1 / 24

Presented by Brittany Washington

Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Authors: Seth Adu-Afarwah , Anna Lartey , Kenneth H Brown, Stanley Zlotking , André Briend , and Kathryn G Dewey.

lora
Download Presentation

Presented by Brittany Washington

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development Authors: Seth Adu-Afarwah, Anna Lartey, Kenneth H Brown, Stanley Zlotking, André Briend, and Kathryn G Dewey Presented by Brittany Washington

  2. Introduction • Complementary feeding – 6 to 24 mo. • Low micronutrient content of complementary foods in disadvantaged populations has been associated with • Growth faltering • Increased morbidity • Delayed motor milestone acquisition

  3. Possible low-cost solution = home fortification of complimentary foods with multiple micronutrient supplements • 3 types of multiple micronutrient supplements: • Sprinkles (SP), powder, 9 vitamins & minerals • Nutritabs (NT), crushable tablet, 16 V&M • Nutributter (NB), peanut-based fortified spread, 19 V&M, with added energy from fat (linoleic and α-linolenic)

  4. Rationale • Purpose = to compare these 3 supplements and determine whether higher content of micronutrients and/or macronutrients would give more positive growth results in infants from 6-12 months • Hypothesis = multiple micronutrient fortification of complementary foods would increase growth and the effect would be greatest with added energy from fat

  5. Methods • The community-based randomized study was carried out in Koforidua, Ghana between February 2004 and June 2005 • 313/409 eligible infants were assigned to receive SP, NT, or NB • 96/409 eligible infants were recruited for the nonintervention group (NI) at 12 mo.

  6. Micronutrient supplements • Designed to generally provide the amounts of key nutrients needed from complementary foods • SP dose = 1 satchet/d • NT dose = 1 tablet/d (came in plastic bags) • NB dose = 20 g/d (came in foil packs with screw caps, net wt = 200g)

  7. Procedures • Parents of selected infants were visited to verify eligibility, explain protocol, and obtain consent • Supplements delivered weekly • Mothers instructed to administer daily dose in a single meal, 7 days/week, mixed with 1-2 tbsp of food • Supplied cups and spoons

  8. Data collection • Background data collected during recruitment • Weekly collection of daily supplement consumption data and morbidity data (diarrhea, symptoms of respiratory infections, fever) • Monthly collection of 24-h dietary recall data, used to calculate energy intake from complementary foods • At 6, 9, and 12 mo., anthropometric data was obtained

  9. Data collection • Calculated weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z-scores using WHO 2006 Child Growth Standards • At 12 mo., 4 motor milestones were assessed: • Standing with assistance • Walking with assistance • Standing independently • Walking independently

  10. Baseline data

  11. Baseline data

  12. Results – Monthly 24-h recall • When the energy contribution of NB was included, energy intake was significantly greater in the NB group (~85 kcal/d)

  13. Results – Mean (+/- SE) absolute weight gain from 6-9 and 9-12 mo.

  14. Results - Mean (+/- SE) absolute length gain from 6-9 and 9-12 mo.

  15. Results- % of children achieving milestones by 12 mo.

  16. Results – prevalence of morbidities between 6 and 12 mo.

  17. Discussion • Multiple micronutrient interventions alone may not improve growth of infants in some populations • Supplementation with SP and NT did not increase growth • NB group had greater weight and length gains than other two intervention groups

  18. Weight and Length gain • Difference in weight gain could be explained by increased calorie intake in NB group - Consumption of NB resulted in avg. increase of ~85 kcal daily intake from complementary foods • Difference in length gain could be explained by essential fatty acid content of NB (provided 65% of recommended linoleic acid and 145% of α-linolenic acid intake)

  19. Motor-skill development • SP and NT infants were 2x as likely, and NB infants were 3.4x as likely to be able to walk independently by 12 mo. than the NI group • Can be due to receiving zinc and iron supplements together and with other micronutrients • Can also be due to increased calorie intake in NB group

  20. Morbidities • The 3 groups did not differ significantly in prevalence of illness, except for cough, which was slightly higher in NT group

  21. Limitations • Possibility of influence on the amount of attention given to children due to Hawthorne effect • Mothers and field workers who delivered supplements were not blind to study design (although anthopometrists were masked to group assignment)

  22. Possibilities for further research • Address micronutrient interactions • Control for micronutrient levels to measure effect of energy/fat intake

More Related