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Community and International Nutrition

Supplementary Feeding with Fortified Spreads Results in Higher Recovery Rates Than with Corn/Soy Blend in Moderately Wasted Children^1,2

³ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110 ⁴ Department of Community Health, College of Medicine, University of Malawi, Blantyre 3, Malawi ⁵ Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, DC 20009 ⁶ Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, 77030

Moderate childhood wasting is defined as having a weight-for-height Z-score (WHZ) < –2, but –3. These children are typically given fortified corn/soy blended flour (CSB), but this intervention has shown limited effectiveness. Fortified spreads (FS) can be used as supplementary foods instead; they are energy-dense, lipid-based pastes with added powdered micronutrients. In this randomized clinical effectiveness trial, the recovery rates were compared among children with moderate wasting who received either milk/peanut FS, soy/peanut FS, or CSB. Children received isoenergetic quantities of food, 314 kJ·kg^–1·d^–1, for up to 8 wk with biweekly follow-up. The primary outcome was recovery, defined as having a WHZ > –2. Time-event analysis was used to compare the recovery rate. A total of 1362 children were enrolled in the study. Children receiving soy/peanut FS had a similar recovery rate to those receiving milk/peanut FS and children in either FS group were more likely to recover than those receiving CSB (80% in both FS groups vs. 72% in the CSB group; P < 0.01). The rate of weight gain in the first 2 wk was greater among children receiving milk/peanut FS (2.6 g·kg^–1·d^–1, n = 465) or children receiving soy/peanut FS (2.4 g·kg^–1·d^–1, n = 450) than among children receiving CSB (2.0 g·kg^–1·d^–1, n = 447; P < 0.05). Rates of length gain did not differ among the 3 groups. A total of 8% of children in each feeding group developed edema, indicative of severe malnutrition, while receiving supplemental feeding. We conclude that FS are superior supplementary foods to CSB for moderately wasted Malawian children.

^* To whom correspondence should be addressed: E-mail: manary{at}kids.wustl.edu.

Manuscript received 23 December 2008. Initial review completed 5 January 2009. Revision accepted 29 January 2009.