Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso

Christian Fabiansen; Charles W Yaméogo; Ann-Sophie Iuel-Brockdorf; Bernardette Cichon; Maren Johanne Heilskov Rytter; Anura Kurpad; Jonathan C Wells; Christian Ritz; Per Ashorn; Suzanne Filteau; André Briend; Susan Shepherd; Vibeke Bak Christensen; Kim F. Michaelsen; Henrik Friis

doi:10.1371/journal.pmed.1002387

Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso

Christian Fabiansen, Charles W Yaméogo, Ann-Sophie Iuel-Brockdorf, Bernardette Cichon, Maren Johanne Heilskov Rytter, Anura Kurpad, Jonathan C Wells, Christian Ritz, Per Ashorn, Suzanne Filteau, André Briend, Susan Shepherd, Vibeke Bak Christensen, Kim F. Michaelsen, Henrik Friis

Lifecourse Nutrition & Health

36 Citations (Scopus)

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Abstract

Background: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Methods and findings: Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p < 0.01) comprising 93.5% (95% CI 89.5, 97.3) FFM. As compared to children who received CSB, FFMI accretion was increased by 0.083 kg/m²(95% CI 0.003, 0.163; p = 0.042) in those who received LNS. In contrast, SI did not increase FFMI compared to DS (mean difference 0.038 kg/m²; 95% CI −0.041, 0.118; p = 0.35), irrespective of matrix. Having 20% milk protein was associated with 0.097 kg/m²(95% CI −0.002, 0.196) greater FFMI accretion than having 0% milk protein, although this difference was not significant (p = 0.055), and there was no effect of 50% milk protein (0.049 kg/m²; 95% CI −0.047, 0.146; p = 0.32). There was no effect modification by season, admission criteria, or baseline FFMI, stunting, inflammation, or breastfeeding (p > 0.05). LNS compared to CSB resulted in 128 g (95% CI 67, 190; p < 0.01) greater weight gain if both contained SI, but there was no difference between LNS and CSB if both contained DS (mean difference 22 g; 95% CI −40, 84; p = 0.49) (interaction p = 0.017). Accordingly, SI compared to DS increased weight by 89 g (95% CI 27, 150; p = 0.005) when combined with LNS, but not when combined with CSB. A limitation of this and other food supplementation trials is that it is not possible to collect reliable data on individual adherence. Conclusions: Based on this study, children with MAM mainly gain fat-free tissue when rehabilitated. Nevertheless, LNS yields more fat-free tissue and higher recovery rates than CSB. Moreover, current LNSs with DS may be improved by shifting to SI. The role of milk relative to soy merits further research.

Original language	English
Article number	e1002387
Journal	P L o S Medicine (Online)
Volume	14
Issue number	9
Number of pages	18
ISSN	1549-1277
DOIs	https://doi.org/10.1371/journal.pmed.1002387
Publication status	Published - Sept 2017

Keywords

Adipose Tissue
Burkina Faso
Dietary Supplements
Female
Humans
Infant
Infant Nutrition Disorders
Infant Nutritional Physiological Phenomena
Male
Micronutrients
Soybeans
Weight Gain
Zea mays
Journal Article
Randomized Controlled Trial

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Fabiansen, C., Yaméogo, C. W., Iuel-Brockdorf, A-S., Cichon, B., Rytter, M. J. H., Kurpad, A., Wells, J. C., Ritz, C., Ashorn, P., Filteau, S., Briend, A., Shepherd, S., Christensen, V. B., Michaelsen, K. F., & Friis, H. (2017). Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso. P L o S Medicine (Online), 14(9), [e1002387]. https://doi.org/10.1371/journal.pmed.1002387

Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition : A randomised 2 × 2 × 3 factorial trial in Burkina Faso. / Fabiansen, Christian; Yaméogo, Charles W; Iuel-Brockdorf, Ann-Sophie et al.

In: P L o S Medicine (Online), Vol. 14, No. 9, e1002387, 09.2017.

