Malian children with moderate acute malnutrition who are treated with lipid-based dietary supplements have greater weight gains and recovery rates than those treated with locally produced cereal-legume products: a community-based, cluster-randomized trial. Growth and Body Composition of Human Milk–fed Premature Infants Provided With Extra Energy and Nutrients Early After Hospital Discharge: 1-year Follow-up Optimal Growth and Lower Fat Mass in Preterm Infants Fed a Protein-enriched Postdischarge Formula A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings. Meat and milk intakes and toddler growth: a comparison feeding intervention of animal-source foods in rural Kenya. An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6-18 months. Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry. Effect of a milk-based food supplement on maternal nutritional status and fetal growth in underweight Chilean women. What is the safe protein-energy ratio for infant formulas? The effects of nutritional supplementation on physical growth of children at risk of malnutrition. Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition. Early childhood supplementation does not benefit the long-term growth of stunted children in Jamaica. Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial. High protein intake from meat as complementary food increases growth but not adiposity in breastfed infants: a randomized trial. The Bacon Chow study: maternal supplementation and infant growth. Dietary protein energy supplementation of pregnant Asian mothers at Sorrento, Birmingham. II: Selective during third trimester only. 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. Lower protein content in infant formula reduces BMI and obesity risk at school age: follow-up of a randomized trial. Effect of Oral Supplementation on Catch-Up Growth in Picky Eaters Neurodevelopment, nutrition, and growth until 12 mo of age in infants fed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Adequacy of Infant Formula With Protein Content of 1.6 g/100 kcal for Infants Between 3 and 12 Months Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial Age differences in the impact of nutritional supplementation on growth. Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh. Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso Effects of Dietary Calcium Intervention on Adolescent Mothers and Newborns: A Randomized Controlled Trial A randomized controlled trial of prenatal nutritional supplementation in New York City. Effects of Formula Protein Level and Ratio on Infant Growth, Plasma Amino Acids and Serum Trace Elements I. Cow's Milk Formula A cluster-randomized trial determining the efficacy of caterpillar cereal as a locally available and sustainable complementary food to prevent stunting and anaemia. Eggs in Early Complementary Feeding and Child Growth: A Randomized Controlled Trial Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso. Energy supplementation in the last trimester of pregnancy in East Java: I. Effect on birthweight The effects of whole milk and infant formula on growth and IGF-I in late infancy The Kingston Project. II. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry. Adequacy and Safety of an Infant Formula With a Protein/Energy Ratio of 1.8 g/100 kcal and Enhanced Protein Efficiency for Term Infants During the First 4 Months of Life Randomized Double-Blind Study of the Nutritional Efficacy and Bifidogenicity of a New Infant Formula Containing Partially Hydrolyzed Protein, a High &bgr;-Palmitic Acid Level, and Nondigestible Oligosaccharides Effects of yogurt supplementation on the growth of preschool children in Beijing suburbs. Meat as Complementary Food for Older Breastfed Infants and Toddlers: A Randomized, Controlled Trial in Rural China Child growth (0-5 years), and the effect of entitlement to a milk supplement. Infant formula composition affects energetic efficiency for growth: the BeMIM study, a randomized controlled trial. Growth of Preterm Infants Fed Nutrient-Enriched or Term Formula After Hospital Discharge Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana. Supplementation of Maternal Diets during Pregnancy and for 6 Months Postpartum and Infant Diets Thereafter with Small-Quantity Lipid-Based Nutrient Supplements Does Not Promote Child Growth by 18 Months of Age in Rural Malawi: A Randomized Controlled Trial. Whey Predominant, Whey Modified Infant Formula with Protein/energy Ratio of 1.8 g/100 kcal: Adequate and Safe for Term Infants From Birth to Four Months Short- and long-term effects of feeding hydrolyzed protein infant formulas on growth at < or = 6 y of age: results from the German Infant Nutritional Intervention Study. Effect of complementary feeding with lipid-based nutrient supplements and corn-soy blend on the incidence of stunting and linear growth among 6- to 18-month-old infants and children in rural Malawi. Tryptophan Fortification of Adapted Formula Increases Plasma Tryptophan Concentrations to Levels Not Different from Those Found in Breast‐Fed Infants Protein requirements of infants and children: growth during recovery from malnutrition. Lower Protein Intake Supports Normal Growth of Full-Term Infants Fed Formula: A Randomized Controlled Trial Provision of 10-40 g/d Lipid-Based Nutrient Supplements from 6 to 18 Months of Age Does Not Prevent Linear Growth Faltering in Malawi. Including whey protein and whey permeate in ready-to-use supplementary food improves recovery rates in children with moderate acute malnutrition: a randomized, double-blind clinical trial.
BACKGROUND Moderate acute malnutrition ( MAM ) , defined as weight-for-length z score between -3 and -2 or midupper arm circumference between 11.5 and 12.5 cm , affects ∼33 million children aged < 5 y worldwide . OBJECTIVE The objective was to compare the effects of 4 dietary supplements for the treatment of MAM . DESIGN Twelve community health centers in rural Mali were r and omly assigned to provide to 1264 MAM children aged 6 - 35 mo one of 4 dietary supplements containing ∼500 kcal/d for 12 wk : 1 ) ready-to-use , lipid-based supplementary food ( RUSF ) ; 2 ) special corn-soy blend ( CSB++ ) ; 3 ) locally processed , fortified flour ( Misola ) ; or 4 ) locally milled flours plus oil , sugar , and micronutrient powder ( LMF ) . RESULTS In total , 1178 children ( 93.2 % ) completed the study . The adjusted mean ( 95 % CI ) change in weight ( kg ) from baseline was greater with RUSF than with the locally processed blends and was intermediate with CSB++ [ 1.16 ( 1.08 , 1.24 ) for RUSF , 1.04 ( 0.96 , 1.13 ) for CSB++ , 0.91 ( 0.82 , 0.99 ) for Misola , and 0.83 ( 0.74 , 0.92 ) for LMF ; P < 0.001 ] . For length change , RUSF and CSB++ differed significantly from LMF . Sustained recovery rates were higher with RUSF ( 73 % ) than with Misola ( 61 % ) and LMF ( 58 % ) , P < 0.0001 ; CSB++ recovery rates ( 68 % ) did not differ from any of the other groups . CONCLUSIONS RUSF was more effective , but more costly , than other dietary supplements for the treatment of MAM ; CSB++ yielded intermediate results . The benefits of treatment should be considered in relation to product costs and availability Objectives : Human milk ( HM ) is the optimal source of nutrition for premature infants ; however , it is unclear whether HM alone is sufficient to meet their elevated nutritional requirements early after hospital discharge . We previously reported that premature infants ( 750–1800 g birth weight ) fed HM containing extra nutrients for 12 weeks after discharge had dietary intakes closer to recommended levels and grew more rapidly than those fed HM alone . The objectives of the present article are to examine the impact of this intervention on bone mineralization , body composition , and HM  use up to 1 year . Data are also presented on general developmental level at 18-month corrected age ( CA ) . Patients and Methods : At discharge , predominantly HM-fed infants were r and omized to receive for 12 weeks either approximately half of their feedings containing a multinutrient fortifier ( intervention , n = 19 ) or all of their feedings as HM alone ( control , n = 20 ) . Results : Intervention infants remained longer ( P < 0.001 ) and had greater whole-body bone mineral content ( P = 0.02 ) until 12-month CA compared with controls . Intervention infants born less than or equal to 1250 g continued to have a larger mean head circumference throughout the first year of life ( P < 0.0001 ) .  Human milk  feeding ( mL · kg−1 · day−1 ) differed between groups at 6- ( P = 0.035 ) , but not 12-month CA . No statistically significant differences were found between groups in the mental , motor , or behavior rating scale scores of the Bayley II at 18-month CA . Conclusions : Adding a multinutrient fortifier to HM provided to predominantly HM-fed  premature infants early after discharge results in sustained differences in weight , length , and whole-body bone mineral content , and in smaller babies , head circumference for the first year of life Background and Objectives : Postdischarge formulas with extra energy and protein improve short-term growth but may also influence long-term body composition in an unwanted manner . Energy- and protein-enriched formulas with an increased protein-to-energy ratio improves gain of lean mass . The objective of the study was to investigate whether feeding a nutrient-enriched formula without extra energy after term , usually 3 to 4 weeks after discharge , would influence growth and body composition in infancy . Methods : In this r and omized controlled trial preterm infants were fed fortified human milk or preterm formula until term . At term , 102 infants were r and omized to a nutrient-enriched formula without extra energy or st and ard formula until 6 months corrected age . Twenty-six infants received unfortified human milk after term . At term and 6 months corrected age , anthropometry and a dual-energy x-ray absorptiometry ( DEXA ) scan were performed . Lean and fat mass ( FM ) were corrected for height . Results : There were no differences in growth or body size between the feeding groups . Infants fed the enriched formula gained less FM and had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula . Infants fed human milk had lower lean mass and higher FM corrected for body size at 6 months corrected age than formula-fed infants . Conclusions : Feeding nutrient-enriched formula without extra energy after term does not change quantity of growth but does influence type of weight gain and body composition of preterm infants . Infants fed the nutrient-enriched formula had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula or human milk Background : There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries . Objective : We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods ( RUSFs ) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau . Methods : A 3-month cluster-r and omized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants ( 6 - 23 months ) and children ( 24 - 59 months ) from 13 villages . The RUSFs contained either 478 ( mothers , children ) or 239 kcal/d ( infants ) with 15 % or 33 % of protein from dairy and were distributed at community health centers 5 d/wk . Controls were wait-listed to receive RUSF . Primary outcomes were mid-upper arm circumference ( MUAC ) in mothers , and weight-for-age and height-for-age z-scores ( WAZ and HAZ ) in infants and children . Results : There was a significant effect of the RUSF-33 % on MUAC in mothers ( P = .03 ) . The WAZ and HAZ increased substantially , by ≈1 z-score , in infants and children ( P < .01 ) independent of group r and omization . In children , but not infants , baseline WAZ and change in maternal MUAC were associated with change in WAZ ( β = .07 , P = .02 ) . Conclusion : Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers , supporting a comparable recent finding in preschool children . In addition , supplementation of children < 2 years result ed in improved growth independent of family nutritional status , whereas success in older children was associated with change in maternal nutrition , suggesting the need for community-level education about preventing malnutrition in older , as well as younger , children 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 OBJECTIVE To examine the effects of animal- source foods on  toddler growth .  