LCNI - Lungwena Child Nutrition Intervention Study

Lipid-based nutrient supplements (LNS) are products that provide energy, protein, essential fatty acids and multiple micronutrients in a form that has a long shelf life, is palatable and easy to consume. Large-quantity (~200-300 g/day) LNS, usually designated as ready-to-use therapeutic foods, have proven effective and now form the core of community—based treatment of children with severe acute malnutrition. This success, coupled with other information on LNS properties including acceptability and rather low price, has raised a wide interest to test the applicability of smaller-dose versions (~10-50 g/day) in the promotion of healthy growth. We have tested the growth promoting effects of LNS in a number of controlled trials, designated Lungwena Child Nutrition Interventions (LCNIs). Many of the trials have also included add-on exploratory studies on the various aspects of dietary supplement use in a rural Malawian community.

LCNI-1 (unregistered) was a two arm trial, in which 4-year old stunted and underweight children were provided with either LNS or micronutrient fortified corn-soy flour for 12-weeks. Main outcome variables included weight gain, length gain, energy and nutrient intakes. The study indicated that LNS was safe and resulted in increased nutrient intakes among the beneficiaries.

LCNI-2 (unregistered) was a 6-arm dose finding trial, in which 6-15-month old underweight children were provided with various doses of LNS for 12-weeks. Main outcome variables included weight and length gain. The main conclusion was that LNS was safe also among the younger, underweight infants and that its provision might result in increased weight and length gain among underweight infants.

LCNI-4LCNI-6 and LCNI-7 (trial registration numbers NCT00131222NCT00420368, NCT00420758) were larger trials that tested the growth promoting effects of 12-week LNS provision to underweight infants and young children either in more controlled or in less controlled conditions. The results suggest that in this target group (that excludes most of the wasted children) LNS supplementation results in modest weight gains that may, however, have limited clinical significance.

LCNI-3 and LCNI-5 (trial registration numbers NCT00131209 and NCT00524446) are prevention trials that tested the growth promoting effects of a 12-month LNS provision to healthy 6-18 month old infants and young children. The results obtained so far suggest that LNS provision, at a daily dose of 25-50 g, promotes linear growth and results in reduced incidence of severe stunting during infancy or early childhood. In LCNI-3, the apparent effect was sustained over the 2-year post-intervention follow-up, in LCNI-5 we are currently doing that follow-up. No effect on motor development was noted in either trial.

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