Stunting affects 27% of Senegal’s population (1). It is known that stunting caused by inadequate complementary feeding leads to many problems later in life, including poor cognitive performance, higher risk of infection and low offspring birth-weight (2, 3).
Lipid based nutrient supplements (LNS) are widely used to treat severe acute malnutrition and have recently been involved in trials that suggests they also improve linear growth(3-5). The supplements are calorie dense, so only a small amount needs to be consumed at a time by the infant to provide energy for growth. The pastes can be produced, stored and transported easily and can also be fortified with micronutrients such as fat-soluble vitamins (3, 6, 7).
Micronutrient supplements have also been shown to increase growth in infants, as shown by Rivera et al who found that “micronutrient deficiencies limited the growth of Mexican infants” (8). Phuka et al. also concluded that micronutrients consumed within a 50mg LNS base had a positive effect on growth and sustained reduction on stunting (3, 9).
The main micronutrients looked at in this study are Iron (to reduce iron deficiency anaemia) and Zinc, which has been found to have some influences over linear growth in infants (10, 11). Iron supplementation has been found to cause diarrhea and respiratory disease in infants (12) and zinc supplementation can help to reduce these side effects (13). In addition, vitamin A, a fat-soluble vitamin that many children worldwide are also deficient in (14), can work synergistically with zinc (15)and also helps to prevent diarrhea (16).
Unlike similar micronutrient studies in Ghana and Mexico, this trial looks at the effect of micronutrients on infant growth when combined with an LNS paste(7, 8).
This study focuses on LNS supplementation for children during the critical growth period of 6-24 months (17) (8). The study aims to replicate the findings of trials such as that in Haiti where enriched LNS supplementation enhanced linear growth (5). The primary outcome is infant length after supplementation with micronutrient enriched LNS compared to LNS without micronutrients. Secondary outcomes were haemoglobin concentration, markers of iron status, plasma zinc and child morbidity defined as episodes of diarrhoea and fever during the intervention.
Methods and Materials:
The study was carried out in the rural Niakhar region of Senegal from January 2010 to June 2012. This is a predominantly subsistence farming region, where a combination of in utero growth faltering, poor quality weaning foods and frequent infectious episodes cause moderately severe growth faltering in almost all children. Using data provided from an ongoing Health and Demographic Surveillance System (HDSS) for the region, all infants aged six months or under were invited to participate. Enrolled infants were randomised in blocks of four at the point they reached six months of age. Supplementation ended at 18 months of age, when...