DESIGN A 5-month comparison feeding intervention study with one of three millet-based porridges r and omized to eighteen feeding stations serving 303 children aged 11 - 40 months . Feeding stations served plain millet porridge ( Plain group ) , porridge with milk ( Milk group ) or porridge with beef ( Meat group ) .  Anthropometry , morbidity and food intake were measured at baseline and regular intervals . Longitudinal mixed models were used to analyse growth . SETTING Embu , Kenya . SUBJECTS Two hundred and seventy-four children were included in final analyses .  RESULTS Linear growth was significantly greater for the Milk group than the Meat group ( P = 0·0025 ) . Slope of growth of mid-arm muscle area of the Plain group was significantly greater than in the Meat group ( P = 0·0046 ) , while the Milk group 's mid-upper arm circumference growth rate was significantly greater than the Meat group 's ( P = 0·0418 ) . The Milk and Plain groups ' measures did not differ . CONCLUSIONS Milk and meat porridges did not have a significantly greater effect on growth  than plain porridge in this undernourished population  . Linear growth was influenced by more than energy intakes , as the Plain group 's total body weight-adjusted energy intakes were significantly greater than the Meat group 's , although linear growth did not differ . Energy intakes may be more important for growth in arm muscle . The diverse age distribution in the study makes interpretation difficult . A longer study period , larger sample size and more focused age group would improve clarity of the results Poor complementary feeding practice s are associated with stunting and growth faltering throughout the developing world . The objective was to compare the effect of using peanut-/soy-based fortified spread ( FS ) and corn porridge fortified with fish powder ( FP ) as complementary foods on growth in rural Malawian children . A total of 240 children were enrolled at the age of 6 mo and r and omized to receive FS or FP .  Both complementary foods provided 836 kJ/d from 6 to 9 mo of age and 1254 kJ/d from 9 to 18 mo of age . Children were followed monthly for anthropometry and fortnightly for the symptoms of fever , cough , or diarrhea until they were 18 mo old . Zn and Se status were assessed at 6 and 12 mo . The primary outcomes were the rates of weight and length gain from 6 - 12 mo and from 12 - 18 mo . Children who received FS gained 110 g more ( 95 % CI 220 to 10 ) from 6 - 12 mo of age than children receiving FP .  Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age , nor did statural growth from 6 to 12 mo or 12 to 18 mo . A total of 23 % of all children were Zn deficient at 6 mo of age and this increased to 37 % at 12 mo of age . Neither FS nor FP was associated with significantly improved Zn status .  FS was associated with better weight gain from 6 - 12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world The effect of prenatal energy supplementation on  maternal anthropometry was assessed in a controlled , r and omized trial in Madura , East Java . At 26 - 28 wk of gestation women were either given 465 kcal/d ( HE group ) or 52 kcal/d ( LE group ) . Two hundred seventy-six women were enrolled in the HE group and 266 women , in the LE group .  Supplement intake was variable . Testing of effect by treatment and compliance was thus done by subcategories ( HE 1 - 3 and LE 1 - 3 , corresponding to less than 45 , 45 - 89 , and greater than or equal to 90 packets of supplement consumed ) . Analysis of variance did not show significant differences among the six subcategories in third-trimester weight gain , sum of skinfold thicknesses , 4-wk postpartum weight , or body mass index . In this population energy supplementation for the short duration of the last 90 - 110 d of pregnancy was not sufficient to improve maternal nutrition as judged by anthropometry The effects on  pregnancy outcome  and  maternal iron status of powdered milk ( PUR ) and a milk-based fortified product ( V-N ) were compared in a group of underweight gravidas . These take-home products were distributed during regular prenatal visits . Women in the V-N group had greater weight gain ( 12.29 vs 11.31 kg , p less than 0.05 ) and mean birth weights ( 3178 vs 3105 g , p less than 0.05 ) than those in the PUR group . Values for various indicators of maternal Fe status were also higher in the V-N group . Compared with self-selected noncompliers , similar in all control variables to compliers , children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g , respectively . Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth Infants eat primarily to satisfy energy needs and the safe amount of protein in infant formulas ( ie , the amount adequate for nearly all infants ) is therefore expressed as the protein-energy ratio . We studied male infants aged 8 - 112 d fed milk-based formulas .  One group ( experimental group ) was fed formulas that provided protein-energy ratios of 3.73 g/MJ ( 1.56 g/100 kcal ) from 8 to 27 d of age , gradually decreasing to 2.99 g/MJ ( 1.25 g/100 kcal ) from 84 to 111 d of age . Growth rates and serum albumin and urea nitrogen of these infants were compared with those of a concurrently studied control group and a previously studied large reference group . Gains in weight and concentrations of serum albumin of the three groups were not significantly different . Gains in length were significantly less for the experimental group than for the reference group . Serum urea nitrogen was significantly less in the experimental group than in the control group or reference group . We conclude that the protein-energy ratios of the experimental formula diet were below the safe level . Because the decrease in growth rate of the experimental group was rather small ( demonstrable only in comparison with the large reference group ) , and because serum albumin of the experimental group increased with age as in normally nourished infants , we suspect that the safe protein-energy ratio of infant formulas lies closer to the ratios fed to the experimental group than to the ratio [ approximately 5.0 g/MJ ( 2.1 g/100 kcal ) ] in currently marketed milk-based formulas The effect of food supplementation on physical growth during the last trimester of pregnancy and the first 3 yr of life was studied in a sample of families at risk of malnutrition living in the urban slums of Bogota , Colombia . Families in which the mother was pregnant and at least one-half of the children under 5 yr of age were below 85 % of weight for age were selected for the study . All were provided with free obstetrical and pediatric care . The families were then r and omly assigned to control and supplemented groups . The supplemented families received a daily allotment of 600 cal or 30 g of protein per capita for home consumption from the onset of the 3rd trimester of pregnancy until the subject children reached the age of 3 yr . Calorie consumption from the supplement by the study children ( offspring of the target pregnancy ) was 458 ± 249 calories at age 18 months and 363 ± 283 cal at age 36 months . Protein consumption at those ages was 34 . 1 ± 20.6 and 23.6 ± 19.7 g,'day . However , substitution of the supplement for foods from the regular diet result ed in net supplementation of approximately 200 cal and 22 g of protein per day . There were significant differences in weight between supplemented and control groups beginning at age 3 months and in length beginning at age 6 months . Supplementation reduced the total prevalence of malnutrition ( Gomez classification ) only slightly ; at 36 months of age , 72 % of the supplemented group and 77.8 % of the control group were malnourished . On the other h and , the prevalence of moderate and severe malnutrition ( Gomez II and III ) , was significantly reduced by supplementation . At 36 months , 20.6 % of the control group and 8.8 % of the supplemented group fell into those categories . Despite improved physical growth in the supplemented group , their height and weight remained substantially below those of the high socioeconomic Colombian st and ards . The failure of supplementation to close the gap between low and high socioeconomic groups was attributed , in part , to the high incidence of diarrheal disease among subjects of the study . It is postulated that simple provision of food supplements , without effective prevention of diarrheal disease , is likely to have limited effects on physical growth among disadvantaged children . Am . J. Clin . Nutr . 34 : 1885 - 1892 , 1981 BACKGROUND Despite the theoretical benefits of nutrient-enriched formula given to preterm infants after hospital discharge , its role in reversing growth deficits after hospital discharge remains poorly defined . OBJECTIVE The aim was to determine the effect of different formulas on the growth , bone mass , and body composition of preterm infants after hospital discharge . DESIGN This was a r and omized , double blind comparison of a nutrient-enriched formula ( EF ) and a formula for term infants ( TF ) given for 1 y after hospital discharge . Compared with the TF , the EF had a higher energy density and higher contents of protein , calcium , and phosphorus ( by 10 % , 21 % , 44 % , and 11 % , respectively ) and higher contents of almost all other nutrients ( by > or=10 % ) . RESULTS  Birth weights of the infants were 630 - 1620 g ( median : 1250 g ) and gestational ages were 24 - 34 wk ( median : 29 wk ) . TF result ed in significantly greater weight , length , head circumference measurements , and their respective z scores on the basis of age- and sex-specific norms . At the end of the study , the mean z scores for the corrected age of infants in the TF group were -0.37 for weight , 0.001 for length , and 0.50 for head circumference . The TF group also had significantly greater dual-energy X-ray absorptiometry measured bone and lean and fat mass than did the EF group ( P < 0.05 for all comparisons ) . CONCLUSIONS The use of EF for preterm infants after hospital discharge shows no advantage over TF in growth , bone mineralization , and body composition . More studies are needed to determine the optimal postdischarge nutrition support for preterm infants The long-term benefits of  early childhood supplementation  and the extent to which catch-up growth occurs following linear growth retardation remain controversial . Stunted children ( height-for-age < -2 SD of NCHS references , n = 122 ) recruited from a survey of poor neighborhoods in Kingston , Jamaica , participated in a 2-yr r and omized , controlled trial of supplementation beginning at ages 9 - 24 mo . A group of 32 non-stunted children from the same neighborhoods was also followed . Four years after the intervention ended , when children were 7 to 8 y old , there were no effects of supplementation on any anthropometric measure . From the end of the trial until follow-up , the children who had been supplemented gained 1.2 cm less ( P < 0.05 ) than the non-supplemented children , approximately the same amount as they had gained during the trial compared with the non-supplemented children . After adjustment for regression to the mean , the height-for-age of stunted children ( supplemented and non-supplemented combined ) increased from enrollment to follow-up by 0.31 Z-score ( 95 % CI 0.17 , 0.46 ) . The height-for-age of the non-stunted children also increased ( 0.96 Z-score ; 95 % CI 0.70 , 1.22 ) . Our results suggest that some catch-up growth is possible even when children remain in poor environments . Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished The effect of supplementation on growth was tested by means of four similar controlled r and omized trials in the Congo ( n = 120 ) , Senegal ( n = 110 ) , Bolivia ( n = 127 ) , and New Caledonia ( n = 90 ) . Four-month-old infants were r and omly allocated to supplement or control groups . A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored . Both groups were free to eat local food . At 7 mo of age , all infants were still breast-fed in the Congo , Senegal , and Bolivia compared with 47 % in New Caledonia . Mean daily consumption of the supplement varied among countries ( 558 - 790 kJ/d ) . Mean length at 4 mo was lowest in Bolivia , higher in Senegal and the Congo , and near the National Center for Health Statistics reference in New Caledonia . The mean 4 - 7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal ( P < 0.05 ) , whereas weight increments did not differ . No significant effect was found in the other countries BACKGROUND High intake of cow-milk protein in formula-fed infants is associated with higher weight gain and increased adiposity , which have led to recommendations to limit protein intake in later infancy . The impact of protein from meats for breastfed infants during complementary feeding may be different . OBJECTIVE We examined the effect of protein from meat as complementary foods on growth and metabolic profiles of breastfed infants . DESIGN This was a secondary analysis from a trial in which exclusively breastfed infants ( 5 - 6 mo old from the Denver , CO , metro area ) were r and omly assigned to receive commercially available pureed meats ( Meat group ; n = 14 ) or infant cereal ( Cereal group ; n = 28 ) as their primary complementary feedings for ∼ 5 mo . Anthropometric measures and diet records were collected monthly from 5 to 9 mo of age ; intakes from complementary feeding and breast milk were assessed at 9 mo of age . RESULTS The Meat group had significantly higher protein intake , whereas energy , carbohydrate , and fat intakes from complementary feeding did not differ by group over time . At 9 mo of age , mean ( ± SEM ) intakes of total ( complementary feeding plus breast milk ) protein were 2.9 ± 0.6 and 1.4 ± 0.4 g · kg(-1 ) · d(-1 ) , ∼ 17 % and ∼ 9 % of daily energy intake , for Meat and Cereal groups , respectively ( P < 0.001 ) . From 5 to 9 mo of age , the weight-for-age z score ( WAZ ) and length-for-age z score ( LAZ ) increased in the Meat group ( ΔWAZ : 0.24 ± 0.19 ; ΔLAZ : 0.14 ± 0.12 ) and decreased in the Cereal group ( ΔWAZ : -0.07 ± 0.17 ; ΔLAZ : -0.27 ± 0.24 ) ( P-group by time < 0.05 ) . The change in weight-for-length z score did not differ between groups . Total protein intake at 9 mo of age and baseline WAZ were important predictors of changes in the WAZ ( R(2 ) = 0.23 , P = 0.01 ) . CONCLUSION In breastfed infants , higher protein intake from meats was associated with greater linear growth and weight gain but without excessive gain in adiposity , suggesting that potential risks of high protein intake may differ between breastfed and formula-fed infants and by the source of protein The effect of  maternal supplementation during both gestation and lactation on infant growth from birth to 12 mth was investigated in the double-blind , r and omly allocated control trial conducted in Taiwan by the late Bacon F. Chow . The supplement was a milk-based formula providing 800 kcal and 40 g protein daily . The placebo provided less than 40 kcal per diem but resembled the supplement in appearance . Supplementation was limited to mothers and began after birth of one infant and continued without interruption until weaning of a second infant . Supplement effects were tested by comparing both supplement and placebo groups and first- and second-infant groups with respect to weight , length and head circumference . Both comparisons of growth curves and analyses of variance were carried out . Both strategies agreed in failing to detect differences in growth between supplement and placebo groups . However , differences were found between first and second infants in the supplement group Unselective dietary protein energy supplementation of Asian mothers at Sorrento Maternity Hospital did not enhance intrauterine growth . The effect of selective supplementation was therefore studied . Forty-five mothers who at 28 weeks were known to be nutritionally at risk ( triceps increment less than or equal to 20 microns/week between 18 and 28 weeks ) received one of three supplements during the third trimester : ( a ) vitamins only -- a multivitamin sachet daily containing vitamins A , B , C , and D ; ( b ) energy--42 - 125 MJ ( 10 000 - 30 000 kcal ) , all from carbohydrate , plus vitamins ; ( c ) protein energy -- energy and vitamins as before , but with 5 - 10 % of energy from milk protein .  Eighty-three mothers regarded as adequately nourished at 28 weeks also received one of the three supplements . In the nutritionally at-risk mothers the protein energy supplement was associated with a heavier crude birth weight and heavier weight for gestational age .  Supplementation did not lead to improved intrauterine growth in those mothers who were adequately nourished . The differential effect of supplementation depending on the mothers ' nutritional state during the second trimester may explain apparently conflicting results of other studies where some have shown a substantial effect of supplementation and others only a small effect . This effect of intervention is further evidence that " poor nutrition " contributes to poor intrauterine growth in selected mothers , even in developed countries 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 BACKGROUND Early nutrition is recognized as a target for the effective prevention of  childhood obesity .  Protein intake was associated with more rapid weight gain during infancy-a known risk factor for later obesity . OBJECTIVE We tested whether the reduction of protein in infant formula reduces body mass index ( BMI ; in kg/m(2 ) ) and the prevalence of obesity at 6 y of age . DESIGN The Childhood Obesity Project was conducted as a European multicenter , double-blind , r and omized clinical trial that enrolled healthy infants born between October 2002 and July 2004 . Formula-fed infants ( n = 1090 ) were r and omly assigned to receive higher protein (HP)- or lower protein (LP)-content formula ( within recommended amounts ) in the first year of life ; breastfed infants ( n = 588 ) were enrolled as an observational reference group . We measured the weight and height of 448 ( 41 % ) formula-fed children at 6 y of age . BMI was the primary outcome . RESULTS HP children had a significantly higher BMI ( by 0.51 ; 95 % CI : 0.13 , 0.90 ; P = 0.009 ) at 6 y of age . The risk of becoming obese in the HP group was 2.43 ( 95 % CI : 1.12 , 5.27 ; P = 0.024 ) times that in the LP group . There was a tendency for a higher weight in HP children ( 0.67 kg ; 95 % CI : -0.04 , 1.39 kg ; P = 0.064 ) but no difference in height between the intervention groups . Anthropometric measurements were similar in the LP and breastfed groups . CONCLUSIONS Infant formula with a lower protein content reduces BMI and obesity risk at school age . Avoidance of infant foods that provide excessive protein intakes could contribute to a reduction in childhood obesity . This trial was registered at clinical trials.gov as NCT00338689 Ninety-two subjects ages 36 to 60 months who had picky-eater behavior and evidence of growth faltering were r and omized to receive either nutrition counseling alone , or nutrition counseling plus a nutritional supplement ( Study ) for 90 days . The Study group had significantly greater increases in weight and height . There were no significant differences between groups in changes in appetite or activity levels , or in gastrointestinal symptom scores . The percent of subjects who developed upper respiratory tract infections was significantly lower in the Study group . These data suggest that a nutritional supplement in addition to nutrition counseling promote catch-up growth and may contribute to lower rates of infectious disease in children with picky eater behavior BACKGROUND Observational studies have indicated that differences in the composition of human milk and infant formula yield benefits in cognitive development and early growth for breastfed infants . OBJECTIVE The objective was to test the hypothesis that feeding an infant formula with reduced energy and protein densities and supplemented with bovine milk fat globule membrane ( MFGM ) reduces differences in cognitive development and early growth between formula-fed and breastfed infants . DESIGN In a prospect i ve , double-blind , r and omized controlled trial , 160 infants < 2 mo of age were r and omly assigned to be fed an MFGM-supplemented , low-energy , low-protein experimental formula ( EF ) or a st and ard formula ( SF ) until 6 mo of age . The energy and protein contents of the EF and SF were 60 and 66 kcal/100 mL and 1.20 and 1.27 g/100 mL , respectively . A breastfed reference ( BFR ) group consisted of 80 infants . RESULTS At 12 mo of age , the cognitive score ( mean ± SD ) on testing with the Bayley Scales of Infant and Toddler Development , Third Edition , was significantly higher in the EF group than in the SF group ( 105.8 ± 9.2 compared with 101.8 ± 8.0 ; P = 0.008 ) but was not significantly different from that in the BFR group ( 106.4 ± 9.5 ; P = 0.73 ) . The EF group ingested larger volumes of formula than did the SF group ( 864 ± 174 compared with 797 ± 165 mL/d ; P = 0.022 ) , fully compensating for the lower energy density . No significant differences in linear growth , weight gain , body mass index , percentage body fat , or head circumference were found between the EF and SF groups . CONCLUSIONS MFGM supplementation to infant formula narrows the gap in cognitive development between breastfed and formula-fed infants . Between 2 and 6 mo of age , formula-fed term infants have the capacity to upregulate their ingested volumes when the energy density of formula is reduced from 66 to 60 kcal/100 BACKGROUND Protein intake during infancy was associated with rapid early weight gain and later obesity  in observational studies . OBJECTIVE The objective was to test the hypothesis that higher protein intake in infancy leads to more rapid length and weight gain in the first 2 y of life . DESIGN In a multicenter European study , 1138 healthy , formula-fed infants were r and omly assigned to receive cow milk-based infant and follow-on formula with lower ( 1.77 and 2.2 g protein/100 kcal , respectively ) or higher ( 2.9 and 4.4 g protein/100 kcal , respectively ) protein contents for the first year . For comparison , 619 exclusively breastfed children were also followed . Weight , length , weight-for-length , and BMI were determined at inclusion and at 3 , 6 , 12 , and 24 mo of age . The primary endpoints were length and weight at 24 mo of age , expressed as length and weight-for-length z scores based on the 2006 World Health Organization growth st and ards . RESULTS Six hundred thirty-six children in the lower ( n = 313 ) and higher ( n = 323 ) protein formula groups and 298 children in the breastfed group were followed until 24 mo . Length was not different between r