Providing lipid-based nutrient supplements does not affect developmental milestones among Malawian children
Aim To assess whether using lipid‐based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones. Methods In rural Malawi, 840 6‐month‐old healthy infants were enrolled to a randomised trial. Control participants r...
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| Published in | Acta Paediatrica Vol. 103; no. 1; pp. e17 - e26 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Norway
Blackwell Publishing Ltd
01.01.2014
Wiley Subscription Services, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0803-5253 1651-2227 1651-2227 |
| DOI | 10.1111/apa.12443 |
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| Abstract | Aim
To assess whether using lipid‐based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones.
Methods
In rural Malawi, 840 6‐month‐old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk‐containing LNS, soy‐containing LNS or corn–soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themself) and language (saying single comprehensible words and waving goodbye).
Results
The mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk‐LNS, soy‐LNS and CSB groups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10).
Conclusion
The findings do not support a hypothesis that providing tested formulations and doses of micronutrient‐fortified LNS or CSB would have an impact on when young children in rural Malawi achieved selected developmental milestones. |
|---|---|
| AbstractList | Aim
To assess whether using lipid‐based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones.
Methods
In rural Malawi, 840 6‐month‐old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk‐containing LNS, soy‐containing LNS or corn–soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themself) and language (saying single comprehensible words and waving goodbye).
Results
The mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk‐LNS, soy‐LNS and CSB groups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10).
Conclusion
The findings do not support a hypothesis that providing tested formulations and doses of micronutrient‐fortified LNS or CSB would have an impact on when young children in rural Malawi achieved selected developmental milestones. To assess whether using lipid-based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones. In rural Malawi, 840 6-month-old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk-containing LNS, soy-containing LNS or corn-soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themselves) and language (saying single comprehensible words and waving goodbye). The mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk-LNS, soy-LNS and CSB groups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10). The findings do not support a hypothesis that providing tested formulations and doses of micronutrient-fortified LNS or CSB would have an impact on when young children in rural Malawi achieved selected developmental milestones. To assess whether using lipid-based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones.AIMTo assess whether using lipid-based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones.In rural Malawi, 840 6-month-old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk-containing LNS, soy-containing LNS or corn-soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themselves) and language (saying single comprehensible words and waving goodbye).METHODSIn rural Malawi, 840 6-month-old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk-containing LNS, soy-containing LNS or corn-soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themselves) and language (saying single comprehensible words and waving goodbye).The mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk-LNS, soy-LNS and CSB groups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10).RESULTSThe mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk-LNS, soy-LNS and CSB groups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10).The findings do not support a hypothesis that providing tested formulations and doses of micronutrient-fortified LNS or CSB would have an impact on when young children in rural Malawi achieved selected developmental milestones.CONCLUSIONThe findings do not support a hypothesis that providing tested formulations and doses of micronutrient-fortified LNS or CSB would have an impact on when young children in rural Malawi achieved selected developmental milestones. Aim To assess whether using lipid-based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones. Methods In rural Malawi, 840 6-month-old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk-containing LNS, soy-containing LNS or corn-soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themself) and language (saying single comprehensible words and waving goodbye). Results The mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk-LNS, soy-LNS and CSB groups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10). Conclusion The findings do not support a hypothesis that providing tested formulations and doses of micronutrient-fortified LNS or CSB would have an impact on when young children in rural Malawi achieved selected developmental milestones. [PUBLICATION ABSTRACT] |
| Author | Cheung, Yin Bun Maleta, Kenneth Ashorn, Per Thakwalakwa, Chrissie Mangani, Charles Phuka, John Manary, Mark Dewey, Kathryn Puumalainen, Taneli |