Research output: Contribution to journal › Journal article › Research › peer-review

Fabiansen, C, Yaméogo, CW, Iuel-Brockdorf, A-S, Cichon, B, Rytter, MJH, Kurpad, A, Wells, JC, Ritz, C, Ashorn, P, Filteau, S, Briend, A, Shepherd, S, Christensen, VB, Michaelsen, KF & Friis, H 2017, 'Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso', P L o S Medicine (Online), vol. 14, no. 9, e1002387. https://doi.org/10.1371/journal.pmed.1002387

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title = "Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso",

abstract = "Background: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Methods and findings: Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p < 0.01) comprising 93.5% (95% CI 89.5, 97.3) FFM. As compared to children who received CSB, FFMI accretion was increased by 0.083 kg/m2(95% CI 0.003, 0.163; p = 0.042) in those who received LNS. In contrast, SI did not increase FFMI compared to DS (mean difference 0.038 kg/m2; 95% CI −0.041, 0.118; p = 0.35), irrespective of matrix. Having 20% milk protein was associated with 0.097 kg/m2(95% CI −0.002, 0.196) greater FFMI accretion than having 0% milk protein, although this difference was not significant (p = 0.055), and there was no effect of 50% milk protein (0.049 kg/m2; 95% CI −0.047, 0.146; p = 0.32). There was no effect modification by season, admission criteria, or baseline FFMI, stunting, inflammation, or breastfeeding (p > 0.05). LNS compared to CSB resulted in 128 g (95% CI 67, 190; p < 0.01) greater weight gain if both contained SI, but there was no difference between LNS and CSB if both contained DS (mean difference 22 g; 95% CI −40, 84; p = 0.49) (interaction p = 0.017). Accordingly, SI compared to DS increased weight by 89 g (95% CI 27, 150; p = 0.005) when combined with LNS, but not when combined with CSB. A limitation of this and other food supplementation trials is that it is not possible to collect reliable data on individual adherence. Conclusions: Based on this study, children with MAM mainly gain fat-free tissue when rehabilitated. Nevertheless, LNS yields more fat-free tissue and higher recovery rates than CSB. Moreover, current LNSs with DS may be improved by shifting to SI. The role of milk relative to soy merits further research.",

keywords = "Adipose Tissue, Burkina Faso, Dietary Supplements, Female, Humans, Infant, Infant Nutrition Disorders, Infant Nutritional Physiological Phenomena, Male, Micronutrients, Soybeans, Weight Gain, Zea mays, Journal Article, Randomized Controlled Trial",

author = "Christian Fabiansen and Yam{\'e}ogo, {Charles W} and Ann-Sophie Iuel-Brockdorf and Bernardette Cichon and Rytter, {Maren Johanne Heilskov} and Anura Kurpad and Wells, {Jonathan C} and Christian Ritz and Per Ashorn and Suzanne Filteau and Andr{\'e} Briend and Susan Shepherd and Christensen, {Vibeke Bak} and Michaelsen, {Kim F.} and Henrik Friis",

note = "CURIS 2017 NEXS 243",

year = "2017",

month = sep,

doi = "10.1371/journal.pmed.1002387",

language = "English",

volume = "14",

journal = "P L o S Medicine (Online)",

issn = "1549-1277",

publisher = "Public Library of Science",

number = "9",

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TY - JOUR

T1 - Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition

T2 - A randomised 2 × 2 × 3 factorial trial in Burkina Faso

AU - Fabiansen, Christian

AU - Yaméogo, Charles W

AU - Iuel-Brockdorf, Ann-Sophie

AU - Cichon, Bernardette

AU - Rytter, Maren Johanne Heilskov

AU - Kurpad, Anura

AU - Wells, Jonathan C

AU - Ritz, Christian

AU - Ashorn, Per

AU - Filteau, Suzanne

AU - Briend, André

AU - Shepherd, Susan

AU - Christensen, Vibeke Bak

AU - Michaelsen, Kim F.