and omized groups at any time . At 24 mo , the weight-for-length z score of infants in the lower protein formula group was 0.20 ( 0.06 , 0.34 ) lower than that of the higher protein group and did not differ from that of the breastfed reference group . CONCLUSIONS A higher protein content of infant formula is associated with higher weight in the first 2 y of life but has no effect on length . Lower protein intake in infancy might diminish the later risk of overweight and obesity . This trial was registered at clinical trials.gov as NCT00338689 Objectives : Infant formulas provide more protein than breast milk . High protein intakes may place infants at risk of later obesity . The present study tested whether a formula with protein content below the regulatory level supports normal growth from age 3 months . Methods : R and omized double-blind trial enrolled healthy infants less than age 3 months . At 3 months , formula-fed infants were assigned to experimental ( EXPL , 1.61 g protein/100 kcal ; modified bovine whey proteins with caseinoglycomacropeptide removed ) or control ( CTRL 2.15 g protein/100 kcal ; unmodified bovine milk protein with a whey/casein ratio of 60/40 ) formula ;  breast-fed ( BF ) infants  were enrolled in a reference group . Complementary foods were allowed in small amounts from 4 to 6 months and unrestricted after 6 months . Results : Weight gain ( g/day ) from 3 to 6 months was similar in the EXPL and CTRL groups ( EXPL-CTRL −0.84 g/day ; 95 % confidence interval −2.25 to 0.57 ) and faster in the EXPL and CTRL groups than in the BF group . Weight analyzed longitudinally from 4 to 12 months was lower in the EXPL group than in the CTRL group ( P = 0.031 ) but higher than in the BF group ( P < 0.0001 ) . Longitudinal analysis of odds ratios from 4 to 12 months indicated fewer infants with weight > 85th percentile in the EXPL group than in the CTRL group ( P = 0.015 ) . Length z scores were lower than , and body mass index z scores were similar to , World Health Organization St and ards in all of the groups . Serum biochemical parameters in the EXPL group reflected lower protein intake and were closer to parameters in the BF infants than in the CTRL group . Conclusions : A formula with 1.61 g of protein/100 kcal supports normal growth of infants after age 3 months . This protein content is adequate if provided from a high- quality source Background : Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50 % . Although nutrition counselling has shown modest benefits , few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting . Methods : A cluster-r and omized controlled trial was conducted in rural Bangladesh to test the effect of two local , ready-to-use foods ( chickpea and rice-lentil based ) and a fortified blended food ( wheat-soy-blend++ , WSB++ ) compared with Plumpy’doz , all with nutrition counselling vs nutrition counselling alone ( control ) on outcomes of linear growth ( length and length-for-age z-score , LAZ ) , stunting ( LAZ < −2 ) , weight-for-length z-score ( WLZ ) and wasting ( WLZ < −2 ) in children 6–18 months of age . Children ( n = 5536 ) were enrolled at 6 months of age and , in the food groups , provided with one of the allocated supplements daily for a year . Results : Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower ( by 0.02–0.04/month ) in the Plumpy’doz ( P = 0.02 ) , rice-lentil ( < 0.01 ) , and chickpea ( < 0.01 ) groups relative to control , whereas WLZ decline was lower only in Plumpy’doz and chickpea groups . WSB++ did not impact on these outcomes . The prevalence of stunting was 44 % at 18 months in the control group , but lower by 5–6 % ( P ≤ 0.01 ) in those receiving Plumpy’doz and chickpea . Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 ( all P < 0.05 ) , respectively , in all four food groups relative to the control . Conclusions : In rural Bangladesh , small amounts of daily fortified complementary foods , provided for a year in addition to nutrition counselling , modestly increased linear growth and reduced stunting at 18 months of age Supplementary feeding programs are common in developing countries . These programs often can not demonstrate an impact on child growth , however , possibly because they tend to reach older children . This study examines the impact of nutritional supplementation on annual growth rates in length and weight from birth to 7 y of age in 1208 rural Guatemalan children . A series of multiple linear regression models is used to control for initial body size , diarrheal disease , home diet , socioeconomic status and gender . During the first year of life , each 100 kcal/d ( 418 kJ ) of supplement was associated with approximately 9 mm in additional length gain and 350 g in additional weight gain ; the benefit decreased to approximately 5 mm in length gain and 250 g in weight gain during the 2nd y of life . Between 24 and 36 mo of age , supplement only had a significant impact on length . There was no impact of nutritional supplementation on growth between 3 and 7 y of age . Patterns were the same if supplement intakes were expressed as a percent of recommended allowances or growth was expressed as a percent of the expected rate . These impacts of nutritional supplementation on growth coincide with the ages when growth velocities , as well as growth deficits , are greatest in this population BACKGROUND Maternal undernutrition and newborn stunting [ birth length-for-age z score ( LAZ ) < -2 ] are common in Bangladesh . OBJECTIVE The objective was to evaluate the effect of lipid-based nutrient supplements for pregnant and lactating women ( LNS-PLs ) on birth outcomes . DESIGN We conducted a cluster-r and omized effectiveness trial ( the Rang-Din Nutrition Study ) within a community health program in rural Bangladesh . We enrolled 4011 pregnant women at ≤20 gestational weeks ; 48 clusters received iron and folic acid ( IFA ; 60 mg Fe + 400 μg folic acid ) and 16 clusters received LNS-PLs ( 20 g/d , 118 kcal ) containing essential fatty acids and 22 vitamins and minerals . Both of the supplements were intended for daily consumption until delivery . Primary outcomes were birth weight and length . RESULTS Infants in the LNS-PL group had higher birth weights ( 2629 ± 408 compared with 2588 ± 413 g ; P = 0.007 ) , weight-for-age z scores ( -1.48 ± 1.01 compared with -1.59 ± 1.02 ; P = 0.006 ) , head-circumference-for-age z scores ( HCZs ; -1.26 ± 1.08 compared with -1.34 ± 1.12 ; P = 0.028 ) , and body mass index z scores ( -1.57 ± 1.05 compared with -1.66 ± 1.03 ; P = 0.005 ) than those in the IFA group ; in adjusted models , the differences in length ( 47.6 ± 0.07 compared with 47.4 ± 0.04 cm ; P = 0.043 ) and LAZ ( -1.15 ± 0.04 compared with -1.24 ± 0.02 ; P = 0.035 ) were also significant . LNS-PLs  reduced the risk of newborn stunting ( 18.7 % compared with 22.6 % ; RR : 0.83 ; 95 % CI : 0.71 , 0.97 ) and small head size ( HCZ < -2 ) ( 20.7 % compared with 24.9 % ; RR : 0.85 ; 95 % CI : 0.73 , 0.98 ) . The effects  of LNS-PL on newborn stunting were greatest in infants born before a 10-wk interruption in LNS-PL distribution ( n = 1301 ; 15.7 % compared with 23.6 % ; adjusted RR : 0.69 ; 95 % CI : 0.53 , 0.89 ) and in infants born to women ≤24 y of age or with household food insecurity . CONCLUSION Prenatal lipid-based nutrient supplements can improve birth outcomes in Bangladeshi women , especially those at higher risk of fetal growth restriction . This trial was registered at clinical trials.gov as NCT01715038 Background Children with moderate acute malnutrition ( MAM ) are treated with lipid-based nutrient supplement ( LNS ) or corn-soy blend ( CSB ) . We assessed the effectiveness of ( a ) matrix , i.e. , LNS or CSB , ( b ) soy quality , i.e. , soy isolate ( SI ) or dehulled soy ( DS ) , and ( c ) percentage of total protein from dry skimmed milk , i.e. , 0 % , 20 % , or 50 % , in increasing fat-free tissue accretion . Methods and findings Between September 9 , 2013 , and August 29 , 2014 , a r and omised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso . The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB , each containing SI or DS , and 0 % , 20 % , or 50 % of protein from milk . Fat-free mass ( FFM ) was assessed by deuterium dilution technique . By dividing FFM by length squared , the primary outcome was expressed independent of length as FFM index ( FFMI ) accretion over 12 weeks . Other outcomes comprised recovery rate and additional anthropometric measures . Of 1,609 children , 4 died , 61 were lost to follow-up , and 119 were transferred out due to supplementation being switched to non-experimental products . No children developed allergic reaction . At inclusion , 95 % were breastfed , mean ( SD ) weight was 6.91 kg ( 0.93 ) , with 83.5 % ( 5.5 ) FFM . In the whole cohort , weight increased 0.90 kg ( 95 % CI 0.88 , 0.93 ; p < 0.01 ) comprising 93.5 % ( 95 % CI 89.5 , 97.3 ) FFM . As compared to children who received CSB , FFMI accretion was increased by 0.083 kg/m2 ( 95 % CI 0.003 , 0.163 ; p = 0.042 ) in those who received LNS . In contrast , SI did not increase FFMI compared to DS ( mean difference 0.038 kg/m2 ; 95 % CI −0.041 , 0.118 ; p = 0.35 ) , irrespective of matrix . Having 20 % milk protein was associated with 0.097 kg/m2 ( 95 % CI −0.002 , 0.196 ) greater FFMI accretion than having 0 % milk protein , although this difference was not significant ( p = 0.055 ) , and there was no effect of 50 % milk protein ( 0.049 kg/m2 ; 95 % CI −0.047 , 0.146 ; p = 0.32 ) . There was no effect modification by season , admission criteria , or baseline FFMI , stunting , inflammation , or breastfeeding ( p > 0.05 ) . LNS compared to CSB result ed in 128 g ( 95 % CI 67 , 190 ; p < 0.01 ) greater weight gain if both contained SI , but there was no difference between LNS and CSB if both contained DS ( mean difference 22 g ; 95 % CI −40 , 84 ; p = 0.49 ) ( interaction p = 0.017 ) . Accordingly , SI compared to DS increased weight by 89 g ( 95 % CI 27 , 150 ; p = 0.005 ) when combined with LNS , but not when combined with CSB . A limitation of this and other food supplementation trials is that it is not possible to collect reliable data on individual adherence . Conclusions Based on this study , children with MAM mainly gain fat-free tissue when rehabilitated . Nevertheless , LNS yields more fat-free tissue and higher recovery rates than CSB . Moreover , current LNSs with DS may be improved by shifting to SI . The role of milk relative to soy merits further research . Trial registration IS RCT N registry IS RCT OBJECTIVE : To evaluate the effects of dietary calcium ( Ca ) intervention on adolescent pregnant mothers and their newborns . METHODS : Seventy-two pregnant adolescent mothers were r and omized into one of 3 groups : control , orange juice fortified with calcium , and dairy . The orange juice and dairy groups were required to take more than 1,200 mg Ca . Calcium tablets were added for those not able to meet required Ca . Maternal and infant weight , length , and blood pressure ( BP ) were recorded . Maternal dietary records were evaluated . Mother ’s blood was drawn for serum Ca , phosphate ( P ) , magnesium ( Mg ) , and vitamin 25-hydroxyvitamin D ( D ) . Cord blood was collected for serum Ca and D. Newborn total body Ca was determined . RESULTS : All mothers were similar in weight , height , and BP . Mothers in the orange juice plus calcium and dairy groups had higher intakes of Ca ( 1,472 mg and 1,771 mg ) than controls ( 862 mg ) . One half of the mothers in the orange juice plus calcium group required Ca tablets . Mothers in the dairy group had higher intakes of P , D , and Mg , higher serum folate and D , and higher cord D levels . Mothers in the orange juice plus calcium group had higher serum P but lower serum folate and D. Infants ( 3,517±273 g ) in the dairy group were heavier than infants in the control ( 3,277±177 g ) and orange juice plus calcium ( 3,292±165 g ) groups . Infants in the dairy group had higher total body calcium than control infants . CONCLUSION : Calcium diet supplemented with dairy products during adolescent pregnancy result ed in higher maternal vitamin D and folate serum levels and higher newborn weight and bone mineralization compared with controls . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00320125 LEVEL OF EVIDENCE : This r and omized controlled trial of nutritional supplementation in pregnancy , in a poor black urban population in the United States , aim ed to increase the birth weight and influence the postnatal development of the offspring of mothers at high risk of having low birth weight infants . The execution of the research design and adherence to the treatment regimen among the experimental population appeared adequate for a reasonable test of the treatments . At birth , the only significant favorable effect of supplementation observed was the prevention of depressed birth weight among the offspring of mothers who smoked heavily . With balanced protein-calorie supplementation , length of gestation was increased , the proportion of low-birth-weight infants reduced , and mean birth weight raised by 41 gm ( not statistically significant ) . With high protein supplementation , there was an excess of very early premature births and associated neonatal deaths , and there was significant growth retardation up to 37 weeks of gestation . At 1 year of age , significant effects of high protein supplement were found on three psychological measures : visual habituation , visual dishabituation , and mean length of free play episodes . These measures were unrelated to measures of growth at birth and at 1 year of age . There were no detectable residual adverse effects of high protein supplementation at 1 year of age Abstract . The optimum level and ratios of protein to be used in cow 's milk formula has recently been under discussion . Healthy term infants were fed from birth exclusively human milk or a formula that varied in protein level or whey : casein ratio : ( A ) 1.4 g/dl ; 55:45 , ( B ) 1.5 g/dl ; 55:45 , ( C ) 1.3 g/dl ; 55:45 , ( D ) 1.4 g/dl ; 60:40 , ( E ) 1.4 g/dl ; 20:80 . Infants were followed for 12 weeks and blood sample s were taken at 2 , 4 , 8 and 12 weeks . Anthropometric indices did not show any significant differences among groups . Plasma amino acid and BUN levels of the C group were closest to the breast‐fed group , while the formula with the highest protein level ( B ) result ed in high values for some amino acids . When comparing the formulas with 1.4 g protein/dl , the high casein group had the lowest plasma tryptophan levels . Taurine was added to all formulas at a level similar to that of breast milk ; plasma taurine levels were similar for all groups . All formulas contained 0.7 mg iron and 0.7 mg zinc/dl ; no differences were found among the groups in hematological indices or serum trace elements . These data show that feeding a formula with 1.3 g protein/dl and 55:45 whey : casein ratio from birth will result in growth and metabolic indices similar to those of breast‐fed infants , although some plasma amino acid levels are not identical , 1990 OBJECTIVE We conducted a cluster-r and omized controlled trial to assess the efficacy of a cereal made from caterpillars , a micronutrient-rich , locally available alternative animal- source food , on reducing stunting and anaemia in infants in the Democratic Republic of Congo . DESIGN Six-month-old infants were cluster r and omized to receive either caterpillar cereal daily until 18 months of age or the usual diet . At 18 months of age , anthropometric measurements and biological sample s were collected . SETTING The rural Equateur Province in the Democratic Republic of Congo . SUBJECTS One hundred and seventy-five infants followed from 6 to 18 months of age . RESULTS Stunting was common at 6 months ( 35 % ) and the prevalence increased until 18 months ( 69 % ) . There was no difference in stunting prevalence at 18 months between the intervention and control groups ( 67 % v. 71 % , P = 0.69 ) . Infants in the cereal group had higher Hb concentration than infants in the control group ( 10.7 v. 10.1 g/dl , P = 0.03 ) and fewer were anaemic ( 26 v. 50 % , P = 0.006 ) , although there was no difference in estimates of body Fe stores ( 6.7 v. 7.2 mg/kg body weight , P = 0.44 ) . CONCLUSIONS Supplementation of complementary foods with caterpillar cereal did not reduce the prevalence of stunting at 18 months of age . However , infants who consumed caterpillar cereal had higher Hb concentration and fewer were anaemic , suggesting that caterpillar cereal might have some beneficial effect . The high prevalence of stunting at 6 months and the lack of response to this micronutrient-rich supplement suggest that factors other than dietary deficiencies also contribute to stunting This rigorously conducted trial showed that when offered early in complementary feeding , the food-based intervention of eggs produced a large effect size on child growth . BACKGROUND : Eggs are a good source of nutrients for growth and development . We hypothesized that introducing eggs early during complementary feeding would improve child nutrition . METHODS : A r and omized controlled trial was conducted in Cotopaxi Province , Ecuador , from March to December 2015 . Children ages 6 to 9 months were r and omly assigned to  treatment  ( 1 egg per day for 6 months [ n = 83 ] ) and  control  ( no intervention [ n = 80 ] ) groups . Both arms received social marketing messages to encourage participation in the Lulun Project ( lulun meaning “ egg ” in Kichwa ) . All households were visited once per week to monitor morbidity symptoms , distribute eggs , and monitor egg intakes ( for egg group only ) . Baseline and end point outcome measures included anthropometry , dietary intake frequencies , and morbidity symptoms . RESULTS : Mothers or other caregivers reported no allergic reactions to the eggs . Generalized linear regression modeling showed the egg intervention  increased length-for-age z score by 0.63 ( 95 % confidence interval [ CI ] , 0.38–0.88 ) and weight-for-age z score by 0.61 ( 95 % CI , 0.45–0.77 ) . Log-binomial models with robust Poisson indicated a reduced prevalence of stunting by 47 % ( prevalence ratio [ PR ] , 0.53 ; 95 % CI , 0.37–0.77 ) and underweight by 74 % ( PR , 0.26 ; 95 % CI , 0.10–0.70 ) . Children in the treatment group had higher dietary intakes of eggs ( PR , 1.57 ; 95 % CI , 1.28–1.92 ) and reduced intake of sugar-sweetened foods ( PR , 0.71 ; 95 % CI , 0.51–0.97 ) compared with control . CONCLUSIONS : The findings supported our hypothesis that early introduction of eggs  significantly improved growth in young children .  Generally accessible to vulnerable groups , eggs have the potential to contribute to global targets to reduce stunting BACKGROUND Management of moderate acute malnutrition ( MAM ) is , currently , focused on food supplementation approaches . However , the sustainability of these strategies remains weak in low- and middle-income countries . In food-secure setting s , an educational/behavioral intervention could be an alternative for improving MAM management . OBJECTIVE This study compared the effectiveness of weekly context -appropriate child-centered counseling ( CCC ) , with an improved corn-soy blend [ corn-soy blend with added micronutrients ( CSB++ ) ] or a locally produced ready-to-use supplementary food ( RUSF ) , in treating MAM through first-line rural health services . DESIGN We used a cluster r and omized controlled trial design with 3 arms , involving 18 rural health centers ( 6 by arm ) and children aged 6 - 24 mo with uncomplicated MAM . In the first arm ( CCC ) , trained health workers provided weekly personalized counseling to caretakers . In the 2 other arms , children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF . Both food supplements provided ∼250 kcal/d . RESULTS The recovery rate after 3 mo of treatment was significantly lower with CCC ( 57.8 % ) than with CSB++ ( 74.5 % ) and RUSF ( 74.2 % ) ( P < 0001 ) . Mothers ' attendance at health facilities was also substantially lower in the CCC arm ( P < 0001 ) ; this arm had a high defaulter rate ( P < 0.003 ) . When the analysis was adjusted for attendance , we did not find a significant difference between the 3 arms , with incidence rate ratios of 1.14 ( 95 % CI : 0.99 , 1.31 ) and 1.13 ( 95 % CI : 0.98 , 1.30 ) for the CSB++ and RUSF arms , respectively , compared with the CCC arm . CONCLUSION Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC , we hypothesize that appropriate and specific nutrition counseling centered on children 's needs , through primary health facilities , might be an alternative strategy for MAM treatment in rural food-secure areas , provided that attendance at counseling sessions by the caregiver is ensured . This trial was registered at clinical trials.gov as NCT01115647 Summary . The effect of two levels of energy supplementation in the last trimester of pregnancy on birthweight  was tested in a controlled r and omized trial in three villages in Madura , East Java .  The high and low energy supplements provided 1·95 MJ ( 465 kcal ) and 218 kj ( 52 kcal ) per day respectively . In the baseline period the home diet provided on average 6·28 MJ ( 1500 kcal ) ( SD 2·1 MJ ( 499 kcal ) ) and 41g(SD 13 g ) of protein . The mean birthweight  was 2835 g and the rate of low birth‐weight 12·2 % . In the experimental period the home diet was better . The average intake ranged from 6·45 to 7·19 MJ ( 1541–1717 kcal ) and 41·4–44·2 g per day , depending on the degree of compliance . Mean birth‐weight increased by 100 g and the rate of low birthweight dropped to 9·5 % . There was no difference between the high and low energy supplemented group as a whole , probably due to the masking effect of the better home diet in the experimental period . It is likely that a positive effect of energy supplementation on birthweight was restricted to the group of pregnant women with the lowest home dietary intake and /or a low prepregnant weight . In this community targeting of supplementation to lean seasons and /or to women with a low prepregnant weight may be cost‐effective Background / Objectives : High protein intake has been associated with increased growth . This may be linked to increased concentrations of insulin-like growth factor I ( IGF-I ) , which seems to be influenced by the diet , especially its protein component . The short-term effects of high protein intake in late infancy are not known . The objective was to investigate the effects of high protein intake in the form of whole milk ( WM ) on growth and IGF-I from 9 to 12 months of age . Subjects/ Methods : Healthy infants ( n=83 ) were r and omized to receive either WM or infant formula and fish oil or no fish oil ( 2 × 2 design ) . Anthropometric variables , IGF-I concentrations , serum urea nitrogen ( SUN ) and diet were recorded before and after the intervention . Results : Intake of WM significantly increased the protein energy percentage ( PE% ; P⩽0.001 ) and SUN ( P=0.01 ) , whereas there was no effect on size . The milk intervention increased IGF-I in boys ( P=0.034 ) but not in girls . Intake of fish oil had no effect on the outcomes . Including all infants in the analysis there was a significant correlation between weight and IGF-I at 12 months ( r=0.316 , P=0.017 ) , and PE% was positively associated with IGF-I after adjusting for sex and breastfeeding at both 9 ( r=0.329 , P=0.015 ) and 12 months ( r=0.272 , P=0.044 ) . Conclusions : R and omization to WM had no overall effect on growth . However , the positive effect of WM on IGF-I in boys and the positive association between PE% intake and IGF-I at 9 and 12 months is consistent with the hypothesis that a high milk intake stimulates growth Malnourished children ( mean age 1.2 years ) referred from public health clinics to a paediatric metabolic ward in Kingston , Jamaica , were enrolled for treatment in a community-based health care project and were r and omly allocated to one of two groups . The first group was treated at home with metronidazole and then for 6 months using the st and ard health care provided from local clinics by community health aides . The second group was given the same drug and home treatment , but in addition received a high energy supplement of 3.31 MJ daily for 3 months . We have previously shown a significant advantage in both weight and height gain for a group given the same supplement in contrast with st and ard health care controls ( Heikens et al. , 1989 , Eur . J. Clin . Nutr . 