Improving nutritional status and health of infants and lactating women through the use of Lipid Based Nutrition Supplements (LNS): Evidence from a longitudinal, randomized trial in Lilongwe, Malawi
Ready to use, lipid-based micronutrient-fortified supplements or foods (LNS) in the form of energy-dense spreads have been used extensively for nutritional rehabilitation of severely malnourished children in clinical settings. Recently, LNS were tested for home use, and found to improve linear growth, nutritional status and weight gain of moderately undernourished children. LNS are now being considered for broader use as complementary weaning foods for breastfed infants or as a major nutrient source for non-breastfed infants. LNS have important advantages in resource-poor settings: they can be locally produced at relatively low cost, are easy for mothers to use, and they can eliminate the risk of bacterial contamination from added water. Local production of LNS also allows for tailoring their nutrient profile to address the most common nutrient deficiencies near the area of production and distribution. While the focus to date has been on child feeding, LNS may also be used to supplement pregnant and lactating women to enhance their own health as well as the health of their child. Our main goal is to provide the scientific evidence to support the broad use of low-cost LNS to enhance the nutritional status of women and children. We will address three broad research questions: (1) How does LNS given to infants who are not breast-fed in the second six months of life affect their nutritional status, growth and health during that time period? (2) How does LNS given to lactating women affect the nutritional status, growth and health of their breastfeeding infant? (3) How does LNS given to lactating women affect their own health and nutritional status? To answer these research questions, we will analyze samples and data from the Centers for Disease Control and Prevention-funded Breastfeeding, Antiretroviral, and Nutrition Study (BAN), a clinical trial in Malawi designed to assess how maternal nutrition supplementation and antiretroviral interventions during lactation influence breastfeeding-associated HIV transmission and maternal nutritional status[1]. Half of BAN-enrolled mothers were randomly assigned to receive LNS formulated to meet women's extra energy, protein and micronutrient needs to support exclusive breastfeeding for 6 months. The other half of mothers received a weekly allocation of maize for family consumption. All BAN participants were counseled to exclusively breastfeed, then to stop breastfeeding by 28 weeks. Infants then received a separately tailored, locally produced LNS as a breast-milk replacement. Mothers and infants were followed during frequent clinic visits until the infant reached 48 weeks of age. Assessments included mother and infant anthropometrics, 24-hour dietary recalls, detailed reports of the use of LNS, physical examinations, and collection of blood and breast milk samples which were stored for future analysis. Our first objective is to conduct laboratory analyses of key micronutrients for which deficiencies are common in low income countries, which have important consequences for maternal health and infant growth and development. We focus on a set of B vitamins (B6, B12), on indicators of iron status (hemoglobin, ferritin, transferrin receptors), and on vitamin A, vitamin D and selenium. Our second objective is to conduct statistical analysis of the BAN data to answer our key research questions, and our third objective is the wide dissemination of results for scientific, program, and policy purposes. If there is evidence of impact of LNS on maternal and child health and nutritional status, the policy implications and potential for scaling up LNS through intervention programs and new markets in low income countries is substantial.
Principal Investigator: Margaret E. Bentley
CPC Fellow Investigator: Linda S. Adair
Funding Source: Bill and Melinda Gates Foundation
Grant Number: OPP53107
Funding Period: 9/1/2009 - 8/31/2012
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