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-4, LCNI-6 and LCNI-7 (trial registration numbers NCT00131222, NCT00420368, 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.
- Lehto KM, Fan YM, Oikarinen S, Nurminen N, Hallamaa L, Juuti R, Mangani C, Maleta K, Hyöty H, Ashorn P. Presence of Giardia lamblia in stools of six to 18 month old asymptomatic Malawians is associated with children’s growth failure. Acta Paediatr. 2019 Apr 30. doi: 10.1111/apa.14832. [Epub ahead of print]
- Fan YM, Oikarinen S, Lehto KM, Nurminen N, Juuti R, Mangani C, Maleta K, Hyöty H, Ashorn P. High prevalence of selected viruses and parasites and their predictors in Malawian children. Epidemiology and Infection. 2019, 147, e90, 1–9. doi: 10.1017/S0950268819000025
- Aakko J, Grzeskowiak L, Asukas T, Päivänsäde E, Lehto KM, Fan YM, Mangani C, Maleta K, Ashorn P, Salminen S. Lipid-based nutrient supplements do not affect gut Bifidobacterium microbiota in Malawian infants: a randomised trial. J Pediatr Gastroenterol Nutr. 2017 Apr;64(4):610-615. doi: 10.1097/MPG.0000000000001333.
- Cheung YB, Xu Y, Mangani C, Fan YM, Dewey K, Salminen SJ, Maleta K, Ashorn P. Gut microbiota in Malawian infants in a nutritional supplementation trial. Trop Med Int Health. 2016 Feb;21(2):283-90. doi: 10.1111/tmi.12650. Epub 2015 Dec 21.
- Aakko J, Endo A, Mangani C, Maleta K, Ashorn P, Isolauri E, Salminen S. Distinctive intestinal Lactobacillus communities in six-month-old infants from rural Malawi and South-western Finland. J Pediatr Gastroenterol Nutr. 2015 Dec;61(6):641-8. doi: 10.1097/MPG.0000000000000878.
- Nurminen N, Juuti R, Oikarinen S, Fan Y, Lehto KM, Mangani C, Maleta K, Ashorn P, Hyöty H. High-Throughput Multiplex Quantitative Polymerase Chain Reaction Method for Giardia lamblia and Cryptosporidium Species Detection in Stool Samples. Am J Trop Med Hyg. 2015 Jun;92(6):1222-6. doi: 10.4269/ajtmh.15-0054. Epub 2015 Apr 27.
- Yakes Jimenez E, Mangani C, Ashorn P, Harris WS, Maleta K, Dewey KG. Breast milk from women living near Lake Malawi is high in docosahexaenoic acid and arachidonic acid. Prostaglandins Leukot Essent Fatty Acids. 2015 Apr;95:71-8. doi: 10.1016/j.plefa.2014.12.002. Epub 2014 Dec 12.
- Kau AL, Planer JD, Liu J, Rao S, Yatsunenko T, Trehan I, Manary MJ, Liu TC, Stappenbeck TS, Maleta KM, Ashorn P, Dewey KG, Houpt ER, Hsieh CS, Gordon JI. Functional characterization of IgA-targeted bacterial taxa from undernourished Malawian children that produce diet-dependent enteropathy. Sci Transl Med 25 February 2015: Vol. 7, Issue 276, p. 276ra24. doi: 10.1126/scitranslmed.aaa4877
- Mangani C, Ashorn P, Maleta K, Phuka J, Thakwalakwa C, Dewey K, Manary M, Puumalainen T, Cheung YB. Lipid-based nutrient supplements do not affect the risk of malaria or respiratory morbidity in 6- to 18-month-old malawian children in a randomized controlled trial. J Nutr. 2014 Nov;144(11):1835-42. doi: 10.3945/jn.114.196139.
- Ashorn P, Ashorn U, Cheung YB. The conclusion on the impact of lipid-based nutrient supplements on child growth in Haiti may be too optimistic. Am J Clin Nutr. 2014 May 20;99(6):1522-1523.
- Rodríguez-Díaz J, Mira-Pascual L, Collado MC, Endo A, Hyöty H, Mangani C, Maleta K, Ashorn P, Salminen S. Presence of human enteric viruses in the stools of healthy Malawian 6-month-old infants. J Pediatr Gastroenterol Nutr. 2014 Apr;58(4):502-4.
- Thakwalakwa CM, Ashorn P, Phuja JC, Cheung YB, Briend A, Maleta KM. Impact of lipid-based nutrient supplements and corn-soy blend on energy and nutrient intake among moderately underweight 8-18-month-old children participating in a clinical trial. Matern Child Nutr. 2014 Feb 17.
- Mangani C, Cheung YB, Maleta K, Phuka J, Thakwalakwa C, Dewey K, Manary M, Puumalainen T, Ashorn P. Providing lipid-based nutrient supplements does not affect developmental milestones among Malawian children. Acta Paediatr. 2014 Jan;103(1):e17-26.
