Complementary feeding: a Global Network cluster randomized controlled trial

Abstract

BackgroundInadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children in low resource settings. Animal source foods in particular are cited as essential to achieve micronutrient requirements. The efficacy of the recommendation for regular meat consumption, however, has not been systematically evaluated.Methods/DesignA cluster randomized efficacy trial was designed to test the hypothesis that 12 months of daily intake of beef added as a complementary food would result in greater linear growth velocity than a micronutrient fortified equi-caloric rice-soy cereal supplement. The study is being conducted in 4 sites of the Global Network for Women's and Children's Health Research located in Guatemala, Pakistan, Democratic Republic of the Congo (DRC) and Zambia in communities with toddler stunting rates of at least 20%. Five clusters per country were randomized to each of the food arms, with 30 infants in each cluster. The daily meat or cereal supplement was delivered to the home by community coordinators, starting when the infants were 6 months of age and continuing through 18 months. All participating mothers received nutrition education messages to enhance complementary feeding practices delivered by study coordinators and through posters at the local health center. Outcome measures, obtained at 6, 9, 12, and 18 months by a separate assessment team, included anthropometry; dietary variety and diversity scores; biomarkers of iron, zinc and Vitamin B12 status (18 months); neurocognitive development (12 and 18 months); and incidence of infectious morbidity throughout the trial. The trial was supervised by a trial steering committee, and an independent data monitoring committee provided oversight for the safety and conduct of the trial.DiscussionFindings from this trial will test the efficacy of daily intake of meat commencing at age 6 months and, if beneficial, will provide a strong rationale for global efforts to enhance local supplies of meat as a complementary food for young children.Trial registrationNCT01084109

Complementary Feeding: Review of Recommendations, Feeding Practices, and Adequacy of Homemade Complementary Food Preparations in Developing Countries – Lessons from Ethiopia

“…During these formative years, poor nutrition has immediate consequences of increased morbidity and mortality and delayed development of the brain and other nervous systems (11). The latent impacts of deficits in nutrients in early ages include impaired cognitive performance and reproductive outcomes and reduced work capacity and health status during adolescence and adulthood.…”

“…The challenges during complementary feeding are context specific, but many are common across settings. They are often characterized by poor feeding practices and poor dietary quality of homemade complementary foods (11–13). …”

Evaluation of energy, protein, and selected micronutrient density of homemade complementary foods consumed by children between 6 months and 23 months in food insecure woredas of Wolayita zone, Southern Ethiopia

“…They are often characterized by a combination of poor feeding practices and poor dietary quality of homemade complementary foods. [7][8][9] Commonly observed dietary quality problems include too little variety; inappropriate consistency; too few essential vitamins and minerals, especially vitamin A, Fe, zinc (Zn), and Ca; too few essential fatty acids; and too few calories among nonbreastfed infants. 8,10,11 Commercial, fortified food products on the other hand are often beyond the reach of the poor.…”

Neurodevelopment: The Impact of Nutrition and Inflammation During Infancy in Low-Resource Settings

“…14 Due to both limited availability (eg cost constraints) and to tradition, animal flesh foods are often not offered as complementary foods to young children, and even more infrequently to infants between 6 and 12 months of age. 15,16 Primary reliance on unfortified, plant-based staple foods during the complementary feeding period, even with continued breastfeeding, often results in inadequate intake of several critical micronutrients. 16 Additionally, lower bioavailability of some micronutrients from primarily plant sources (except for some beans) may additionally compromise the adequacy of the intake of a given micronutrient.…”