title: Provision of 10-40 g/d Lipid-Based Nutrient Supplements from 6 to 18 Months of Age Does Not Prevent Linear Growth Faltering in Malawi.
abstract: BACKGROUND
  Complementing infant diets with lipid-based nutrient supplements (LNSs) has been suggested to improve growth and reduce morbidity, but the daily quantity and the milk content of LNSs affect their cost.
  
  
  OBJECTIVE
  We tested the hypotheses that the change in mean length-for-age z score (LAZ) for infants provided with 10-40 g LNSs/d from ages 6 to 18 mo would be greater than that for infants receiving no dietary intervention at the same age and that provision of LNSs that did not contain milk would be as good as milk-containing LNSs in promoting linear growth.
  
  
  METHODS
  We enrolled in a randomized single-blind trial 6-mo-old infants who were allocated to 1 of 6 groups to receive 10, 20, or 40 g LNSs/d containing milk powder; 20 or 40 g milk-free LNSs/d; or no supplement until 18 mo of age. The primary outcome was change in LAZ.
  
  
  RESULTS
  Of the 1932 enrolled infants, 78 (4.0%) died and 319 (16.5%) dropped out during the trial. The overall reported supplement consumption was 71.6% of days, with no difference between the groups (P = 0.26). The overall mean ± SD length and LAZ changes were 13.0 ± 2.1 cm and -0.45 ± 0.77 z score units, respectively, which did not differ between the groups (P = 0.66 for length and P = 0.74 for LAZ). The difference in mean LAZ change in the no-milk LNS group compared with the milk LNS group was -0.02 (95% CI: -0.10, 0.06; P = 0.72).
  
  
  CONCLUSIONS
  Our results do not support the hypothesis that LNS supplementation during infancy and childhood promotes length gain or prevents stunting between 6 and 18 mo of age in Malawi. This trial was registered at clinicaltrials.gov as NCT00945698.
authors.affiliation: Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi; kmaleta@medcol.mw.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Maleta
authors.affiliation: Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
authors.forename: John
authors.initials: J
authors.lastname: Phuka
authors.affiliation: Department of International Health, University of Tampere School of Medicine, Tampere, Finland;
authors.forename: Lotta
authors.initials: L
authors.lastname: Alho
authors.affiliation: Department of International Health, University of Tampere School of Medicine, Tampere, Finland; Center for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore;
authors.forename: Yin Bun
authors.initials: YB
authors.lastname: Cheung
authors.affiliation: Departments of Nutrition and.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: Department of International Health, University of Tampere School of Medicine, Tampere, Finland;
authors.forename: Ulla
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
authors.forename: Nozgechi
authors.initials: N
authors.lastname: Phiri
authors.affiliation: Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
authors.forename: Thokozani E
authors.initials: TE
authors.lastname: Phiri
authors.affiliation: Agricultural and Resource Economics, University of California, Davis, Davis, CA;
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Nutriset S.A.S., Hameau du Bois Ricard, Malaunay, France; and.
authors.forename: Mamane
authors.initials: M
authors.lastname: Zeilani
authors.affiliation: Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
authors.forename: Chiza
authors.initials: C
authors.lastname: Kumwenda
authors.affiliation: Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
authors.forename: Jaden
authors.initials: J
authors.lastname: Bendabenda
authors.affiliation: Department of International Health, University of Tampere School of Medicine, Tampere, Finland;
authors.forename: Anna
authors.initials: A
authors.lastname: Pulakka
authors.affiliation: Department of International Health, University of Tampere School of Medicine, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
mesh_terms: D000818:Animals; D002657:Child Development / Q000187:drug effects*; D004041:Dietary Fats / Q000008:administration & dosage; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage; D007227:Infant Nutritional Physiological Phenomena; D008055:Lipids / Q000008:administration & dosage / Q000494:pharmacology*; D008295:Malawi; D044342:Malnutrition / Q000517:prevention & control; D008892:Milk; D012424:Rural Population
chemical_list: D004041:Dietary Fats; D008055:Lipids
keywords: LNS; efficacy; infants; randomized controlled trial; stunting; sub-Saharan Africa