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Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial

Kuusipalo, Heli*; Maleta, Kenneth†; Briend, André‡; Manary, Mark§; Ashorn, Per*∥

Journal of Pediatric Gastroenterology & Nutrition: October 2006 - Volume 43 - Issue 4 - pp 525-532
doi: 10.1097/01.mpg.0000235981.26700.d3
Original Articles: Hepatology & Nutrition

Objective: Fortified spreads (FSs) have proven effective in the rehabilitation of severely malnourished children. We examined acceptability, growth and change in blood haemoglobin (Hb) concentration among moderately underweight ambulatory infants given FS.

Methods: This was a randomised, controlled, parallel-group, investigator-blind clinical trial in rural Malawi. Six- to 17-month-old underweight infants (weight for age <−2), whose weight was greater than 5.5 kg and weight-for-height z score greater than −3 received for 12 weeks at home 1 of 8 food supplementation schemes: nothing, 5, 25, 50, or 75 g/day milk-based FS or 25, 50, or 75 g/day soy-based FS. Outcome measures included change in weight, length and blood Hb concentration.

Results: A total of 126 infants started and 125 completed the intervention. All infants accepted the spread well, and no intolerance was recorded. Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS. Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS. All average gains were largest among infants receiving 50 g of FS daily: mean difference (95% confidence interval) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g (range, −130 to 700 g), 0.9 cm (range, −0.3 to 2.2 cm), and 17 g/L (range, 0 to 34 g/L) for weight, length and blood Hb concentration, respectively. In soy- vs milk-based FS groups, average outcomes were comparable.

Conclusions: Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants. Further trials should test this hypothesis.

*Department of International Health, University of Tampere Medical School, Tampere, Finland; †College of Medicine, University of Malawi, Blantyre, Malawi; ‡IRD, Département Sociétés et Santé, Paris, France; §Washington University School of Medicine, St. Louis, MO; and ∥Department of Paediatrics, Tampere University Hospital, Tampere, Finland

Received December 29, 2005; accepted June 23, 2006.

Address correspondence and reprint requests to Ms. Heli Kuusipalo, Department of International Health, University of Tampere Medical School, Finn-Medi 3 Building, FIN-33014 University of Tampere, Tampere, Finland (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.