Micronutrient Fortification to Improve Growth and Health of Maternally HIV-Unexposed and Exposed Zambian Infants: A Randomised Controlled Trial


Filteau, S; Kasonka, L; Gibson, R; Gompels, UA; Jaffar, S; Kafwembe, E; Monze, M; Sinkala, M; Tomkins, A; Zulu, R; Chisenga, M; Siame, J; Mabuda, HB; Baisley, K; Dale, H; Rehman, A; Bates, M; Mullen, A; Bwalya, HK; Chileshe, M; Kowa, PK; Kumwenda, M; Likando, M; Mambwe, S; Muzyamba, M; Mwale, A; Nyaywa, L; Kapambwe, M; Bima, H; Gosset, L; Hackett, L; Jackson, A; Njunju, E; Mwanza, S; Shampwaya, N; Kabanga, C; Chobo, J; Kapumba, W; Musonda, C; Soko, P; ( Chilenje Infant Growth, Nutrition and Infection (CIGNIS) Study, ; ), ; (2010) Micronutrient Fortification to Improve Growth and Health of Maternally HIV-Unexposed and Exposed Zambian Infants: A Randomised Controlled Trial. PLoS One, 5 (6). e11165. ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0011165

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Abstract

BACKGROUND: The period of complementary feeding, starting around 6 months of age, is a time of high risk for growth faltering and morbidity. Low micronutrient density of locally available foods is a common problem in low income countries. Children of HIV-infected women are especially vulnerable. Although antiretroviral prophylaxis can reduce breast milk HIV transmission in early infancy, there are no clear feeding guidelines for after 6 months. There is a need for acceptable, feasible, affordable, sustainable and safe (AFASS by WHO terminology) foods for both HIV-exposed and unexposed children after 6 months of age.<br/> METHODS AND FINDINGS: We conducted in Lusaka, Zambia, a randomised double-blind trial of two locally made infant foods: porridges made of flour composed of maize, beans, bambaranuts and groundnuts. One flour contained a basal and the other a rich level of micronutrient fortification. Infants (n = 743) aged 6 months were randomised to receive either regime for 12 months. The primary outcome was stunting (length-for-age Z<-2) at age 18 months. No significant differences were seen between trial arms overall in proportion stunted at 18 months (adjusted odds ratio 0.87; 95% CI 0.50, 1.53; P = 0.63), mean length-for-age Z score, or rate of hospital referral or death. Among children of HIV-infected mothers who breastfed <6 months (53% of HIV-infected mothers), the richly-fortified porridge increased length-for-age and reduced stunting (adjusted odds ratio 0.17; 95% CI 0.04, 0.84; P = 0.03). Rich fortification improved iron status at 18 months as measured by hemoglobin, ferritin and serum transferrin receptors.<br/> CONCLUSIONS: In the whole study population, the rich micronutrient fortification did not reduce stunting or hospital referral but did improve iron status and reduce anemia. Importantly, in the infants of HIV-infected mothers who stopped breastfeeding before 6 months, the rich fortification improved linear growth. Provision of such fortified foods may benefit health of these high risk infants.<br/> TRIAL REGISTRATION: Controlled-Trials.com ISRCTN37460449.<br/>

Item Type: Article
Keywords: COMPLEMENTARY FOODS, CHILDREN, MALARIA, IMPACT, ACID, BORN, COMPLEMENTARY FOODSCHILDRENMALARIAIMPACTACIDBORN
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Pathogen Molecular Biology
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Tropical Epidemiology Group
PubMed ID: 20567511
Web of Science ID: 278886300011
URI: http://researchonline.lshtm.ac.uk/id/eprint/3363

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