title: Ready-to-use supplementary food increases fat mass and BMI in Haitian school-aged children.
abstract: BACKGROUND
  In Haiti and other countries, large-scale investments in school feeding programs have been made with marginal evidence of nutrition outcomes.
  
  
  OBJECTIVE
  We aimed to examine the effectiveness of a fortified ready-to-use supplementary food (RUSF), Mamba, on reduced anemia and improved body composition in school-aged children compared to an unfortified cereal bar, Tablet Yo, and control groups.
  
  
  METHODS
  A cluster, randomized trial with children ages 3-13 y (n = 1167) was conducted in the north of Haiti. Six schools were matched and randomized to the control group, Tablet Yo group (42 g, 165 kcal), or Mamba group (50 g, 260 kcal, and >75% of the RDA for critical micronutrients). Children in the supplementation groups received the snack daily for 100 d, and all were followed longitudinally for hemoglobin concentrations, anthropometry, and bioelectrical impedance measures: baseline (December 2012), midline (March 2013), and endline (June 2013). Parent surveys were conducted at baseline and endline to examine secondary outcomes of morbidities and dietary intakes. Longitudinal regression modeling using generalized least squares and logit with random effects tested the main effects.
  
  
  RESULTS
  At baseline,14.0% of children were stunted, 14.5% underweight, 9.1% thin, and 73% anemic. Fat mass percentage (mean ± SD) was 8.1% ± 4.3% for boys and 12.5% ± 4.4% for girls. In longitudinal modeling, Mamba supplementation increased body mass index z score (regression coefficient ± SEE) 0.25 ± 0.06, fat mass 0.45 ± 0.14 kg, and percentage fat mass 1.28% ± 0.27% compared with control at each time point (P < 0.001). Among boys, Mamba increased fat mass (regression coefficient ± SEE) 0.73 ± 0.19 kg and fat-free mass 0.62 ± 0.34 kg compared with control (P < 0.001). Mamba reduced the odds of developing anemia by 28% compared to control (adjusted OR: 0.72; 95% CI: 0.57, 0.91; P < 0.001). No treatment effect was found for hemoglobin concentration.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to give evidence of body composition effects from an RUSF in school-aged children.
authors.affiliation: Institute for Public Health, George Warren Brown School of Social Work, Washington University, St. Louis, MO; liannotti@wustl.edu.
authors.forename: Lora L
authors.initials: LL
authors.lastname: Iannotti
authors.affiliation: Edesia, Providence, RI;
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Henretty
authors.affiliation: Meds & Food for Kids, St. Louis, MO; and.
authors.forename: Jacques Raymond
authors.initials: JR
authors.lastname: Delnatus
authors.affiliation: Meds & Food for Kids, St. Louis, MO; and.
authors.forename: Windy
authors.initials: W
authors.lastname: Previl
authors.affiliation: Meds & Food for Kids, St. Louis, MO; and.
authors.forename: Tom
authors.initials: T
authors.lastname: Stehl
authors.affiliation: Meds & Food for Kids, St. Louis, MO; and.
authors.forename: Susan
authors.initials: S
authors.lastname: Vorkoper
authors.affiliation: Institute for Public Health, George Warren Brown School of Social Work, Washington University, St. Louis, MO;
authors.forename: Jaime
authors.initials: J
authors.lastname: Bodden
authors.affiliation: Institute for Public Health, George Warren Brown School of Social Work, Washington University, St. Louis, MO;
authors.forename: Amanda
authors.initials: A
authors.lastname: Maust
authors.affiliation: Institute for Public Health, George Warren Brown School of Social Work, Washington University, St. Louis, MO;
authors.forename: Rachel
authors.initials: R
authors.lastname: Smidt
authors.affiliation: National Soybean Research Laboratory, University of Illinois at Urbana-Champaign, Champaign, IL.
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Nash
authors.affiliation: National Soybean Research Laboratory, University of Illinois at Urbana-Champaign, Champaign, IL.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Tamimie
authors.affiliation: National Soybean Research Laboratory, University of Illinois at Urbana-Champaign, Champaign, IL.
authors.forename: Bridget C
authors.initials: BC
authors.lastname: Owen
authors.affiliation: Meds & Food for Kids, St. Louis, MO; and.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Wolff
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000740:Anemia / Q000178:diet therapy / Q000453:epidemiology*; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D002523:Edible Grain; D017097:Electric Impedance; D002149:Energy Intake; D005260:Female; D005522:Food Services; D005523:Food Supply; D005527:Food, Fortified / Q000032:analysis*; D006205:Haiti; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000453:epidemiology*; D018977:Micronutrients / Q000008:administration & dosage; D009752:Nutritional Status; D015995:Prevalence; D012959:Socioeconomic Factors
chemical_list: D006454:Hemoglobins; D018977:Micronutrients
keywords: dietary intakes; fat mass; hemoglobin concentrations; longitudinal regression; micronutrient-fortified food