Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial.
BACKGROUND
Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40-50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.


METHODS
A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy'doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < -2), weight-for-length z-score (WLZ) and wasting (WLZ < -2) in children 6-18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.


RESULTS
Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02-0.04/month) in the Plumpy'doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy'doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5-6% (P ≤ 0.01) in those receiving Plumpy'doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27-0.30 cm and 0.07-0.10 (all P < 0.05), respectively, in all four food groups relative to the control.


CONCLUSIONS
In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, pchrist1@jhu.edu.
Parul
P
Christian
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, JiVitA Project, Gaibandha, Bangladesh.
Saijuddin
S
Shaikh
JiVitA Project, Gaibandha, Bangladesh.
Abu Ahmed
AA
Shamim
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sucheta
S
Mehra
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lee
L
Wu
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Maithilee
M
Mitra
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, JiVitA Project, Gaibandha, Bangladesh.
Hasmot
H
Ali
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Rebecca D
RD
Merrill
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
Nuzhat
N
Choudhury
United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and.
Monira
M
Parveen
United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and.
Rachel D
RD
Fuli
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
Md Iqbal
MI
Hossain
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
Md Munirul
MM
Islam
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Rolf
R
Klemm
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Kerry
K
Schulze
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Alain
A
Labrique
Office of Nutrition Advisor, United Nations World Food Programme, Rome, Italy.
Saskia
S
de Pee
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
Tahmeed
T
Ahmed
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Keith P
KP
West
D001459:Bangladesh; D001942:Breast Feeding; D002657:Child Development; D029863:Cicer; D003376:Counseling / Q000379:methods*; D019422:Dietary Sucrose; D019587:Dietary Supplements; D005260:Female; D005527:Food, Fortified; D006130:Growth Disorders / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000517:prevention & control*; D027806:Lens Plant; D008297:Male; D018977:Micronutrients; D012275:Oryza; D012424:Rural Population; D013024:Soybean Oil
D019422:Dietary Sucrose; D018977:Micronutrients; D013024:Soybean Oil
Bangladesh; Complementary food; growth; micronutrients; stunting; supplementation