Effectiveness of a locally produced ready-to-use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial

Bindi Borg, Daream Sok, Seema Mihrshahi, Mark Griffin, Chhoun Chamnan, Jacques Berger, Arnaud Laillou, Nanna Roos, Frank T Wieringa, Bindi Borg, Daream Sok, Seema Mihrshahi, Mark Griffin, Chhoun Chamnan, Jacques Berger, Arnaud Laillou, Nanna Roos, Frank T Wieringa

Abstract

This cluster randomised controlled trial tested the effectiveness of a locally produced, fish-based, ready-to-use supplementary food (RUSF) to prevent growth faltering (decline in z-scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn-Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight-for-age z-scores (WAZ; -0.02, 95%CI = -0.03 - -0.01, P= 0.001) and height-for-age z-scores (HAZ; -0.07, 95%CI = -0.09 - -0.05, P < 0.001), and increased mid-upper arm-circumference (MUAC; 0.02cm, 95%CI = 0.01 - 0.04, P = 0.010), but no statistically significant change in weight-for-height z-scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 - 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01-0.06, P = 0.006; 0.04, 95%CI = 0.01-0.08, P = 0.026; and 0.05cm, 95%CI = 0.02-0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.

Trial registration: ClinicalTrials.gov NCT02257762.

Keywords: childhood malnutrition; fish; growth faltering; lipid-based nutrient supplement (LNS); ready-to-use supplementary food (RUSF).

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.

Figures

Figure 1
Figure 1
Trial profile‐site selection, recruitment, enrolment of children and trial completion. *Reasons for exclusion: severe acute malnutrition, overnutrition, severe anaemia, food allergy. †Reasons for loss to follow up: dropped out, moved away permanently, travelling temporarily, too busy to attend. ‡One site recruited only one child who dropped out, leaving 6 CSB++ sites and 27 sites in total

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