43 , 145 - 160 ) , and in this study test the addition of a drug treatment aim ed at reducing malabsorbtion due to a possible microbial overgrowth of the small bowel in malnourished children . This paper reports anthropometric findings showing significant benefits from both the drug and nutritional treatments . Greatest gains were by the group given both treatments , but the group given the antibiotic treatment , without energy supplementation , also made better growth recovery than did controls . Only 8 % of the children treated with metronidazole failed to respond to community-based intervention and were admitted to hospital , compared with 19 % for the other groups ( P < 0.05 ) . These findings support targetted high-energy supplementation for the rehabilitation of moderately malnourished children receiving health clinic care , and suggest further that such programs should include antibiotic treatment directed at SBBO Objective : Excess protein in infant formula may lead to renal overload and play a role in later obesity . The objective of this controlled , prospect i ve , r and omized , double-blind study was to assess the suitability and safety of a modified protein content infant formula and its noninferiority as compared to a conventional formula . Patients and Methods : Healthy term infants age < 7 days were either breast-fed or r and omized to be fed exclusively with a conventional casein-predominant formula ( protein/energy ratio : 2.6 g/100 kcal ) or the isocaloric whey-predominant study formula  ( protein/energy ratio : 1.8 g/100 kcal ) for 120 days . Primary outcome was daily weight gain between D0 and D120 ( noninferiority criterion : difference in daily weight gain ≤4 g ) . Secondary outcomes were daily gain in weight , length , head circumference and body mass index at monthly intervals . Tolerance and safety were assessed at each visit . Results : 162 infants were enrolled , 84 % of the formula-fed infants and 36 % of the breast-fed infants completing the study . Mean daily weight gain from D0 to D120 in the formula-fed groups differed by 0.38 g/day [ 95 % CI : −2.59 ; 1.83 ] signifying the noninferiority of the study formula . Secondary outcomes did not differ between the 2 groups at any time and were comparable to outcomes in the breast-fed group . Tolerance was good and adverse events were not different between study groups . Conclusions : The whey-predominant study infant formula with a protein/energy ratio of 1.8 g/100 kcal and enhanced protein efficiency is safe and not inferior to a conventional formula in ensuring normal growth during the first four months of life Objectives The aim of this study was to evaluate the nutritional efficacy and bifidogenic characteristics of a new infant formula containing partially hydrolyzed whey protein , modified vegetable oil with a high & bgr;-palmitic acid content , prebiotic oligosaccharides , and starch . Methods In a double-blind study , healthy formula-fed term infants aged younger than 2 weeks were r and omized to receive either the new infant formula ( NF ) or a st and ard formula ( SF )  until the age of 12 weeks .  Anthropometric measurements were taken at enrollment , 6 weeks , and 12 weeks . In a sub sample of infants , blood sample s were taken at 6 weeks and stool sample s were taken at enrollment and 6 weeks . Blood sample s were analyzed for biochemical measures of protein status and amino acids , and stools were analyzed for total bacteria and bifidobacteria . Mothers completed a feeding diary and question naire at 6 and 10 weeks . Results One hundred fifty-four infants were enrolled in the study ; 102 completed the trial . The growth of infants in both formula groups was in line with published growth curves . During the first 6 weeks , NF girls gained more weight and head circumference than the SF girls . These velocity differences were not maintained throughout the 12-week study period . The NF stools had a higher proportion of bifidobacteria at 6 weeks compared with the SF stools , and they were softer . There were no clinical ly significant differences in the blood biochemical and amino acid values between groups . Both formulas were well tolerated by the infants . Conclusions When compared with a st and ard infant formula , the new formula supported satisfactory growth , led to higher counts of bifidobacteria in the feces , produced blood bio-chemical values typical of formula-fed infants , and was well tolerated OBJECTIVE To investigate the effect of yogurt supplementation on the growth of preschool children in Beijing suburbs . METHODS Four hundred and two preschool children ( 217 males , 185 females ) , aged 3 - 5 years , whose height for age and /or weight for age were less than the reference level , were selected as subjects from 7 kindergartens in Beijing Fangshan District . The subjects were divided r and omly into control group ( CG , 201 ) and yogurt supplemented group ( YG , 201 ) . Each subject in YG was given one serving of yogurt ( 125 g ) for 5 days a week from March to December in 2001 , while nothing additional was provided to CG . All subjects kept their usual diet during the study . Anthropometry ( body height and weight and upper-arm circumference ) and the bone mineral density ( BMD ) of forearm were measured every 3 months . Disease status and dietary intake were also recorded and assessed . RESULTS The intake of calcium , zinc , and vitamin B2 in YG was significantly higher than that in CG . The incidence and duration of upper-respiratory infection and diarrhea of children in YG were significantly less than those in CG . The height gain of children in YG was significantly higher than that in CG after yogurt was supplemented for 3 , 6 , and 9 months ( P<0.05 ) ( 1.90+/-0.49 cm vs 1.77+/-0.54 cm , 3.83+/-0.57 cm vs 3.64+/-0.66 cm and 5.43+/-0.69 cm vs 5.24+/-0.76 cm , respectively ) . The weight gain of children in YG was significantly higher than that in CG after yogurt was supplemented for 3 , 6 , and 9 months ( P<0.05 ) ( 0.70+/-0.43 kg vs 0.49+/-0.35 kg , 0.98+/-0.62 kg vs 0.80+/-0.60 kg and 1.42+/-0.76 kg vs 1.20+/-0.67 kg , respectively ) . The BMD of children in YG was significantly higher than that in CG after yogurt was supplemented for 9 months ( P<0.05 ) ( 0.415+/-0.058 g/cm2 vs 0.400+/-0.065 g/cm2 ) . CONCLUSION Yogurt is beneficial to the improvement of calcium , zinc , and vitamin B2 intake , the decreasing of the incidence and duration of upper-respiratory infection and diarrhea , and the promotion of the health and the growth and development of preschool children Background . Because of its contribution to dietary diversity and to favorable intakes of micronutrients , including iron and zinc , meat is hypothesized to be a valuable complementary food for the infant and young child . However , the evidence base remains limited . Objective . To compare the difference in anthropometric measurements of rural Chinese infants and toddlers 6 to 18 months of age who received a daily supplement of meat or cereal for 12 months . Methods . This cluster-r and omized , controlled study provided a daily supplement of either meat ( n = 514 , 20 clusters ) or cereal ( n = 957 , 40 clusters ) starting as a first complementary food at 6 months of age . Anthropometric measurements were assessed longitudinally . Results . After 12 months of intervention , the meat group ( Δ13.01 ± 1.9 cm ) had greater ( p = .01 ) linear growth than the cereal group ( Δ12.75 ± 1.8 cm ) and a smaller decrease in length-for-age z-score ( LAZ ) over time ( –0.43 ± 0.72 in the meat group vs. –0.54 ± 0.67 in the cereal group ) , after adjustment for baseline length , LAZ , maternal education , work status , and maternal height and weight . Conclusions . Linear growth was modestly greater in the meat group than in the cereal group . LAZ was substantially negative at 6 months , and the intervention did not prevent ongoing decline over the course of the study Twelve hundred and fifty-one pregnant women were contacted and their infants followed to age 5 years . Nine hundred and fifty-one ( 76 % ) children completed the trial . Measurements were made of birthweight , length , head circumference , and triceps skinfold at 10 days , and of weight , height , head circumference , and triceps at 5 years . Throughout the entire period of the study half the families , selected at r and om , were supplied with milk tokens entitling the mother , while pregnant , and all children under age 5 years , to 1 pint of milk a day at half its current price . The tokens led to a small increase in milk purchases by the families and to a small increase in milk drunk by the children . However no effect was detected in any growth measurement either in the total group , or in a more " vulnerable " group of children from the largest families BACKGROUND & AIMS Protein source , macronutrient composition and content of long chain-polyunsaturated fatty acids ( LC-PUFA ) of infant formulae may influence infant growth . We aim ed to assess the effect of a modified infant formula on growth . METHODS In a r and omized , double-blind trial , 213 healthy term infants consumed  isoenergetic study formulae ( intervention formula - IF , control formula - CF ) from the first month of life until the age of 120 days . IF ( 1.89 g protein/100 kcal ) contained α-lactalbumin ( ALAB ) and LC-PUFA , while CF ( 2.30 g protein/100 kcal ) provided st and ard whey and no LC-PUFA . Anthropometry and dietary intake were regularly assessed . A venous blood sample was obtained on day 120 . RESULTS Both formulae were well-accepted without significant differences in health related observations . Weight gain was not statistically different between formula groups ( IF : 30.2 ± 6.3 vs. CF : 28.3 ± 6.5 g/day , mean ± SD , P = 0.06 ) . Length gain was higher in IF ( 0.11 ± 0.02 vs. 0.10 ± 0.02 cm/day , P = 0.02 ) . Energy intake from formula was higher in CF at 90 and 120 days ( IF : 509 ± 117 and 528 ± 123 vs. CF : 569 ± 152 and 617 ± 169 kcal/day , P < 0.01 ) . Protein intake in CF was significantly higher at each assessment . Growth per energy intake was higher in IF compared to CF for weight ( 6.45 ± 2.01 vs. 5.67 ± 2.21 g/100 kcal , P = 0.02 ) and length ( 0.23 ± 0.08 vs. 0.20 ± 0.08 mm/100 kcal , P = 0.04 ) . CONCLUSIONS The modified infant formula with reduced protein content with added ALAB and LC-PUFA , meets infant requirements of protein for adequate growth . The increased energetic efficiency of the new infant formula might result from improved protein composition by added ALAB . Apparently minor differences in composition can markedly affect energetic efficiency for growth . The study was registered at Clinical