effects , inadequate postnatal nutrient intake , and recurrent infections . Low-birth-weight ( LBW ) infants are at high risk of stunting . More than 25 % of live births in low- and middle-income countries are at full term with low birth weight ( FT-LBW ) . Evidence on the efficacy of specific interventions to enhance growth in this vulnerable group remains scant . OBJECTIVE We investigated the independent and combined effects of a directed use of a water-based h and sanitizer ( HS ) and a mineral- and vitamin-enhanced micronutrient powder ( MNP ) ( 22 minerals and vitamins ) to prevent infections and improve nutrient intake to reduce stunting in FT-LBW infants . DESIGN The study was a prospect i ve 2 × 2 factorial , cluster-r and omized trial in 467 FT-LBW infants during 2 periods : from 0 to 5 mo postpartum ( 0 - 180 d postpartum ) and from 6 to 12 mo postpartum ( 181 - 360 d postpartum ) with the use of 48 clusters . All groups received the same general nutrition , health , and hygiene education ( NHHE ) at enrollment and throughout the 12 mo . Group assignments initially included the following 2 groups : no HS ( control ) group or HS from 0 to 5 mo postpartum . These assignments were followed by further divisions into the following 4 groups from 6 to 12 mo postpartum : 1 ) no HS and no MNP ( control ) , 2 ) HS only , 3 ) MNP only , and 4 ) HS and MNP . RESULTS When delivered in combination with NHHE , the use of an HS showed no additional benefit in reducing indicators of infection in the first or second half of infancy or the likelihood of stunting at 12 mo postpartum . FT-LBW infants who received the MNP ( with or without the HS ) were significantly less likely to be stunted at 12 mo than were controls ( OR : 0.35 ; 95 % CI : 0.15 , 0.84 ; P = 0.017 ) . CONCLUSIONS The use of a mineral- and vitamin-enhanced MNP  significantly reduced stunting in FT-LBW infants in this high-risk setting . The use of a water-based HS did not have an additive effect . This trial was registered at clinical trials.gov as NCT01455636 Background : Stunting in linear growth occurs mainly during the first 1000 d , from conception through 24 mo of age . Despite the recognition of this critical period , there have been few evaluations of the growth impact of interventions that cover most of this window . Objective : We evaluated home fortification approaches for preventing maternal and child undernutrition within a community-based health program . We hypothesized that small-quantity lipid-based nutrient supplements ( LNSs ) provided to women during pregnancy and the first 6 mo postpartum , LNSs provided to their offspring from 6 to 24 mo of age , or both would result in greater child length-for-age z score ( LAZ ) at 24 mo than iron and folic acid ( IFA ) provided to women during pregnancy and postpartum plus micronutrient powder ( MNP ) or no supplementation for their offspring from 6 to 24 mo . Design : We conducted a cluster-r and omized effectiveness trial with 4 arms : 1 ) women and children both received LNSs ( LNS-LNS group ) , 2 ) women received IFA and children received LNSs ( IFA-LNS group ) , 3 ) women received IFA and children received MNP ( IFA-MNP group ) , and 4 ) women received IFA and children received no supplements ( IFA-Control group ) . We enrolled 4011 women at ≤20 wk of gestation within 64 clusters , each comprising the supervision area of a community health worker . Analyses were primarily performed by using ANCOVA F tests and Tukey-Kramer-corrected pairwise comparisons . Results : At 24 mo , the LNS-LNS group had significantly higher LAZ ( + 0.13 compared with the IFA-MNP group ) and head circumference ( + 0.15 z score compared with the IFA-Control group ) ; these outcomes did not differ between the other groups . Stunting prevalence ( LAZ < -2 ) was lower in the LNS-LNS group at 18 mo than in the IFA-MNP group ( OR : 0.70 ; 95 % CI : 0.53 , 0.92 ) , but the difference diminished by 24 mo ( OR : 0.81 ; 95 % CI : 0.63 , 1.04 ) . Conclusion : Home fortification with small-quantity LNSs , but not MNP , during the first 1000 d improved child linear growth and head size in rural Bangladesh . This trial was registered at clinical trials.gov as NCT01715038 OBJECTIVES To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months , and to compare growth patterns of Honduran infants with those of breast-fed infants in the United States . DESIGN R and omized intervention trial from 4 to 6 months and longitudinal study of infants from birth to 12 months . SETTING Low-income communities in San Pedro Sula , Honduras . SUBJECTS Primiparous , breast-feeding mothers and their infants ( n = 141 ) recruited from public maternity hospitals . INTERVENTION Infants were r and omly assigned to exclusive breast-feeding to 6 months , or exclusive breast-feeding with addition of hygienically prepared , nutritionally adequate complementary foods at 4 months , with or without maintenance of baseline breast-feeding frequency . After 6 months , mothers continued to breast-feed and also fed their infants home-prepared foods after receiving instruction in appropriate feeding practice s. OUTCOME MEASURES Infant weight was