title: Lipid-Based Nutrient Supplements Increase Energy and Macronutrient Intakes from Complementary Food among Malawian Infants.
abstract: BACKGROUND
  Low intakes of good-quality complementary foods (CFs) contribute to undernutrition and consequently negatively affect health, growth, and development. Lipid-based nutrient supplements (LNSs) are designed to ensure dietary adequacy in micronutrients and essential fatty acids and to provide some energy and high-quality protein. In populations in which acute energy deficiency is rare, the dose-dependent effect of LNSs on CF intakes is unknown.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the difference in energy and macronutrient intakes from CF between a control (no supplement) group and 3 groups that received 10, 20, or 40 g LNS/d.
  
  
  METHODS
  We collected repeated interactive 24-h dietary recalls from caregivers of rural Malawian 9- to 10-mo-old infants (n = 748) to estimate dietary intakes (LNS and all non-breast-milk foods) of energy and macronutrients and their dietary patterns. All infants were participating in a 12-mo randomized controlled trial to investigate the efficacy of various doses of LNS for preventing undernutrition.
  
  
  RESULTS
  Dietary energy intakes were significantly higher among infants in the LNS intervention groups than in the control group (396, 406, and 388 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d; each pairwise P < 0.05), but no significant differences were found in energy intakes between groups who were administered the different LNS doses (10 g LNS/d compared with 20 g LNS/d: P = 0.72; 10 g LNS/d compared with 40 g LNS/d: P ≥ 0.67; 20 g LNS/d compared with 40 g LNS/d: P = 0.94). Intakes of protein and fat were significantly higher in the LNS intervention groups than in the control group. No significant intergroup differences were found in median intakes of energy from non-LNS CFs (357, 347, and 296 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d in the control group; P = 0.11).
  
  
  CONCLUSIONS
  LNSs in doses of 10-40 g/d increase intakes of energy and macronutrients among 9- to 10-mo-old Malawian infants, without displacing locally available CFs. This trial was registered at clinicaltrials.gov as NCT00945698.
authors.affiliation: Department of Population Health, Nutrition Group, jaimiehemsworth@gmail.com.
authors.forename: Jaimie
authors.initials: J
authors.lastname: Hemsworth
authors.affiliation: Department for International Health, School of Medicine, and.
authors.forename: Chiza
authors.initials: C
authors.lastname: Kumwenda
authors.affiliation: Program in International and Community Nutrition, and.
authors.forename: Mary
authors.initials: M
authors.lastname: Arimond
authors.affiliation: College of Medicine, University of Blantyre, Blantyre, Malawi.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.affiliation: College of Medicine, University of Blantyre, Blantyre, Malawi.
authors.forename: John
authors.initials: J
authors.lastname: Phuka
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Rehman
authors.affiliation: Department of Agricultural and Resource Economics, University of California, Davis, CA; and.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Department for International Health, School of Medicine, and.
authors.forename: Ulla
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: Department of Population Health, Nutrition Group.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Filteau
authors.affiliation: Program in International and Community Nutrition, and.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: Department for International Health, School of Medicine, and Department of Pediatrics, Tampere University Hospital, Tampere, Finland;
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: Department of Population Health, Nutrition Group.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Ferguson
mesh_terms: D015930:Diet Records; D004034:Diet Surveys; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake / Q000187:drug effects*; D005228:Fatty Acids, Essential / Q000494:pharmacology; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008055:Lipids / Q000494:pharmacology*; D008295:Malawi; D008297:Male; D044342:Malnutrition / Q000517:prevention & control*; D011939:Mental Recall; D018977:Micronutrients / Q000494:pharmacology; D015596:Nutrition Assessment; D009752:Nutritional Status
chemical_list: D004041:Dietary Fats; D004044:Dietary Proteins; D005228:Fatty Acids, Essential; D008055:Lipids; D018977:Micronutrients
keywords: complementary foods; dietary assessment; infants; lipid-based nutrient supplement; undernutrition