Trials.gov ( NCT01094080 ) Objective . At hospital discharge , preterm infants may have low body stores of nutrients , deficient bone mineralization , and an accumulated energy deficit . This double-blind , r and omized study evaluated the growth of premature infants with birth weights < 1800 g who were fed a 22 kcal/fl oz nutrient-enriched postdischarge formula ( PDF ) or a 20 kcal/fl oz term-infant formula ( TF )  from hospital discharge to 12 months ' corrected age ( CA ) . Methods . Infants were r and omized to PDF or TF a few days before hospital discharge with stratification by gender and birth weight ( < 1250 g or ≥1250 g ) . The formulas were fed to 12 months ' CA . Growth was evaluated using analysis of variance controlling for site , feeding , gender , and birth weight group . Interaction effects were also assessed . Secondary analyses included a repeated measures analysis and growth modeling . Results . One hundred twenty-five infants were r and omized ; 74 completed to 6 months ' CA and 53 to 12 months ' CA . PDF-fed infants weighed more than TF-fed infants at 1 and 2 months ' CA , gained more weight from study day 1 to 1 and 2 months ' CA , and were longer at 3 months ' CA . There were significant interactions between feeding and birth weight group — among infants with birth weights < 1250 g , those fed PDF weighed more at 6 months ' CA , were longer at 6 months ' CA , had larger head circumferences at term 1 , 3 , 6 , and 12 months ' CA , and gained more in head circumference from study day 1 to term and to 1 month CA . The repeated measures and growth modeling analyses confirmed the analysis of variance results . The PDF formula seemed to be of particular benefit for the growth of male infants . Infants fed the PDF consumed less formula and had higher protein intakes at several time points . Energy intakes , however , were not different . Conclusions . Growth was improved in preterm infants fed a nutrient-enriched postdischarge formula after hospital discharge to 12 months ' CA . Beneficial effects were most evident among infants with birth weights < 1250 g , particularly for head circumference measurements BACKGROUND The International Lipid-Based Nutrient Supplements Project developed a small-quantity ( 20 g/d ) lipid-based nutrient supplement ( LNS ) for pregnant and lactating women . OBJECTIVE We evaluated the effects of prenatal LNS supplementation on fetal growth . DESIGN In a community-based , partially double-blind , individually r and omized controlled trial , 1320 women ≤20 wk pregnant received 60 mg Fe/400 μg folic acid ( IFA ) , or 1 - 2 Recommended Dietary Allowances of 18 micronutrients , including 20 mg Fe ( MMN ) , or LNS with the same micronutrients as the MMN group , plus 4 minerals and macronutrients contributing 118 kcal ( LNS ) daily until delivery . Fetal growth was compared across groups by using intention-to-treat analysis . The primary outcome was birth length . RESULTS This analysis included 1057 women ( IFA = 349 , MMN = 354 , LNS = 354 ) . Groups did not differ significantly in mean birth length , length-for-age z score ( LAZ ) , head circumference , or percentage low birth length but differed in mean birth weight ( P = 0.044 ) , weight-for-age z score ( WAZ ; P = 0.046 ) , and BMI -for-age z score ( BMI Z ; P = 0.040 ) , with a trend toward differences in low birth weight ( P = 0.069 ) . In pairwise comparisons , the LNS group had greater mean birth weight ( + 85 g ; P = 0.040 ) , WAZ ( + 0.19 ; P = 0.045 ) , and BMI Z ( + 0.21 ; P = 0.035 ) and a lower risk of low birth weight ( RR : 0.61 , 95 % CI : 0.39 , 0.96 ; P = 0.032 ) than did the IFA group . The other group differences were not significant . The effect of intervention was modified by mother 's parity , age , height , baseline hemoglobin , household food insecurity , and child sex , with parity being the most consistent modifier . Among primiparous women ( IFA = 131 ; MMN = 110 ; LNS = 128 ) , the LNS group had greater mean birth length ( + 0.91 cm ; P = 0.001 ) , LAZ ( + 0.47 ; P = 0.001 ) , weight ( + 237 g ; P < 0.001 ) , WAZ ( + 0.56 ; P < 0.001 ) , BMI Z ( + 0.52 ; P < 0.001 ) , head circumference ( 0.50 cm ; P = 0.017 ) , and head circumference-for-age z score ( + 0.40 ; P = 0.022 ) than did the IFA group ; similar differences were found when comparing the LNS and MMN groups among primiparous women , and no group differences were found among multiparous women . CONCLUSION Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana , particularly primiparous women . This trial was registered at clinical trials.gov as NCT00970866 BACKGROUND Intrauterine growth restriction may be reduced by supplementing maternal diets during pregnancy , but few studies have assessed the impact of combined prenatal and postnatal interventions on child growth . OBJECTIVE We tested a hypothesis that provision of small-quantity lipid-based nutrient supplements ( SQ-LNSs ) to mothers in pregnancy and 6 mo postpartum and to their infants from 6 to 18 mo of age would promote infant and child growth in the study area in rural Malawi . METHODS We enrolled 869 pregnant women in a r and omized trial in Malawi . During pregnancy and 6 mo thereafter , the women received daily 1 capsule of iron-folic acid ( IFA ) , 1 capsule containing 18 micronutrients ( MMN ) , or one 20-g sachet of SQ-LNS [ lipid-based nutrient supplements ( LNS ) , containing 21 MMN , protein , carbohydrates , essential fatty acids , and 118 kcal ] . Children in the IFA and MMN groups received no supplementation ; children in the LNS group received SQ-LNSs from 6 to 18 mo . Primary outcome was child length at 18 mo . RESULTS At 18 mo , the mean length in the IFA , MMN  , and LNS groups was 77.0 , 76.9 , and 76.8 cm ( P = 0.90 ) , respectively , and the prevalence of stunting was 32.7 % , 35.6 % , and 37.9 % ( P = 0.54 ) , respectively . No intergroup differences were found in the mean weight , head circumference , or midupper arm circumference or the proportions with low z scores for these variables ( P > 0.05 ) . Covariate adjustment did not change the analysis results , and the associations between the intervention and child length were not modified by maternal parity , age , or nutritional status ( P > 0.10 ) . CONCLUSIONS The findings do not support a hypothesis that provision of SQ-LNSs to women in pregnancy and postpartum and to children from 6 to 18 mo of age would promote child growth in this Malawian study area . This trial was registered at clinical trials.gov as NCT01239693 Background Protein quality of breast milk is superior to that of formula proteins . To ensure that the protein intake is sufficient , starter formulas with conventional protein composition provide a protein/energy ratio of 2.2–2.5 g per 100 kcal to infants , which is much higher than that supplied with breast milk . Several studies have shown that formula-fed infants have higher plasma or serum urea concentrations than breast-fed infants do . We tested if feeding formulas with improved protein quality and a protein content corresponding to the minimum level that is consistent with international recommendations ( 1.8 g/100 kcal ) allows patients to achieve normal growth and plasma urea concentrations . Methods Healthy term infants were enrolled into the study and were either breast-fed or r and omly assigned to three formula-fed groups . Formula-fed infants received either a st and ard formula with a protein/energy ratio of 2.2 g/100 kcal , whereas the two other groups received formulas with a protein/energy ratio of 1.8g/100 kcal differing mainly by their source of protein . Subjects received breast milk or these formulas ad libitum as the sole source of energy from birth to four months of age in a controlled blind design ( except for the breast-fed group ) . Anthropometric measurements ( body weight and length ) were obtained at birth , at 30 , 60 , 90 , and 120 days . Energy and protein intakes were calculated from three-day dietary records . Blood was collected for biochemical measurements at 30 , 60 , and 120 days . Results No differences were found between the four feeding groups for weight- and length-gains or for body mass indices ( BMI ) . No differences in energy intakes between the formula-fed groups could be found , whereas protein intakes were less in infants fed the 1.8 g/100 kcal formulas . Plasma urea levels of the infants fed the 1.8 g/100 kcal formulas were closer to those found in the breast-fed infants . Conclusion Improvement of the amino acid profile permits a whey predominant starter formula with 1.8 g protein per 100 kcal to meet the needs of normal term infants during the first four months of life BACKGROUND The short- and long-term effects of feeding with hydrolyzed formulas on growth are uncertain . OBJECTIVE Our aim was to investigate the potential differences in body mass index ( BMI ) over the first 6 y of life between infants fed with partially hydrolyzed whey ( pHF-W ) , extensively hydrolyzed whey ( eHF-W ) , extensively hydrolyzed casein ( eHF-C ) , or cow-milk formula ( CMF ) and infants exclusively breastfed for the first 16 wk of life . DESIGN We established a prospect i ve , r and omized , double-blind trial of full-term neonates with atopic heredity in the German birth cohort followed by the German Infant Nutritional Intervention Study through the first 6 y of life . Intention-to-treat and per- protocol analyses of absolute and World Health Organization-st and ardized BMI trajectories for 1840 infants ( pHF-W : n = 253 ; eHF-W : n = 265 ; eHF-C : n = 250 , CMF : n = 276 ; breastfed : n = 796 ) were performed . RESULTS No significant differences in absolute or World Health Organization-st and ardized BMI trajectories were found among the pHF-W , eHF-W , CMF , and breastfed groups during the 6-y follow-up . However , in the eHF-C group , both intention-to-treat and per- protocol analyses showed a significantly slower sex-adjusted BMI gain through the 8th to 48th week of life ( -0.1 to -0.2 lower BMI z score ) but not beyond . Analyses of weight and length revealed that this difference is due to a slightly diminished weight gain in the first year of life because growth in length did not differ among study groups for the entire follow-up . CONCLUSIONS To our knowledge , this is the first r and omized trial investigating both short- and long-term effects of partially and extensively hydrolyzed formula ( pHF-W , eHF-W , eHF-C ) , CMF , and breastfeeding on growth in one trial . Feeding with eHF-C led to a transient lower weight gain in the first year of life . No long-term consequences of different formulas on BMI were observed Low nutritional value of complementary foods is associated with high incidence of childhood growth stunting in low-income countries . This study was done to test a hypothesis that dietary complementation with lipid-based nutrient supplements ( LNS ) promotes linear growth and reduces the incidence of severe stunting among at-risk infants . A total of 840 6-month-old healthy infants in rural Malawi were enrolled to a r and omised assessor-blinded trial . The participants received 12-month supplementation with nothing , milk-LNS , soy-LNS , or corn-soy blend ( CSB ) . Supplements provided micronutrients and approximately 280 kcal energy per day . Outcomes were incidence of severe and very severe stunting [ length-for-age z-score , ( LAZ ) < -3.00 and < -3.50 , respectively ] , and change in LAZ . The incidence of severe stunting was 11.8 % , 8.2 % , 9.1 % and 15.5 % ( P = 0.098 ) and that of very severe stunting 7.4 % , 2.9 % , 8.0 % and 6.4 % ( P = 0.138 ) in control , milk-LNS , soy-LNS and CSB groups , respectively . Between 9 and 12 months of age , the mean change in LAZ was -0.15 , -0.02 , -0.12 and -0.18 ( P = 0.045 ) for control , milk-LNS , soy-LNS and CSB groups , respectively . There was no significant between-group difference in linear growth during other age-intervals . Although participants who received milk-LNS had the lowest incidence of severe and very severe stunting , the differences between the groups were smaller than expected . Thus , the results do not provide conclusive evidence on a causal association between the LNS supplementation and the lower incidence of stunting . Exploratory analyses suggest that provision of milk-LNS , but not soy-LNS promotes linear growth among at-risk infants mainly between 9 and 12 months of age Several recent studies have demonstrated significantly lower plasma total tryptophan concentrations in formula-fed than in breast-fed infants . We have measured prepr and ial plasma amino acid concentrations in infants breast-fed or fed a formula with a protein concentration of 1–57 g/dl and with a whey/casein ratio of 60:40 or a formula with a protein concentration of 1.37 g/dl and a whey/casein ratio of 40:60 and fortified with 10 mg/dl ( 15 mg/100 kcal ) of tryptophan .  