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| Copyright | 2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd. Copyright © 2014 Foundation Acta Pædiatrica |
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| Keywords | Infants and young children Developmental milestones Complementary feeding Child development Lipid-based nutrient supplements |
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| References | Flax VL, Ashorn U, Phuka J, Maleta K, Manary MJ, Ashorn P. Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home. Matern Child Nutr 2008; 4: 65-73. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 1999; 129: 1555-62. Machin D, Cheung YB, Parmar M. Survival Analysis: A Practical Approach. 2nd ed. Chichester: John Wiley & Sons, 2006. Kwok MK, Leung GM, Lam TH, Schooling CM. Early life infections and onset of puberty: evidence from Hong Kong's children of 1997 birth cohort. Am J Epidemiol 2011; 173: 1440-52. Lindsey JK. A study of interval censoring in parametric regression models. Lifetime Data Anal 1998; 4: 329-354. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243-60. Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet 2005; 366: 1804-07. Diop EHI, Dossou NI, Ndour MM, Briend A, Wade S. Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. Am J Clin Nutr 2003; 78: 302-307. Bayley N. Manual of the Bayley Scales of Infant Development. San Antonio, TX: Psychological Corporation, 1969. Neligan G, Prudham D. Norms for four standard developmental milestones by sex, social class and place in family. Dev Med Child Neurol 1969; 11: 413-22. Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 2008; 371: 411-416. Phuka JC, Gladstone M, Maleta K, Thakwalakwa C, Cheung YB, Briend A, et al. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour. Matern Child Nutr 2012; 8: 239-48. Manary MJ, Sandige HL. Management of acute moderate and severe childhood malnutrition. BMJ 2008; 337: a2180. Greenfield PM. You can't take it with you: why ability assessments don't cross cultures. Am Psychol 1997; 52: 1115-1124. Vaahtera M, Kulmala T, Hietanen A, Ndekha M, Cullinan T, Salin ML, et al. Breastfeeding and complementary feeding practices in rural Malawi. Acta Paediatr 2001; 90: 328-332. Gladstone M, Lancaster GA, Umar E, Nyirenda M, Kayira E, van denBroek NR, et al. The Malawi Developmental Assessment Tool (MDAT): the creation, validation, and reliability of a tool to assess child development in rural African settings. PLoS Med 2010; 7: e1000273. Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, et al. Complementary feeding with fortified spread and incidence of severe stunting in 6-to 18-month-old rural Malawians. Arch Pediatr Adolesc Med 2008; 162: 619-62. Frankenburg WK, Dodds J, Archer P, Shapiro H, Bresnick B. The Denver II: a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics 1992; 89: 91-7. Ministry of Health and Populatzion (MoHP). Malawi 2010 Infant and Young Child Nutrition Policy and Guidelines. Lilongwe, Malawi: Ministry of Health and Population, 2008-2013. Dewey KG, Arimond M. Lipid-based nutrient supplements: how can they combat child malnutrition? PLoS Med 2012; 9: e1001314. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B; International Child Development Steering Group. Developmental potential in the first 5 years for children in developing countries. Lancet 2007; 369: 60-70. WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: windows of achievement for six gross motor development milestones. Acta Paediatr 2006; 450: 86-95. Mangani C, Maleta K, Phuka J, Cheung YB, Thakwalakwa C, Dewey K, et al. The effect of complementary feeding with lipid based nutrient supplements on the incidence of stunting among 6- to 18-month-old infants and children in rural Malawi. Matern Child Nutr 2013; doi: 10.1111/mcn.12068. in press. Griffin JT, Fraser C, Gras L, de Wolf F, Ghani AC. The effect on treatment comparisons of different measurement frequencies in human immunodeficiency virus observational databases. Am J Epidemiol 2006; 163: 676-83. Maleta K, Virtanen S, Espo M, Kulmala T, Ashorn P. Child malnutrition and its predictors in Rural Malawi. Paediatr Perinat Epidemiol 2003a; 17: 384-390. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008; 371: 340-57. Adu-Afarwuah S, Lartey A, Brown KH, Briend A, Zlotkin Z, Dewey KG. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr 2007; 86: 412-20. Thompson RA, Nelson CA. Developmental science and the media: early brain development. Am Psychol 2001; 56: 5-15. 2007; 369 2001; 90 2003a; 17 2008 1969; 11 2006; 450 2006 2005 2008; 4 1999; 129 2011; 173 2008; 162 2003; 78 2005; 366 1997; 52 2006; 163 2008; 337 2013 2007; 86 2001; 56 1992; 89 1998; 4 2010; 7 1969 2008; 371 2012; 8 2012; 9 |
