title: Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour.
abstract: BACKGROUND
  Therapeutic feeding with micronutrient-fortified lipid-based nutrient supplements (LNSs) has proven useful in the rehabilitation of severely malnourished children. We recently reported that complementary feeding of 6-18-mo-old infants with an LNS known as FS50 was associated with improved linear growth and a reduction in the incidence of severe stunting during the supplementation period.
  
  
  OBJECTIVE
  Our objective was to assess whether a reduction in stunting seen with 12-mo LNS supplementation was sustained over a subsequent 2-y nonintervention period.
  
  
  METHODS
  One hundred eighty-two 6-mo-old healthy rural Malawian infants were randomly assigned to receive daily supplementation for 12 mo with 71 g of maize-soy flour [likuni phala (LP); control group, 282 kcal] or either 50 g of FS50 (264 kcal; main intervention group), or 25 g of FS25 (130 kcal). Main outcome measures were incidence of severe stunting and mean z score changes in weight-for-age, length-for-age, and weight-for-length during a 36-mo follow-up period.
  
  
  RESULTS
  The cumulative 36-mo incidence of severe stunting was 19.6% in LP, 3.6% in FS50, and 10.3% in FS25 groups (P = 0.03). Mean weight-for-age changes were -1.09, -0.76, and -1.22 (P = 0.04); mean length-for-age changes were -0.47, -0.37, and -0.71 (P = 0.10); and mean weight-for-length changes were -1.52, -1.18, and -1.48 (P = 0.27). All differences were more marked among individuals with baseline length-for-age below the median. Differences in length developed during the intervention at age 10-18 mo, whereas weight differences continued to increase after the intervention.
  
  
  CONCLUSIONS
  Twelve-month-long complementary feeding with 50 g/d FS50 is likely to have a positive and sustained impact on the incidence of severe stunting in rural Malawi. Half-dose intervention may not have the same effect. This trial was registered at (clinicaltrials.gov) as NCT00131209.
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi. johnphuka@malawi.net
authors.forename: John C
authors.initials: JC
authors.lastname: Phuka
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.forename: Chrissie
authors.initials: C
authors.lastname: Thakwalakwa
authors.forename: Yin Bun
authors.initials: YB
authors.lastname: Cheung
authors.forename: André
authors.initials: A
authors.lastname: Briend
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
mesh_terms: D001827:Body Height / Q000187:drug effects* / Q000502:physiology; D002657:Child Development / Q000187:drug effects / Q000502:physiology; D004041:Dietary Fats / Q000008:administration & dosage*; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D002149:Energy Intake / Q000187:drug effects / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D008295:Malawi; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D012424:Rural Population; D015430:Weight Gain
chemical_list: D004041:Dietary Fats; D018977:Micronutrients