- Flax VL, Mäkinen S, Ashorn U, Cheung YB, Maleta K, Ashorn P, Bentley ME. Responsive feeding and child interest in food vary when rural Malawian children are fed lipid-based nutrient supplements or local complementary food. Matern Child Nutr. 2013 Jul;9(3):369-80. doi: 10.1111/j.1740-8709.2011.00377.x. Epub 2011 Nov 24.
- Mangani C, Maleta K, Phuka J, Cheung YB, Thakwalakwa C, Dewey K, Manary M, Puumalainen T, Ashorn P. Effect of complementary feeding with lipid-based nutrient supplements and corn-soy blend on the incidence of stunting and linear growth among 6- to 18-month-old infants and children in rural Malawi. Matern Child Nutr. 2013 Jun 25.
- Thakwalakwa CM, Ashorn P, Jawati M, Phuka JC, Cheung YB, Maleta KM. An effectiveness trial showed lipid-based nutrient supplementation but not corn-soya blend offered a modest benefit in weight gain among 6- to 18-month-old underweight children in rural Malawi. Public Health Nutr. 2012 Sep;15(9):1755-62.
- Thakwalakwa CM, Kuusipalo HM, Maleta KM, Phuka JC, Ashorn P, Cheung YB. The validity of a structured interactive 24-hour recall in estimating energy and nutrient intakes in 15-month-old rural Malawian children.Matern Child Nutr. 2012 Jul;8(3):380-9.
- Grześkowiak Ł, Collado MC, Mangani C, Maleta K, Laitinen K, Ashorn P, Isolauri E, Salminen S. Distinct gutmicrobiota in southeastern African and northern European infants. J Pediatr Gastroenterol Nutr. 2012 Jun;54(6):812-6.
- Phuka JC, Gladstone M, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour. Matern Child Nutr. 2012 Apr;8(2):239-48.
- Phuka J, Ashorn U, Ashorn P, Zeilani M, Cheung YB, Dewey KG, Manary M, Maleta K. Acceptability of three novel lipid-based nutrient supplements among Malawian infants and their caregivers. Matern Child Nutr. 2011 Oct;7(4):368-77.
- Thakwalakwa C, Ashorn P, Phuka J, Cheung YB, Briend A, Puumalainen T, Maleta K. A lipid-based nutrientsupplement but not corn-soy blend modestly increases weight gain among 6- to 18-month-old moderately underweight children in rural Malawi. J Nutr. 2010 Nov;140(11):2008-13.
- Flax VL, Phuka J, Cheung YB, Ashorn U, Maleta K, Ashorn P. Feeding patterns and behaviors during home supplementation of underweight Malawian children with lipid-based nutrient supplements or corn-soy blend. Appetite. 2010 Jun;54(3):504-11.
- Flax VL, Thakwalakwa C, Phuka J, Ashorn U, Cheung YB, Maleta K, Ashorn P. Malawian mothers’ attitudes towards the use of two supplementary foods for moderately malnourished children. Appetite. 2009 Oct;53(2):195-202.
- Thakwalakwa C, Phuka J, Flax V, Maleta K, Ashorn P. Prevention and treatment of childhood malnutrition in rural Malawi: Lungwena nutrition studies. Malawi Med J. 2009 Sep;21(3):116-9.
- Phuka J, Thakwalakwa C, Maleta K, Cheung YB, Briend A, Manary M, Ashorn P. Supplementary feeding with fortified spread among moderately underweight 6-18-month-old rural Malawian children. Matern Child Nutr. 2009 Apr;5(2):159-70.
- Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. Am J Clin Nutr. 2009 Jan;89(1):382-90.
- Flax VL, Maleta K, Ashorn U, Manary MJ, Briend A, Ashorn P. Intake of lipid-based nutrient supplements during illness and convalescence among moderately-underweight Malawian children. J Health Popul Nutr. 2008 Dec;26(4):468-70.
- Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Arch Pediatr Adolesc Med. 2008 Jul;162(7):619-26.
- Lin CA, Manary MJ, Maleta K, Briend A, Ashorn P. An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6-18 months.J Nutr. 2008 Mar;138(3):593-8.
- Flax VL, Ashorn U, Phuka J, Maleta K, Manary MJ, Ashorn P. Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home. Matern Child Nutr. 2008 Jan;4(1):65-73.
- Galpin L, Thakwalakwa C, Phuka J, Ashorn P, Maleta K, Wong WW, Manary MJ. Breast milk intake is not reduced more by the introduction of energy dense complementary food than by typical infant porridge. J Nutr. 2007 Jul;137(7):1828-33.
- Kuusipalo H, Maleta K, Briend A, Manary M, Ashorn P. Growth and change in blood haemoglobin concentration among underweight Malawian infants receiving fortified spreads for 12 weeks: a preliminary trial. J Pediatr Gastroenterol Nutr. 2006 Oct;43(4):525-32.
- Maleta K, Kuittinen J, Duggan MB, Briend A, Manary M, Wales J, Kulmala T, Ashorn P. Supplementary feeding of underweight, stunted Malawian children with a ready-to-use food. J Pediatr Gastroenterol Nutr. 2004 Feb;38(2):152-8.