AU - Friis, Henrik

N1 - CURIS 2017 NEXS 243

PY - 2017/9

Y1 - 2017/9

N2 - Background: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Methods and findings: Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p < 0.01) comprising 93.5% (95% CI 89.5, 97.3) FFM. As compared to children who received CSB, FFMI accretion was increased by 0.083 kg/m2(95% CI 0.003, 0.163; p = 0.042) in those who received LNS. In contrast, SI did not increase FFMI compared to DS (mean difference 0.038 kg/m2; 95% CI −0.041, 0.118; p = 0.35), irrespective of matrix. Having 20% milk protein was associated with 0.097 kg/m2(95% CI −0.002, 0.196) greater FFMI accretion than having 0% milk protein, although this difference was not significant (p = 0.055), and there was no effect of 50% milk protein (0.049 kg/m2; 95% CI −0.047, 0.146; p = 0.32). There was no effect modification by season, admission criteria, or baseline FFMI, stunting, inflammation, or breastfeeding (p > 0.05). LNS compared to CSB resulted in 128 g (95% CI 67, 190; p < 0.01) greater weight gain if both contained SI, but there was no difference between LNS and CSB if both contained DS (mean difference 22 g; 95% CI −40, 84; p = 0.49) (interaction p = 0.017). Accordingly, SI compared to DS increased weight by 89 g (95% CI 27, 150; p = 0.005) when combined with LNS, but not when combined with CSB. A limitation of this and other food supplementation trials is that it is not possible to collect reliable data on individual adherence. Conclusions: Based on this study, children with MAM mainly gain fat-free tissue when rehabilitated. Nevertheless, LNS yields more fat-free tissue and higher recovery rates than CSB. Moreover, current LNSs with DS may be improved by shifting to SI. The role of milk relative to soy merits further research.

AB - Background: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Methods and findings: Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p < 0.01) comprising 93.5% (95% CI 89.5, 97.3) FFM. As compared to children who received CSB, FFMI accretion was increased by 0.083 kg/m2(95% CI 0.003, 0.163; p = 0.042) in those who received LNS. In contrast, SI did not increase FFMI compared to DS (mean difference 0.038 kg/m2; 95% CI −0.041, 0.118; p = 0.35), irrespective of matrix. Having 20% milk protein was associated with 0.097 kg/m2(95% CI −0.002, 0.196) greater FFMI accretion than having 0% milk protein, although this difference was not significant (p = 0.055), and there was no effect of 50% milk protein (0.049 kg/m2; 95% CI −0.047, 0.146; p = 0.32). There was no effect modification by season, admission criteria, or baseline FFMI, stunting, inflammation, or breastfeeding (p > 0.05). LNS compared to CSB resulted in 128 g (95% CI 67, 190; p < 0.01) greater weight gain if both contained SI, but there was no difference between LNS and CSB if both contained DS (mean difference 22 g; 95% CI −40, 84; p = 0.49) (interaction p = 0.017). Accordingly, SI compared to DS increased weight by 89 g (95% CI 27, 150; p = 0.005) when combined with LNS, but not when combined with CSB. A limitation of this and other food supplementation trials is that it is not possible to collect reliable data on individual adherence. Conclusions: Based on this study, children with MAM mainly gain fat-free tissue when rehabilitated. Nevertheless, LNS yields more fat-free tissue and higher recovery rates than CSB. Moreover, current LNSs with DS may be improved by shifting to SI. The role of milk relative to soy merits further research.

KW - Adipose Tissue

KW - Burkina Faso

KW - Dietary Supplements

KW - Female

KW - Humans

KW - Infant

KW - Infant Nutrition Disorders

KW - Infant Nutritional Physiological Phenomena

KW - Male

KW - Micronutrients

KW - Soybeans

KW - Weight Gain

KW - Zea mays

KW - Journal Article

KW - Randomized Controlled Trial

U2 - 10.1371/journal.pmed.1002387

DO - 10.1371/journal.pmed.1002387

M3 - Journal article

C2 - 28892496

SN - 1549-1277

VL - 14

JO - P L o S Medicine (Online)

JF - P L o S Medicine (Online)

IS - 9

M1 - e1002387

ER -

Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso

Abstract

Keywords

UN SDGs

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