Table of Contents Summary251. Introduction33 1.1 Importance of complementary feeding for child health33 1.2 Guiding principles for complementary feeding34 1.3 Scope and organization of this report342. Energy and nutrients needed from complementary foods35 2.1 Energy, protein and lipids35 2.2 Micronutrients353. Methods36 3.1 Sources searched and search strategy36 3.2 Measurement of the treatment effect of interventions36 3.3 Evaluation of methodological quality and level of evidence37 3.4 Number of relevant studies identified384. Findings of the systematic review38 4.1 Types of intervention strategies38  4.1.1 Educational interventions38  4.1.2 Provision of food offering extra energy (with or without micronutrient fortification)43  4.1.3 Micronutrient fortification of complementary foods43  4.1.4 Increasing energy density of complementary foods through simple technology46  4.1.5 Categorization of results by intervention strategy46 4.2 Growth outcomes46  4.2.1 Interventions using educational approaches46  4.2.2 Interventions in which provision of complementary food was the only treatment49  4.2.3 Interventions in which provision of complementary food was combined with another strategy, usually education for mothers51  4.2.4 Interventions in which complementary foods were fortified with additional micronutrients53  4.2.5 Interventions to increase energy density of complementary foods55 4.3 Morbidity outcomes55  4.3.1 Interventions using educational approaches55  4.3.2 Interventions in which provision of complementary food was the only treatment57  4.3.3 Interventions in which provision of complementary food was combined with another strategy, usually education for mothers57  4.3.4 Interventions in which complementary foods were fortified with additional micronutrients58  4.3.5 Interventions to increase energy density of complementary foods59 4.4 Child development61  4.4.1 Interventions in which provision of complementary food was the only treatment61  4.4.2 Interventions in which complementary foods were fortified with additional micronutrients62 4.5 Micronutrient intake63  4.5.1 Intervention studies using educational approaches63  4.5.2 Interventions in which provision of complementary food was the only treatment64  4.5.3 Interventions in which provision of complementary food was combined with another strategy, usually education for mothers64  4.5.4 Interventions in which complementary foods were fortified with additional micronutrients65  4.5.5 Interventions to increase energy density of complementary foods66 4.6 Iron status66  4.6.1 Intervention studies using educational approaches66  4.6.2 Interventions in which complementary food was provided, with or without another strategy such as education for mothers68  4.6.3 Interventions in which commercially processed complementary foods were fortified with iron or multiple micronutrients68  4.6.4 Interventions in which home fortification of complementary foods was the primary intervention68 4.7 Zinc status72  4.7.1 Interventions in which complementary foods were fo...

All 3 supplements had positive effects on motor milestone acquisition by 12 mo compared with no intervention, but only NB affected growth.

Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana, particularly primiparous women. This trial was registered at clinicaltrials.gov as NCT00970866.

None.

Background: Micronutrient deficiencies are common during infancy, and optimal approaches for their prevention need to be identified. Objective: The objective was to compare the efficacy and acceptability of Sprinkles (SP), crushable Nutritabs (NT), and fat-based Nutributter (NB; 108 kcal/d), which provide 6, 16, and 19 vitamins and minerals, respectively, when used for home fortification of complementary foods. Design: Ghanaian infants were randomly assigned to receive SP (n ҃ 105), NT (n ҃ 105), or NB (n ҃ 103) daily from 6 to 12 mo of age. We assessed dietary intake, morbidity, and compliance weekly. Hemoglobin and plasma ferritin, TfR, C-reactive protein, and zinc were measured at 6 and 12 mo. We used an exit interview to assess acceptability. A randomly selected control group of infants who received no intervention (NI; n ҃ 96) were assessed at 12 mo. Results: All supplements were well accepted, and the mean percentage of days that supplements were consumed (87%) did not differ between groups. At 12 mo, all 3 intervention groups had significantly higher ferritin and lower TfR concentrations than did the NI control group. Mean (Ȁ SD) hemoglobin was significantly higher in NT (112 Ȁ 14 g/L) and NB (114 Ȁ 14 g/L) but not in SP (110 Ȁ 14 g/L) infants than in NI infants (106 Ȁ 14 g/L). The prevalence of iron deficiency anemia was 31% in the NI control group compared with 10% in the intervention groups combined (P 0.0001). Conclusion: All 3 options for home fortification of complementary foods are effective for reducing the prevalence of iron deficiency in such populations.Am J Clin Nutr 2008;87:929 -38.

Background: Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life.Objective: We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age.Design: In this partially double-blind, individually randomized trial, 1320 women at ≤20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age.Results: At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for-age z score (LAZ) were 79.3 cm and −0.83, respectively, and 12% of the children were stunted (LAZ <−2). In analysis based on the intended treatment, mean ± SD length and LAZ for the LNS group (79.7 ± 2.9 cm and −0.69 ± 1.01, respectively) were significantly greater than for the IFA (79.1 ± 2.9 cm and −0.87 ± 0.99) and MMN (79.1 ± 2.9 cm and −0.91 ± 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045).Conclusion: Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child’s attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.

Inadequate micronutrient intake during pregnancy, lactation and infancy is a major problem in many developing countries. Lipid-based nutrient supplements (LNS) can improve micronutrient status, growth and development of infants, and also have potential to improve nutritional status of pregnant and lactating women. The objective of the study was to test the acceptability of LNS designed for infants (LNS-20gM) and pregnant or lactating women (LNS-P&L). Participants were infants (n = 22, mean age = 8 months) and pregnant or lactating women (n = 24) attending routine services at a hospital in Ghana. Infants consumed 45 g of a test meal consisting of one part LNS-20gM and three parts fermented maize porridge, while women consumed 50 g of a similar test meal containing LNS-P&L instead. Participants also used their respective LNS at home for 14 days. Primary outcome was the proportion of the test meal consumed. On average, infants consumed 76.2% of the test meal [95% (confidence interval) CI: 65.7, 86.7], while women consumed 87.1% (95% CI: 82.6, 91.6). During the 14-day period, median daily consumption of LNS-20gM was 19.3 g, very close to the recommended 20 g d(-1), while that of LNS-P&L was one sachet, as recommended. We conclude that LNS-20gM and LNS-P&L were well accepted.

BackgroundPrevious reviews have identified 44 risk factors for poor early child development (ECD) in low‐ and middle‐income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.MethodsWe conducted path analyses of factors associated with 18‐month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid‐Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.ResultsOut of 42 indicators of the 34 factors examined, 6 were associated with 18‐month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.ConclusionsKey elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status.