Healthy term infants ( 10 per group ) were either breast-fed from birth or r and omly assigned to one of the two study formulas . At 4 and 12 weeks of age , anthropometric measurements were performed and blood sample s were obtained . During the study period of 12 weeks , all infants showed normal growth ( weight , length , and head circumference ) and there were no statistically significant differences between the groups . The plasma concentrations of the essential amino acids phenylalanine , threonine , valine , and lysine were significantly lower in the breast-fed group than in both formula-fed groups . For tyrosine , methionine , leucine , histidine , isoleucine , and arginine , no significant differences could be found between the feeding groups . Concentration of total plasma tryptophan was significantly higher in the breast-fed group than in the group fed the tryptophan-unfortified formula , but no statistically significant difference could be found between the plasma tryptophan concentration in the breast-fed group versus the group fed the tryptophan-fortified formula . The results indicate that tryptophan fortification of adapted formula is necessary to achieve plasma total tryptophan concentrations similar to those found in breast-fed infants . The data also confirm that a formula with reduced protein concentration will support normal growth and will produce a plasma amino acid profile not much different from that of a conventional type of formula OBJECTIVE To evaluate the adequacy of protein intakes now recommended as safe for infants and toddlers . METHODS Subjects were recovering malnourished infants , age 5.3 to 17.9 months , length age ( LA ) 2.5 to 6.4 months , weight age ( WA ) 1.5 to 5.2 months , weight/length ( W/L ) 78 % to 100 % of National Center for Health Statistics data ; and toddlers age 11.4 to 31.6 months , LA 6.1 to 17.9 months , WA 3.9 to 12.0 months , W/L 79 % to 99 % . Infants were assigned at r and om to formulas with 5.5 % , 6.7 % , or 8.0 % energy as 60:40 whey : casein protein . The 5.5 % was based on FAO-WHO-UNU safe protein and average energy for ages 2.5 to 6.0 months . Toddlers received 4.7 % ( recommended for 6 to 18 months ) , 6.4 % , or 8.0 % . Identical concentrations ( weight/kcal ) of other nutrients were maintained ; intakes were adjusted weekly to reach , in 90 days , the 50th percentile of weight for a LA 3 months greater than the initial one . RESULTS Infants consumed 125 + /- 11 ( SD ) , 116 + /- 10 , and 126 + /- kcal and 1.7 + /- 0.1 , 1.9 + /- 0.2 , and 2.5 + /- 0.3 g protein kg-1 . d-1 ; gained 2.4 + /- 0.7 , 2.9 + /- 0.7 , and 2.6 + /- 0.5 months in LA , and reached a W/L of 105 + /- 5 , 103 + /- 6 , and 105 + /- 5 % of reference . Sum of four fat-folds ( sigma FF ) grew 13.1 + /- 6.9 , 10.4 + /- 4.8 , and 11.7 + /- 5.3 mm to 32.5 + /- 5.2 , 31.7 + /- 4.7 , and 30.5 + /- 5.5 mm ; arm muscle areas ( AMA ) 57 % , 51 % , 70 % to 1004 + /- 109 , 1017 + /- 110 , and 1004 + /- 116 mm2 , still low ; arm fat areas ( AFA ) 93 % , 66 % , and 93 % to higher-than-normal 598 + /- 105 , 610 + /- 101 , and 541 + /- 116 mm2 . Regression of intake on weight gain estimated energy for maintenance + activity to be 81.0 + /- 7.5 ( SEM ) kcal . kg-1 . d-1 , and cost of gain ( storage + metabolic cost ) as 7.6 + /- 1.7 kcal/g , with no significant effect of % protein . Toddlers consumed 107 + /- 9 , 103 + /- 12 , and 105 + /- 10 kcal and 1.3 + /- 0.1 , 1.6 + /- 0.2 , and 2.1 + /- 0.2 g protein . kg-1 . d-1 , gained 3.3 + /- 0.7 , 2.9 + /- 0.6 , and 3.3 + /- 0.7 months in LA ; to a W/L of 102 + /- 1 , 102 + /- 3 , and 101 + /- 4 % . Sigma FF grew 9.2 + /- 4.0 , 7.4 + /- 4.3 , and 6.0 + /- 3.8 to 28.9 + /- 5.2 , 30.5 + /- 3.7 , and 27.0 + /- 2.7 mm ; AMA 31 % , 33 % , and 34 % to 1121 + /- 115 , 1124 + /- 110 , and 1117 + /- 120 mm2 ; AFA 53 % , 44 % , and 45 % to higher-than normal 578 + /- 106 , 636 + /- 99 , and 569 + /- 68 mm2 . Cost of maintenance + activity was 70.8 + /- 3.8 ( SEM ) kcal . kg-1 . d-1 , that of weight gain 9.7 + /- 1.35 kcal/g , with no effect of % protein . CONCLUSIONS Within age groups , there were no significant protein-related differences in growth . In both infants and toddlers , high-energy intakes result ed in mild obesity , with lean body mass still deficient . Protein intakes two SD below the means in the lowest protein/energy cells , 1.5 g . kg-1 . d-1 for infants and 1.1 g times kg-1 . d-1 for toddlers , should still be safe for nearly all children of comparable biological ages Infant formulas have been conventionally prepared with an excess of total protein in order to provide sufficient amounts of essential amino acids to the rapidly growing infant . However , this practice leads to higher than necessary protein intake during early infant development , inducing accelerated growth patterns correlated with the development of chronic diseases later in life . This study was aim ed at assessing the safety of an infant formula enriched with bovine alpha-lactalbumin containing a total protein concentration very close to that of human milk , and determining its efficacy in the support of healthy infant growth from the first month to the fourth month of age . Healthy full-term infants ≤40 days of age were r and omized in this controlled single blind trial to one of the following infant formulas : IF 1 ( containing 1.0 g protein/dL ; n = 30 ) , IF 2 ( containing 1.3 g protein/dL ; n = 24 ) , and IF 3 ( containing 1.5 g protein/dL ; n = 42 ) . A control group consisting of exclusively breastfed infants ( HM ; n = 212 ) was included in the study . Anthropometric measurements and Z-scores were evaluated at baseline , at 1 month of age , and at 4 months of age . Weight gain ( g/day ) was similar in the IF 1 and the HM groups ( p = 0.644 ) , and it was significantly greater in the IF 2 and IF 3 groups than in the HM group . Growth patterns in both breastfed or IF-fed infants were in accordance with the World Health Organization ( WHO ) growth st and ards . At four months of age , the mean weight-for-age Z-score ( WAZ ) adjusted for initial value in the IF 1 group was similar to that of the HM group and significantly lower than that of the IF 2 and IF 3 groups ( p = 0.031 and p = 0.014 for IF 2 and IF 3 , respectively ) . Length-for-age ( LAZ ) adjusted for initial value was similar among all groups at four months of age . From 1 to 4 months of life , IF 1 containing 1.0 g protein/dL promotes growth and weight gain similar to those observed in exclusively breastfed infants . As this is a first approach to study ing an IF containing total protein in a level below that recommended by international committees on nutrition , further investigations are needed to support these findings evaluating infant ’s metabolic profile and growth in the long term BACKGROUND Complementing infant diets with lipid-based nutrient supplements ( LNSs ) has been suggested to improve growth and reduce morbidity , but the daily quantity and the milk content of LNSs affect their cost . OBJECTIVE We tested the hypotheses that the change in mean length-for-age z score ( LAZ ) for infants provided with 10 - 40 g LNSs/d from ages 6 to 18 mo would be greater than that for infants receiving no dietary intervention at the same age and that provision of LNSs that did not contain milk would be as good as milk-containing LNSs in promoting linear growth . METHODS We enrolled in a r and omized single-blind trial 6-mo-old infants who were allocated to 1 of 6 groups to receive 10 , 20 , or 40 g LNSs/d containing milk powder ; 20 or 40 g milk-free LNSs/d ; or no supplement until 18 mo of age . The primary outcome was change in LAZ . RESULTS Of the 1932 enrolled infants , 78 ( 4.0 % ) died and 319 ( 16.5 % ) dropped out during the trial . The overall reported supplement consumption was 71.6 % of days , with no difference between the groups ( P = 0.26 ) . The overall mean ± SD length and LAZ changes were 13.0 ± 2.1 cm and -0.45 ± 0.77 z score units , respectively , which did not differ between the groups ( P = 0.66 for length and P = 0.74 for LAZ ) . The difference in mean LAZ change in the no-milk LNS group compared with the milk LNS group was -0.02 ( 95 % CI : -0.10 , 0.06 ; P = 0.72 ) . CONCLUSION Our results do not support the hypothesis that LNS supplementation during infancy and childhood promotes length gain or prevents stunting between 6 and 18 mo of age in Malawi . This trial was registered at clinical trials.gov as NCT00945698 BACKGROUND The utility of dairy ingredients in the supplementary foods used in the treatment of childhood moderate acute malnutrition ( MAM ) remains unsettled . OBJECTIVE We evaluated the effectiveness of a peanut-based ready-to-use supplementary food ( RUSF ) with soy protein compared with a novel RUSF containing dairy ingredients in the form of whey permeate and whey protein concentrate in the treatment of children with MAM . DESIGN We conducted a r and omized , double-blind clinical effectiveness trial involving rural Malawian and Mozambican children 6 - 59 mo of age with MAM treated with either soy RUSF or a novel whey RUSF treatment of ~75 kcal · kg(-1 ) · d(-1 ) for up to 12 wk . RESULTS The proportion of children that recovered from MAM was significantly higher in the group that received whey RUSF ( 960 of 1144 ; 83.9 % ) than in the group that received soy RUSF ( 874 of 1086 ; 80.5 % ; P < 0.04 ; risk difference 3.4 % , 95 % CI : 0.3 % , 6.6 % ) . Children who consumed whey RUSF also demonstrated better growth markers , with a higher mean midupper arm circumference ( MUAC ) at the time of discharge ( P < 0.009 ) , greater MUAC gain during the course of treatment ( P < 0.003 ) , higher mean weight-for-height z score at discharge ( P < 0.008 ) , and greater weight gain ( P < 0.05 ) . No significant differences were identified in length gain or time to recovery between the 2 groups . CONCLUSION This study highlights the importance of milk protein in the treatment of MAM , because the use of a novel whey RUSF result ed in higher recovery rates and improved  growth than did soy RUSF , although the whey RUSF supplement provided less total protein and energy than the soy RUSF . This study was registered at clinical trials.gov as NCT01790048
BACKGROUND  Child stunting  is a major public health problem , afflicting 155 million people worldwide .
Lack of animal- source protein has been identified as a risk , but effects of animal protein supplementation are not well established .
OBJECTIVE The aim of this study was to investigate effects of animal protein supplementation  in mothers , preterm infants , and term infants/children on birth and growth outcomes .