measured monthly during the first year of life and infant length monthly from 4 to 12 months . STATISTICAL ANALYSIS Growth parameters were compared between the Honduran and US cohorts using multiple-regression and repeated- measures analysis of variance . Stepwise multiple regression was used to identify determinants of infant growth . RESULTS There were no differences in growth patterns by intervention group . Mean birth weight of the Honduran infants was significantly less than that of a cohort of breast-fed infants in an affluent US population ( n = 46 ) ( 2889 + /- 482 vs 3611 + /- 509 g ) , but the Honduran infants exhibited rapid catch up in weight in the first few months of life , and the cohorts were similar in weight by 3 months . Mean weight and length gain were similar to those of the US cohort from 4 to 9 months but were lower from 9 to 12 months . Mean length for age was significantly less than that of the US cohort from 4 to 12 months ; this was attributable to the difference in maternal height ( 12 cm shorter in Honduras on average ) . Within the Honduran cohort , growth velocity of low birth weight infants ( < 2500 g ; n = 28 ) was similar to that of their normal birth weight peers ; thus , the former subgroup remained smaller than the latter throughout the first year of life . CONCLUSIONS In poor population s , when breast-feeding is exclusive for the first 4 to 6 months , continues from 6 to 12 months , and is accompanied by generally adequate complementary foods , faltering in weight does not occur before 9 months among infants born with birth weights of more than 2500 Objective : Fortified spreads ( FSs ) have proven effective in the rehabilitation of severely malnourished children . We examined acceptability , growth and change in blood haemoglobin ( Hb ) concentration among moderately underweight ambulatory infants given FS . Methods : This was a r and omised , controlled , parallel-group , investigator-blind clinical trial in rural Malawi . Six- to 17-month-old underweight infants ( weight for age < −2 ) , whose weight was greater than 5.5 kg and weight-for-height z score greater than −3 received for 12 weeks at home 1 of 8 food supplementation schemes : nothing , 5 , 25 , 50 , or 75 g/day milk-based FS or 25 , 50 , or 75 g/day soy-based FS . Outcome measures included change in weight , length and blood Hb concentration . Results : A total of 126 infants started and 125 completed the intervention . All infants accepted the spread well , and no intolerance was recorded . Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS . Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS . All average gains were largest among infants receiving 50 g of FS daily : mean difference ( 95 % confidence interval ) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g ( range , −130 to 700 g ) , 0.9 cm ( range , −0.3 to 2.2 cm ) , and 17 g/L ( range , 0 to 34 g/L ) for weight , length and blood Hb concentration , respectively . In soy- vs milk-based FS groups , average outcomes were comparable . Conclusions : Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants . Further trials should test this hypothesis The major aim of this trial was to compare the development of 18-month-old infants who received complementary feeding for 1 year either with lipid-based nutrient supplements or micronutrient fortified corn-soy porridge .  Our secondary aim was to determine the socio-economic factors associated with developmental outcomes in the same population . A total of 163 six-month-old rural Malawian children were enrolled in a r and omized controlled trial where the control population received daily supplementation with 71 g corn-soy flour [ Likuni Phala ( LP ) ] ( 282 kcal ) and individuals in the intervention groups received daily either 50 g of lipid-based nutrient supplement ( FS50 ) ( 264 kcal ) or 25 g of lipid-based nutrient supplement ( FS25 ) ( 130 kcal ) . The main outcome measures were Griffiths ' developmental scores at 0 - 2 years . Independent comparison of study groups was carried out using analysis of variance ( ANOVA ) statistics where mean raw scores , quotients , or mental ages were compared . Association of developmental outcome with predictor variables were examined using multiple regression . At 18 months of chronological age , the mean ± st and ard deviation ( SD ) mental ages in the LP , FS50 , and FS25 groups were 17.9 ± 1.3 , 17.9 ± 1.3 , and 17.9 ± 1.2 ( P > 0.99 ) , respectively . Likewise , the mean raw developmental scores and mean developmental quotients did not differ significantly . Length-for-age z-score gain during the intervention period , and maternal education were associated with developmental outcome at 18 months ( P = 0.03 and P = 0.04 ; respectively ) . In conclusion , rural Malawian infants receiving 12-month daily supplementation of their diet either with the tested lipid-based nutrient supplements or fortified corn-soy flour have comparable development outcomes by 18 months of age Summary Background Poor nutrition and exposure to faecal contamination are associated with diarrhoea and growth faltering , both of which have long-term consequences for child health . We aim ed to assess whether water , sanitation , h and washing , and nutrition interventions reduced diarrhoea or growth faltering . Methods The WASH Benefits cluster-r and omised trial enrolled pregnant women from villages in rural Kenya and evaluated outcomes at 1 year and 2 years of follow-up . Geographically-adjacent clusters were block-r and omised to active control ( household visits to measure mid-upper-arm circumference ) , passive control ( data collection only ) , or compound-level interventions including household visits to promote target behaviours : drinking chlorinated water ( water ) ; safe sanitation consisting of disposing faeces in an improved latrine ( sanitation ) ; h and washing with soap ( h and washing ) ; combined water , sanitation , and h and washing ; counselling on appropriate maternal , infant , and young child feeding plus small-quantity lipid-based nutrient supplements from 6–24 months ( nutrition ) ; and combined water , sanitation , h and washing , and nutrition . Primary outcomes were caregiver-reported diarrhoea in the past 7 days and length-for-age Z score at year 2 in index children born to the enrolled pregnant women . Masking was not possible for data collection , but analyses were masked . Analysis was by intention to treat . This trial is registered with Clinical Trials.gov , number NCT01704105 . Findings Between Nov 27 , 2012 , and May 21 , 2014 , 8246 women in 702 clusters were enrolled and r and omly assigned an intervention or control group . 1919 women were assigned to the active control group  ; 938 to passive control ; 904 to water ; 892 to sanitation ; 917 to h and washing ; 912 to combined water , sanitation , and h and washing ; 843 to nutrition ; and 921 to combined water , sanitation , h and washing , and nutrition .  Data on diarrhoea at year 1 or year 2 were available for 6494 children and data on length-for-age Z score in year 2 were available for 6583 children ( 86 % of living children were measured at year 2 ) . Adherence indicators for sanitation , h and washing , and nutrition were more than 70 % at year 1 , h and washing fell to less than 25 % at year 2 , and for water was less than 45 % at year 1 and less than 25 % at year 2 ; combined groups were comparable to single groups . None of the interventions reduced diarrhoea prevalence compared with the active control . Compared with active control ( length-for-age Z score −1·54 ) children in nutrition and combined water , sanitation , h and washing , and nutrition  were taller by year 2 ( mean difference 0·13 [ 95 % CI 0·01–0·25 ] in the nutrition group ; 0·16 [ 0·05–0·27 ] in the combined water , sanitation , h and washing , and nutrition group ) . The individual water , sanitation , and h and washing groups , and combined water , sanitation , and h and washing group had no effect on linear growth . Interpretation Behaviour change messaging combined with technologically simple interventions such as water treatment , household sanitation up grade s from unimproved to improved latrines , and h and washing stations did not reduce childhood diarrhoea or improve growth , even when adherence was at least as high as has been achieved by other programmes . Counselling and supplementation in the nutrition group and combined water , sanitation , h and washing , and nutrition interventions led to small growth benefits , but there was no advantage to integrating water , sanitation , and h and washing with nutrition . The interventions might have been more efficacious with higher adherence or in an environment with lower baseline sanitation coverage , especially in this context of high diarrhoea prevalence . Funding Bill & Melinda Gates Foundation , United States Agency for International Development Abstract Background Food-assisted maternal and child health and nutrition ( FA-MCHN ) programs may foster child growth during the first 1000 d ( pregnancy and the first 2 y of a child 's life ) , but evidence is scant . Objective We evaluated the impact of an FA-MCHN program , PROCOMIDA , on linear growth ( stunting [ length-for-age z score ( LAZ ) < –2 ] and length-for-age difference [ LAD ] ) among children aged 1–24 mo .  PROCOMIDA was implemented in Guatemala by Mercy Corps and was available to beneficiaries throughout the first 1000 d. Methods We used a longitudinal , cluster-r and omized controlled trial with groups varying in family ration sizes [ full ( FFR ) , reduced ( RFR ) , and none ( NFR ) ] and individual ration types provided to mothers ( pregnancy to 6 mo postpartum ) and children ( 6–24 mo of age )  [ corn-soy blend ( CSB ) , lipid-based nutrient supplement ( LNS ) , micronutrient powder ( MNP ) ] : 1 ) FFR + CSB ( n = 576 ) ; 2 ) RFR + CSB ( n = 575 ) ; 3 ) NFR + CSB ( n = 542 ) ; 4 ) FFR + LNS ( n = 550 ) ; 5 ) FFR + MNP ( n = 587 ) ; 6 ) control ( n = 574 ) . Program impacts compared with control , and differential impacts between groups varying family ration size or individual ration type , were assessed through the use of linear mixed-effects models and post hoc simple effect tests ( significant if P < 0.05 ) . Results PROCOMIDA  significantly reduced stunting at age 1 mo in FFR + CSB , RFR + CSB , and FFR + MNP groups compared with control [ 5.05 , 4.06 , and 3.82 percentage points ( pp ) , respectively ] . Stunting impact increased by age 24 mo in FFR + CSB and FFR + MNP relative to control ( impact = 11.1 and 6.5 pp at age 24 mo , respectively ) . For CSB recipients , the FFR compared with RFR or NFR significantly reduced stunting ( 6.47–9.68 pp ) . CSB reduced stunting significantly more than LNS at age 24 mo ( 8.12 pp ) . Conclusions FA-MCHN programs can reduce stunting during the first 1000 d , even in relatively energy/food-secure population s. Large family rations with individual rations of CSB or MNP were most effective . The widening of impact as children age highlights the importance of intervening throughout the full first 1000 d. This trial was registered at clinical trials.gov as NCT01072279 ABSTRACT Background Evidence on the effect of small-quantity lipid-based nutrient supplements ( SQ-LNSs ) on early child growth and development is mixed . Objective This study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth ( primary outcome ) , psychomotor development , iron status ( secondary outcomes ) , and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet . Methods Infants ( n = 750 ) were r and omly assigned to receive SQ-LNS , SQ-LNS-plus , or no supplement . Both SQ-LNS products contained micronutrients and essential fatty acids . SQ-LNS-plus contained , in addition , docosahexaenoic acid , arachidonic acid ( important for brain and eye development ) , lysine ( limiting amino acid in maize ) , phytase ( enhances iron absorption ) , and other nutrients . Infants ’ weight and length were measured bimonthly . At age 6 and 12 mo , psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin , plasma ferritin , C-reactive protein , and α1-acid glycoprotein were assessed . WHO Motor Milestone outcomes , adherence , and morbidity were monitored weekly through home visits . Primary analysis was by intention-to-treat , comparing each SQ-LNS group with the control . Results SQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo ( mean difference : 0.11 ; 95 % CI : 0.01 , 0.22 ; P = 0.032 ) and 10 mo ( 0.16 ; 95 % CI : 0.04 , 0.27 ; P = 0.008 ) but not at 12 mo ( 0.09 ; 95 % CI : −0.02 , 0.21 ; P = 0.115 ) , locomotor development score ( 2.05 ; 95 % CI : 0.72 , 3.38 ; P = 0.003 ) , and Parent Rating Score ( 1.10 ; 95 % CI : 0.14 , 2.07 ; P = 0.025 ) , but no effect for weight-for-age zscore . Both SQ-LNS ( P = 0.027 ) and SQ-LNS-plus ( P = 0.005 ) improved hemoglobin concentration and reduced the risk of anemia , iron deficiency , and iron-deficiency anemia  . Both SQ-LNS products reduced longitudinal prevalence of fever , coughing , and wheezing but increased incidence and longitudinal prevalence of diarrhea , vomiting , and rash/sores . Conclusions Point-of-use fortification with SQ-LNS-plus showed an early transient effect on linear growth and improved locomotor development . Both SQ-LNS products had positive impacts on anemia and iron status . This trial was registered at clinical trials.gov as NCT01845610 Traditional complementary foods ( CF ) with a low nutrient density have been implicated in growth faltering , stunting , and other adverse outcomes in children . The efficacy of 2 types of locally produced , micronutrient-fortified CF to prevent stunting of infants living in rural Vietnam was evaluated . In a village-r and omized controlled study , 426 infants , 5 mo of age , received for 6 mo a fortified CF , either as an instant flour ( FF ) or a food complement ( FC ) in village canteens , or traditional CF at home ( C ) . After 6 mo of intervention , weight , length , length-for-age Z-score ( LAZ ) and weight-for-age Z-score were greater in the 2 intervention groups compared with the C group , with an estimated effect of + 0.22 LAZ for the FF group and + 0.21 LAZ for the FC group . At the last follow-up , 18 mo after the intervention , there was no significant difference in height-for-age Z-score ( HAZ ) between the groups , even though the HAZ in the FF group was 0.17 greater than that in the C group ( P = 0.18 ) . In contrast , the weight-for-height Z-score and BMI Z-score , indices of ponderal growth , were greater in the FF group ( -0.49 and -0.26 , respectively ) than in the FC group ( -0.73 and -0.49 , respectively ) , with Z-scores in the C group intermediate and not significantly different from the others . This study shows that regular provision of locally produced CF fortified with micronutrients partly stopped growth faltering in Vietnamese infants , with differential effects on long-term length and ponderal growth . Providing only micronutrients instead of a complete array of nutrients might result in only short-term length growth benefits
Background : Optimizing linear growth in children during complementary feeding period ( CFP ) ( 6 - 24 months ) are critical for their development .
Several interventions , such as micronutrient and food supplements , deworming , maternal education , and water , sanitation and hygiene ( WASH ) , could potentially be provided to prevent stunting , but their comparative effectiveness is currently unclear .