title: Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings.
abstract: BACKGROUND
  Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested.
  
  
  OBJECTIVE
  The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal.
  
  
  METHODS
  This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion.
  
  
  RESULTS
  A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-for-age z score (LAZ) <-2.0] rates increased from ~33% to nearly 50%. Years of maternal education and maternal height were positively associated with linear growth velocity (P = 0.0006 and 0.003, respectively); LAZ at 6 mo was negatively associated (P < 0.0001). Anemia rates did not differ by group; iron deficiency was significantly lower in the cereal group.
  
  
  CONCLUSIONS
  The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods.
authors.affiliation: Department of Pediatrics, Section of Nutrition, University of Colorado Denver, Aurora, CO 80045, USA. nancy.krebs@ucdenver.edu
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.forename: Manolo
authors.initials: M
authors.lastname: Mazariegos
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Neelofar
authors.initials: N
authors.lastname: Sami
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tshefu
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Carl L
authors.initials: CL
authors.lastname: Bose
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.forename: Norman
authors.initials: N
authors.lastname: Goco
authors.forename: Mark
authors.initials: M
authors.lastname: Kindem
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Jamie
authors.initials: J
authors.lastname: Westcott
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.forename: Adrien
authors.initials: A
authors.lastname: Lokangaka
authors.forename: Albert
authors.initials: A
authors.lastname: Manasyan
authors.forename: Edna
authors.initials: E
authors.lastname: Imenda
authors.forename: Tyler D
authors.initials: TD
authors.lastname: Hartwell
authors.forename: K Michael
authors.initials: KM
authors.lastname: Hambidge
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000178:diet therapy / Q000517:prevention & control; D002657:Child Development; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D002523:Edible Grain / Q000009:adverse effects / Q000737:chemistry; D004522:Educational Status; D005527:Food, Fortified / Q000009:adverse effects / Q000032:analysis; D006130:Growth Disorders / Q000150:complications / Q000178:diet therapy* / Q000453:epidemiology; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000032:analysis; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D008460:Meat / Q000009:adverse effects; D018977:Micronutrients / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009035:Mothers / Q000193:education; D010154:Pakistan / Q000453:epidemiology; D011204:Poverty Areas; D015995:Prevalence; D012423:Rural Health; D014504:Urban Health; D015024:Zambia / Q000453:epidemiology
chemical_list: D018977:Micronutrients