Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso

Bernardette Cichon; Christian Fabiansen; Ann-Sophie Julie D Iuel-Brockdorf; Charles W Yaméogo; Christian Ritz; Vibeke B Christensen; Suzanne Filteau; André Briend; Kim F. Michaelsen; Henrik Friis

doi:10.1093/ajcn/nqx050

Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso

Bernardette Cichon, Christian Fabiansen, Ann-Sophie Julie D Iuel-Brockdorf, Charles W Yaméogo, Christian Ritz, Vibeke B Christensen, Suzanne Filteau, André Briend, Kim F. Michaelsen, Henrik Friis

Lifecourse Nutrition & Health

9 Citations (Scopus)

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 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 α ₁ -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.

Original language	English
Journal	American Journal of Clinical Nutrition
Volume	107
Issue number	2
Pages (from-to)	278-286
Number of pages	9
ISSN	0002-9165
DOIs	https://doi.org/10.1093/ajcn/nqx050
Publication status	Published - Feb 2018

Keywords

Faculty of Science
Acute-phase proteins
Africa
Anemia
Corn-soy blends
Young children
Inflammation
Lipid-based nutrient supplements
Malaria
Moderate acute malnutrition

UN SDGs

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

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Cite this

Cichon, B., Fabiansen, C., Iuel-Brockdorf, A.-S. J. D., Yaméogo, C. W., Ritz, C., Christensen, V. B., Filteau, S., Briend, A., Michaelsen, K. F., & Friis, H. (2018). Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso. American Journal of Clinical Nutrition, 107(2), 278-286. https://doi.org/10.1093/ajcn/nqx050

Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso. / Cichon, Bernardette; Fabiansen, Christian; Iuel-Brockdorf, Ann-Sophie Julie D et al.
In: American Journal of Clinical Nutrition, Vol. 107, No. 2, 02.2018, p. 278-286.

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

Cichon, B, Fabiansen, C, Iuel-Brockdorf, A-SJD, Yaméogo, CW, Ritz, C, Christensen, VB, Filteau, S, Briend, A, Michaelsen, KF & Friis, H 2018, 'Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso', American Journal of Clinical Nutrition, vol. 107, no. 2, pp. 278-286. https://doi.org/10.1093/ajcn/nqx050

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title = "Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso",

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 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 α 1 -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. ",

keywords = "Faculty of Science, Acute-phase proteins, Africa, Anemia, Corn-soy blends, Young children, Inflammation, Lipid-based nutrient supplements, Malaria, Moderate acute malnutrition",

author = "Bernardette Cichon and Christian Fabiansen and Iuel-Brockdorf, {Ann-Sophie Julie D} and Yam{\'e}ogo, {Charles W} and Christian Ritz and Christensen, {Vibeke B} and Suzanne Filteau and Andr{\'e} Briend and Michaelsen, {Kim F.} and Henrik Friis",

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volume = "107",

pages = "278--286",

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TY - JOUR

T1 - Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition

T2 - a 2 × 2 × 3 factorial randomized trial in Burkina Faso

AU - Cichon, Bernardette

AU - Fabiansen, Christian

AU - Iuel-Brockdorf, Ann-Sophie Julie D

AU - Yaméogo, Charles W

AU - Ritz, Christian

AU - Christensen, Vibeke B

AU - Filteau, Suzanne

AU - Briend, André

AU - Michaelsen, Kim F.

AU - Friis, Henrik

N1 - CURIS 2018 NEXS 096

PY - 2018/2

Y1 - 2018/2

N2 - 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 α 1 -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.

AB - 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 α 1 -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.

KW - Faculty of Science

KW - Acute-phase proteins

KW - Africa

KW - Anemia

KW - Corn-soy blends

KW - Young children

KW - Inflammation

KW - Lipid-based nutrient supplements

KW - Malaria

KW - Moderate acute malnutrition

U2 - 10.1093/ajcn/nqx050

DO - 10.1093/ajcn/nqx050

M3 - Journal article

C2 - 29529160

SN - 0002-9165

VL - 107

SP - 278

EP - 286

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 2

ER -