Bernardette Cichon1,2, Christian Fabiansen1,2, Ann-Sophie Iuel-Brockdorf1,2, Charles W Yaméogo1,3, Christian Ritz1, Vibeke B Christensen2,4, Suzanne Filteau5, André Briend1,6, Kim F Michaelsen1, Henrik Friis1. 1. Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark. 2. Doctors Without Borders, Denmark, Copenhagen, Denmark. 3. Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso. 4. Department of Pediatrics, Righospitalet, Copenhagen, Denmark. 5. London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK. 6. Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, University of Tampere, Tampere, Finland.
Abstract
Background: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplements (LNSs) or corn-soy blends (CSBs) but little is known about the impact of these supplements on hemoglobin, iron status, and inflammation. Objective: The objective of this study was to investigate the impact of supplementary foods for treatment of MAM on hemoglobin, iron status, inflammation, and malaria. Design: A randomized 2 × 2 × 3 factorial trial was conducted in Burkina Faso. Children aged 6-23 mo withMAM received 500 kcal/d as LNS or CSB, containing either dehulled soy (DS) or soy isolate (SI) and different quantities of dry skimmed milk (0%, 20% or 50% of total protein) for 12 wk. The trial was double-blind with regard to quality of soy and quantity of milk, but not matrix (CSB compared to LNS). Hemoglobin, serum ferritin (SF), serum soluble transferrin receptor (sTfR), serum C-reactive protein (CRP), serum α1-acid glycoprotein (AGP), and malaria antigens were measured at inclusion and after supplementation. Results: Between September 2013 and August 2014, 1609 children were enrolled. Among these, 61 (3.8%) were lost to follow-up. During the 12-wk supplementation period, prevalence of anemia, low SF adjusted for inflammation (SFAI), elevated sTfR, and iron-deficiency anemia decreased by 16.9, 8.7, 12.6 and 10.5 percentage points. Children who received LNS compared to CSB had higher hemoglobin (2 g/L; 95% CI: 1, 4 g/L), SFAI (4.2 µg/L; 95% CI: 2.9, 5.5 µg/L), and CRP (0.8 mg/L; 95% CI: 0.4, 1.2 mg/L) and lower sTfR (-0.9 mg/L, 95% CI: -1.3, -0.6 mg/L) after the intervention. Replacing DS with SI or increasing milk content did not affect hemoglobin, SFAI, sTfR, or CRP. Conclusion: Supplementation with LNS compared to CSB led to better hemoglobin and iron status, but overall prevalence of anemia remained high. The higher concentrations of acute-phase proteins in children who received LNSs requires further investigation. This trial was registered at www.controlled-trials.com as ISRCTN42569496.
RCT Entities:
Background: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplements (LNSs) or corn-soy blends (CSBs) but little is known about the impact of these supplements on hemoglobin, iron status, and inflammation. Objective: The objective of this study was to investigate the impact of supplementary foods for treatment of MAM on hemoglobin, iron status, inflammation, and malaria. Design: A randomized 2 × 2 × 3 factorial trial was conducted in Burkina Faso. Children aged 6-23 mo with MAM received 500 kcal/d as LNS or CSB, containing either dehulled soy (DS) or soy isolate (SI) and different quantities of dry skimmed milk (0%, 20% or 50% of total protein) for 12 wk. The trial was double-blind with regard to quality of soy and quantity of milk, but not matrix (CSB compared to LNS). Hemoglobin, serum ferritin (SF), serum soluble transferrin receptor (sTfR), serum C-reactive protein (CRP), serum α1-acid glycoprotein (AGP), and malaria antigens were measured at inclusion and after supplementation. Results: Between September 2013 and August 2014, 1609 children were enrolled. Among these, 61 (3.8%) were lost to follow-up. During the 12-wk supplementation period, prevalence of anemia, low SF adjusted for inflammation (SFAI), elevated sTfR, and iron-deficiency anemia decreased by 16.9, 8.7, 12.6 and 10.5 percentage points. Children who received LNS compared to CSB had higher hemoglobin (2 g/L; 95% CI: 1, 4 g/L), SFAI (4.2 µg/L; 95% CI: 2.9, 5.5 µg/L), and CRP (0.8 mg/L; 95% CI: 0.4, 1.2 mg/L) and lower sTfR (-0.9 mg/L, 95% CI: -1.3, -0.6 mg/L) after the intervention. Replacing DS with SI or increasing milk content did not affect hemoglobin, SFAI, sTfR, or CRP. Conclusion: Supplementation with LNS compared to CSB led to better hemoglobin and iron status, but overall prevalence of anemia remained high. The higher concentrations of acute-phase proteins in children who received LNSs requires further investigation. This trial was registered at www.controlled-trials.com as ISRCTN42569496.
Authors: Mette F Olsen; Ann-Sophie Iuel-Brockdorff; Charles W Yaméogo; Bernardette Cichon; Christian Fabiansen; Suzanne Filteau; Kevin Phelan; Albertine Ouédraogo; Kim F Michaelsen; Melissa Gladstone; Per Ashorn; André Briend; Christian Ritz; Henrik Friis; Vibeke B Christensen Journal: PLoS Med Date: 2020-12-23 Impact factor: 11.069
Authors: Henrik Friis; Bernardette Cichon; Christian Fabiansen; Ann-Sophie Iuel-Brockdorff; Charles W Yaméogo; Christian Ritz; Ruth Frikke-Schmidt; André Briend; Kim F Michaelsen; Vibeke B Christensen; Suzanne Filteau; Mette F Olsen Journal: PLoS Med Date: 2022-03-09 Impact factor: 11.069
Authors: Anne M Williams; Chandresh N Ladva; Juan S Leon; Ben A Lopman; Vin Tangpricha; Ralph D Whitehead; Andrew E Armitage; Katherine Wray; Alireza Morovat; Sant-Rayn Pasricha; David Thurnham; Sherry A Tanumihardjo; Setti Shahab-Ferdows; Lindsay Allen; Rafael C Flores-Ayala; Parminder S Suchdev Journal: Am J Clin Nutr Date: 2019-12-01 Impact factor: 7.045