title: A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response.
abstract: There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries.
  
  
  
  We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods (RUSFs) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau.
  
  
  
  A 3-month cluster-randomized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants (6-23 months) and children (24-59 months) from 13 villages. The RUSFs contained either 478 (mothers, children) or 239 kcal/d (infants) with 15% or 33% of protein from dairy and were distributed at community health centers 5 d/wk. Controls were wait-listed to receive RUSF. Primary outcomes were mid-upper arm circumference (MUAC) in mothers, and weight-for-age and height-for-age z-scores (WAZ and HAZ) in infants and children.
  
  
  
  There was a significant effect of the RUSF-33% on MUAC in mothers ( P = .03). The WAZ and HAZ increased substantially, by ≈1 z-score, in infants and children ( P < .01) independent of group randomization. In children, but not infants, baseline WAZ and change in maternal MUAC were associated with change in WAZ (β = .07, P = .02).
  
  
  
  Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers, supporting a comparable recent finding in preschool children. In addition, supplementation of children <2 years resulted in improved growth independent of family nutritional status, whereas success in older children was associated with change in maternal nutrition, suggesting the need for community-level education about preventing malnutrition in older, as well as younger, children.
authors.affiliation: 1 Global Food & Nutrition Inc, Washington, DC, USA.|2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Schlossman
authors.affiliation: 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Brown
authors.affiliation: 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA.
authors.forename: Payal
authors.initials: P
authors.lastname: Batra
authors.affiliation: 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau.
authors.forename: Augusto Braima
authors.initials: AB
authors.lastname: de Sa
authors.affiliation: 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau.
authors.forename: Ionela
authors.initials: I
authors.lastname: Balan
authors.affiliation: 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau.
authors.forename: Adrian
authors.initials: A
authors.lastname: Balan
authors.affiliation: 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA.
authors.forename: Madeleine G
authors.initials: MG
authors.lastname: Gamache
authors.affiliation: 1 Global Food & Nutrition Inc, Washington, DC, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Wood
authors.affiliation: 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau.
authors.forename: William
authors.initials: W
authors.lastname: Pruzensky
authors.affiliation: 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Saltzman
authors.affiliation: 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Roberts
authors.affiliation: 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau.
authors.forename: Carlito
authors.initials: C
authors.lastname: Balé
mesh_terms: D000328:Adult; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D016000:Cluster Analysis; D003611:Dairy Products; D004041:Dietary Fats / Q000008:administration & dosage*; D019587:Dietary Supplements; D005260:Female; D006169:Guinea-Bissau; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000517:prevention & control*; D039382:Maternal Nutritional Physiological Phenomena; D009752:Nutritional Status; D010865:Pilot Projects; D011247:Pregnancy; D012424:Rural Population; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004041:Dietary Fats
keywords: Guinea-Bissau; HAZ; RUSF; WAZ; dairy; preschool; protein; retinol binding protein; undernutrition; vitamin A