Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial

Abstract

Stunting is reportedly associated with low circulating levels of essential amino acids (EAAs). This study examined the effect of a macronutrient- and micronutrient-fortified complementary food supplement (KOKO Plus) on specific plasma EAA levels and stunting in infants aged 6-18 months. In a single-blind cluster-randomized controlled trial conducted in Ghana, infants were enrolled at 6 months and followed until 18 months. Thirty-eight communities were randomly assigned to receive KOKO Plus (KP, fourteen communities, n = 321), multiple-micronutrient powder (MN, thirteen communities, n = 327), or only nutritional education as control group (NE, eleven communities, n = 318), and all groups received nutrition education. Plasma amino acids (AAs) were measured at 6, 12, and 18 months (end point). Mixed-effects models were used to assess the effect of the intervention on plasma AAs, and the relationship between plasma branched-chain AAs (BCAAs) and the risk of stunting was assessed. At the end point, total BCAA concentrations (±standard error) significantly exceeded baseline in the KP (284.2 ± 4.3 μM) and NE (289.1 ± 4.4 μM) groups but not the MN group (264.4 ± 4.1 μM). After adjustment for compliance at 200 sachets, plasma BCAAs exceeded in the KP group (284.5 ± 4.2 μM) compared to the MN group (264.6 ± 4 μM). Plasma BCAAs were positively correlated with changes in length-for-age Z-score from baseline (R = 0.327, p = 0.048). In conclusion, the plasma BCAA concentrations of infants that received KP and the NE group was significantly higher compared to the MN group but there were no differences between the KP and NE group at end point. Improved plasma BCAAs may be due to improved nutrient intake by infants exposed to KP or NE. Low BCAAs were associated with stunting, replicating the previous finding. Clinical Trial Registration: https://ichgcp.net/clinical-trials-registry/NCT03181178?term=NCT03181178&draw=2&rank=1, identifier: NCT03181178.

Keywords: complementary food supplement; length-for-age z-score; plasma branched-chain amino acids; plasma essential amino acids; stunting.

Conflict of interest statement

CF, WS, and HM are Ajinomoto Co., Inc. employees. DS, GO, KT-D, and SG were supported by grants from both Ajinomoto Co., Inc. (Tokyo, Japan) and Japan International Cooperation Agency (JICA). SG and DS was affiliated at Nevin Scrimshaw International Nutrition Foundation at the time of the intervention trial.

Copyright © 2021 Furuta, Sato, Murakami, Suri, Otoo, Tano-Debrah and Ghosh.

Figures

Figure 1

Study participants and follow-up by group [KOKO Plus (KP), micronutrient powder (MN) and nutrition education (NE)]. *Lost to follow-up includes deaths and severe acute malnutrition (SAM).

Figure 2

The correlation between delta LAZ and delta plasma BCAA concentration. The horizontal axis indicates the delta of plasma BCAA concentration [μM] from baseline to end point. The vertical axis indicates the delta of LAZ from baseline to end point. Each plot indicate community average. KP, MN, and NE are shown in red, green and blue, respectively. The regression line was shown in black and pearson's correlation was significant (R = 0.327; p = 0.048). KP, KOKO Plus; MN, Micronutrient; NE, Nutrition Education; BCAA, Branch chain amino acid; LAZ, Length for age z-score.