Complementary feeding with cowpea reduces growth faltering in rural Malawian infants: a blind, randomized controlled clinical trial

Abstract

Growth faltering is common in rural African children and is attributed to inadequate dietary intake and environmental enteric dysfunction (EED). We tested the hypothesis that complementary feeding with cowpea or common bean flour would reduce growth faltering and EED in 6-mo-old rural Malawians compared with the control group receiving a corn-soy blend. A prospective, double-blind, randomized controlled clinical trial was conducted in which children received daily feeding for 6 mo (200 kcal/d when 6-9 mo old and 300 kcal/d when 10-12 mo old). The primary outcomes were change in length-for-age score (LAZ) and improvements in EED, as measured by percentage of lactulose excretion (%L). %L<0.2% was considered normal. Anthropometric measurements and %L through urine were compared between each legume group and the control group with Student's test. Of the 355 infants enrolled, 291 infants completed the trial, and 288 were breastfed throughout the duration of the study. Cowpea and common bean added 4.6-5.2 g protein/d and 4-5 g indigestible carbohydrate/d to the diet. LAZ and weight-for-height score were reduced in all 3 groups from 6 to 12 mo of age. The changes in LAZ [mean (95% CI)] for the cowpea, common bean, and control groups from 6 to 9 mo were -0.14 (-0.24, -0.04), -0.27 (-0.38, -0.16), and -0.27 (-0.35, -0.19), respectively. LAZ was reduced less in infants receiving cowpea than in those receiving control food from 6 to 9 mo ( = 0.048). The absolute value of %L did not differ between the dietary groups at 9 mo of age (mean ± SD: 0.30 ± 0.43, 0.23 ± 0.21, and 0.26 ± 0.31 for cowpea, common bean, and control, respectively), nor did the change in %L from 6 to 9 mo. Addition of cowpea to complementary feeding in Malawian infants resulted in less linear growth faltering. This trial was registered at clinicaltrials.gov as NCT02472262.

Does sustainable intensification of maize production enhance child nutrition? Evidence from rural Tanzania

“…The negative effects of the “Intensification” category on HAZ are not robust to the model specification, as they cease to be statistically significant when we limit the sample to children aged 25–59 months. The lack of statistically significant effects of any SI categories on the HAZ and WAZ of children aged 6–24 months may be because these children are still being breastfed and largely dependent on complementary/weaning foods instead of consuming adult foods (Stephenson et al., ; Tanzania Food and Nutrition Centre, ; Zeng et al., ). Consistent with our findings, a recent study (Jain, ) finds that nutrient intake has no association with the HAZ of children aged 6–23 months in rural Bangladesh.…”

Impact of Infant and Young Child Feeding (IYCF) Nutrition Interventions on Breastfeeding Practices, Growth and Mortality in Low- and Middle-Income Countries: Systematic Review

“…Complementary feeding provision had a significant effect on HAZ in food insecure settings [20,28,34,46,48,61,62,69,71,72,80,85] but had no effect in a food secure setting [78] when compared with control groups (see Table 1).…”

“…The studies spanned three continents. Seven studies were conducted in Africa i.e., two in Ghana [20,60], two in Malawi [62,85], and one each in Burkina Faso [46], Democratic Republic of Congo [28], Nigeria [69] and South Africa [71]. Five studies were conducted in South America i.e., two in Ecuador [48,61] and one each in Guatemala [64], Colombia [72] and Brazil [78].…”

Detection and interpretation of fecal host mRNA in rural Malawian infants aged 6–12 months at risk for environmental enteric dysfunction

“…11 Since EED is thought to be more consequential when it occurs in infants, it is of interest whether fecal mRNA can be detected in this population. [11][12][13] This study tested the hypotheses that host mRNAs would be detectable in similar quantities in fecal samples from infants as they are in young children, and that a similar panel of mRNAs would predict EED in infants as does in children.…”

“…Subjects resided in rural southern Malawi, were aged 6 to12 months, and participated in a clinical trial of legume supplementation in which %L was measured simultaneously with a fecal collection. 12 Infants with acute malnutrition, chronic debilitating illness, congenital deformity, or recent diarrhea were excluded. Families relied on subsistence farming, retrieved their water from boreholes or wells, resided in unelectrified mud huts, and were at high risk for EED.…”