| References_xml | – reference: Maleta K, Virtanen S, Espo M, Kulmala T, Ashorn P. Child malnutrition and its predictors in Rural Malawi. Paediatr Perinat Epidemiol 2003a; 17: 384-390. – reference: Neligan G, Prudham D. Norms for four standard developmental milestones by sex, social class and place in family. Dev Med Child Neurol 1969; 11: 413-22. – reference: Lindsey JK. A study of interval censoring in parametric regression models. Lifetime Data Anal 1998; 4: 329-354. – reference: Frankenburg WK, Dodds J, Archer P, Shapiro H, Bresnick B. The Denver II: a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics 1992; 89: 91-7. – reference: Bayley N. Manual of the Bayley Scales of Infant Development. San Antonio, TX: Psychological Corporation, 1969. – reference: Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008; 371: 340-57. – reference: Mangani C, Maleta K, Phuka J, Cheung YB, Thakwalakwa C, Dewey K, et al. The effect of complementary feeding with lipid based nutrient supplements on the incidence of stunting among 6- to 18-month-old infants and children in rural Malawi. Matern Child Nutr 2013; doi: 10.1111/mcn.12068. in press. – reference: Diop EHI, Dossou NI, Ndour MM, Briend A, Wade S. Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. Am J Clin Nutr 2003; 78: 302-307. – reference: Greenfield PM. You can't take it with you: why ability assessments don't cross cultures. Am Psychol 1997; 52: 1115-1124. – reference: Flax VL, Ashorn U, Phuka J, Maleta K, Manary MJ, Ashorn P. Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home. Matern Child Nutr 2008; 4: 65-73. – reference: Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B; International Child Development Steering Group. Developmental potential in the first 5 years for children in developing countries. Lancet 2007; 369: 60-70. – reference: Adu-Afarwuah S, Lartey A, Brown KH, Briend A, Zlotkin Z, Dewey KG. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr 2007; 86: 412-20. – reference: Kwok MK, Leung GM, Lam TH, Schooling CM. Early life infections and onset of puberty: evidence from Hong Kong's children of 1997 birth cohort. Am J Epidemiol 2011; 173: 1440-52. – reference: Machin D, Cheung YB, Parmar M. Survival Analysis: A Practical Approach. 2nd ed. Chichester: John Wiley & Sons, 2006. – reference: Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 1999; 129: 1555-62. – reference: Gladstone M, Lancaster GA, Umar E, Nyirenda M, Kayira E, van denBroek NR, et al. The Malawi Developmental Assessment Tool (MDAT): the creation, validation, and reliability of a tool to assess child development in rural African settings. PLoS Med 2010; 7: e1000273. – reference: Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet 2005; 366: 1804-07. – reference: Phuka JC, Gladstone M, Maleta K, Thakwalakwa C, Cheung YB, Briend A, et al. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour. Matern Child Nutr 2012; 8: 239-48. – reference: Vaahtera M, Kulmala T, Hietanen A, Ndekha M, Cullinan T, Salin ML, et al. Breastfeeding and complementary feeding practices in rural Malawi. Acta Paediatr 2001; 90: 328-332. – reference: Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243-60. – reference: Ministry of Health and Populatzion (MoHP). Malawi 2010 Infant and Young Child Nutrition Policy and Guidelines. Lilongwe, Malawi: Ministry of Health and Population, 2008-2013. – reference: Manary MJ, Sandige HL. Management of acute moderate and severe childhood malnutrition. BMJ 2008; 337: a2180. – reference: Dewey KG, Arimond M. Lipid-based nutrient supplements: how can they combat child malnutrition? PLoS Med 2012; 9: e1001314. – reference: Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 2008; 371: 411-416. – reference: WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: windows of achievement for six gross motor development milestones. Acta Paediatr 2006; 450: 86-95. – reference: Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, et al. Complementary feeding with fortified spread and incidence of severe stunting in 6-to 18-month-old rural Malawians. Arch Pediatr Adolesc Med 2008; 162: 619-62. – reference: Griffin JT, Fraser C, Gras L, de Wolf F, Ghani AC. The effect on treatment comparisons of different measurement frequencies in human immunodeficiency virus observational databases. Am J Epidemiol 2006; 163: 676-83. – reference: Thompson RA, Nelson CA. Developmental science and the media: early brain development. Am Psychol 2001; 56: 5-15. – volume: 9 start-page: e1001314 year: 2012 article-title: Lipid‐based nutrient supplements: how can they combat child malnutrition? publication-title: PLoS Med – volume: 371 start-page: 411 year: 2008 end-page: 416 article-title: Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults publication-title: Lancet – volume: 52 start-page: 1115 year: 1997 end-page: 1124 article-title: You can't take it with you: why ability assessments don't cross cultures publication-title: Am Psychol – year: 2005 – volume: 162 start-page: 619 year: 2008 end-page: 62 article-title: Complementary feeding with fortified spread and incidence of severe stunting in 6‐to 18‐month‐old rural Malawians publication-title: Arch Pediatr Adolesc Med – volume: 4 start-page: 65 year: 2008 end-page: 73 article-title: Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home publication-title: Matern 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To assess whether using lipid‐based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected... To assess whether using lipid-based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected... Aim To assess whether using lipid-based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected... |
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| SubjectTerms | Child Development Complementary feeding Developmental milestones Dietary Supplements Female Humans Infant Infants and young children Lipid-based nutrient supplements Lipids - administration & dosage Malawi Male Motor Skills |
| Title | Providing lipid-based nutrient supplements does not affect developmental milestones among Malawian children |
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