4. Discussion
MP
INFLAMMATION, CURB, MALNUTRITION
In our nutrition intervention study using large-quantity LNS, neither MP nor WP had an effect on any development domain or head circumference. Irrespective of milk ingredients, LNS vs. no supplementation had no effect on any development domain but seemed to increase head circumference. A further test for interactions revealed that the effect of MP on social skills was modified by sex and current breastfeeding. The effect of WP on motor and social skills was modified by stunting severity while the effect of LNS irrespective of dairy was modified by current breastfeeding and inflammation.Several nutrition studies have shown that milk protein, or milk per se [Despite the scant literature on the developmental effects of supplementation with large-quantity LNS, studies using small-quantity LNS have also had inconsistent results [Among other challenges, comparability is difficult across studies due to variations in definitions and measurements used for the different variables. Additionally, most previous studies have used small-quantity LNS, which provides minimal energy (~100 kcal/d), to meet the part of the child’s daily energy requirements (~1000 kcal/d). To some extent, our results concur with these studies that LNS intervention does not generally result in development, despite using large-quantity supplements providing more energy (~535 kcal/day), and fully satisfying the child’s daily micronutrient requirements. We already reported that the same milk ingredients had no effect, but rather, LNS, irrespective of milk ingredients, benefited growth [In the management of malnutrition, there were concerns about the polyunsaturated fat acid (PUFA) composition of earlier WHO standard LNS versions in facilitating neurocognitive and immune recovery. This was mainly due to the content of linoleic acid in those products when given at high doses (150–200 kcal/kg/day), thus, calls for data on optimal omega-6 and omega-3 PUFA content. Studies testing novel products revealed that adding omega-3 DHA or a reduction of omega-6 linoleic acid by using high-oleic peanuts improved overall omega-3 (DHA) status with subsequent development [A stimulative home environment may have interacted with MP, resulting in more rapid ontogenetic development, hence, a higher increase in cognitive scores among those with stimulative compared to non-stimulative home environment. It may have also been more of an interaction with the household’s socioeconomic status (SES), consequently resulting in better cognitive development. This is a key research gap noted by some scholars as to whether it is lack of stimulation or poverty that is responsible for poor development [Studies have reported lower early child development scores among stunted than non-stunted children [From the literature, breastfeeding has been associated with improved cognitive performance and socio-affective response [Key strengths of our study are the randomized 2 × 2 factorial design with an un-supplemented group for comparison, a very low attrition rate, use of a contextually developed and local tool to measure the outcome and pre-specified subgroup analysis plan to avoid chance findings. Limitations may include the incomplete blinding of the caregivers with respect to supplementation, despite measures in place to curb this, recall, and information bias from caregiver’s reports on the family care indicators.