evidence-based blog of Filippo Dibari

Posts Tagged ‘complementary feeding’

WFP: nutrient gap explained in 3 min youtube (fun-to-watch) video

In Over-nutrition, Under-nutrition on February 4, 2016 at 10:18 am


GAIN – x2 new working papers detailing lessons learned from six year Infant and Young Child Nutrition (IYCN) program

In Under-nutrition on April 15, 2015 at 12:44 pm

from GAIN website.


GAIN has recently published two new working papers detailing lessons learned from six year Infant and Young Child Nutrition (IYCN) program.

The papers were launched at our one day #Nutrition Now: 1,000 Days Symposium in London.

The two papers outline in detail challenges met and strategies used across 23 projects in 17 countries in Asia, Africa and Latin America. The projects are an innovative mix of public and private models and combine proven infant interventions, such as the promotion of breast feeding, with novel market-based strategies.

The papers each focus on a different element of GAINs approach:
Paper 1 examines lessons learned regarding effective public and private sector business models for production and delivery of complementary feeding products and fortified foods
Paper 2 analyses what we’ve learned about driving consumer awareness and behaviour change to ensure good feeding practices and uptake of complementary feeding products

Download the full reports:

Working Paper 1: Improving complementary feeding: Assessing public and private sector business models_

Working Paper 2: Promoting optimal infant feeding practices and effective use of complementary food for infants: Delivery lessons

Watch our videos:

GAIN in Indonesia: Improving nutrition and changing behaviours in the first 1,000 days  

Improving nutrition for infants and children

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Effect of Supplementation with a Lipid-Based Nutrient Supplement on the Micronutrient Status of Children Aged 6-18 Months Living in the Rural Region of Intibucá, Honduras.

In Under-nutrition on March 26, 2014 at 4:35 pm

Siega-Riz AM1, Estrada Del Campo Y, Kinlaw A, Reinhart GA, Allen LH, Shahab-Ferdows S, Heck J, Suchindran CM, Bentley ME.

Paediatr Perinat Epidemiol. 2014 Mar 13





Lipid-based nutrient supplements (LNS) have been effective in the treatment of acute malnutrition among children. We evaluated the use of LNS supplementation for improving the micronutrient status of young children.


A 12-month randomised controlled trial was conducted among children aged 6-18 months living in Intibucá, Honduras. Communities (n = 18) were randomised into clusters matched by poverty indicators (9 intervention, n = 160 and 9 controls, n = 140). Intervention participants received LNS. All children received food vouchers and nutrition education. Primary outcomes included measures of micronutrient status: at baseline, 6 and 12 months’ blood were collected for assessment of folate, iron, zinc, riboflavin, and vitamin B12 status; haemoglobin was measured every 3 months; and dietary and anthropometry collected monthly. Longitudinal analyses were based on intent to treat and LNS adherence. Generalised estimating equations were used in the estimation of generalised linear regression models specified for the data.


At 6-month follow-up, children in the intervention group had a lower proportion classified as deficient for B12 (43.6%) compared with the control (67.7%; P = 0.03). The intervention group had a higher mean concentration for folate at 6 months (P = 0.06), and improvements continued through 12 months for folate (P = 0.002) and vitamin A deficiency (P = 0.03). This pattern of results, with improved significance, remained in subanalysis based on LNS adherence.


These data demonstrate that LNS improved select micronutrient status in young non-malnourished Honduran children.

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Systematic Review of Complementary Feeding Strategies amongst Children Less than Two Years of Age

In Under-nutrition on March 26, 2014 at 3:24 pm

by Zohra S. Lassi, Guleshehwar Zahid, Jai K. Das, Zulfiqar A. Bhutta

UKAID – 2013 (download)

Extract from Executive Summary

The prevalence of malnutrition in low- and middle-income countries (LMICs) is considerably high. Malnutrition leads to susceptibility to preventable infectious diseases and has an indirect association with the leading causes of death in children. According to an estimate, 19.4% of children less than five years of age in these countries wereunderweight (weight-for-age [WAZ] Z score <-2) and about 29.9% werestunted in the year 2011 (height-for-age [HAZ] Z score <-2). Malnutrition is preventable through effective complementary feeding practices. Several strategies have been employed to improve complementary feeding practices. These include nutritional education to mothers designed to promote healthy feeding practices; provision of complementary food offering extra energy (with or without micronutrient fortification); and increasing energy density of complementary foods through simple technology.

In this review, we have included randomised controlled trials (RCTs)and non-RCTsthat assessed the impact of complementary feedingand education on complementary feeding on linear growth, weight gain, iron status, and morbidity. Broadly, interventions were classified as education on complementary feedingand complementary feedingwith or without nutrition education. We have also mentioned the costs of the interventions given in the included studies and other complementary foods available globally.

All available papers/reports on the effect of complementary feeding(fortified or unfortified, but not micronutrients alone) and education on complementary feeding on children less than twoyears of age in Low and middle income countries (LMIC) were included. Studies that delivered intervention and assessed outcome for at least sixmonths were included. We excluded all those studies in which intervention was given for supplementary and therapeutic purposes and those that assessed the impact of micronutrients alone.

We included 11 randomised controlled trials (RCTs) and 7 non-RCTs. We conducted meta-analysis on RCTs. Amongst all RCTs, eight were on nutritionaleducation only.We found significant impact of nutritional education on linear growth (height-for-age Z scores: SMD 0.22; 95% Confidence Interval [CI]: 0.08, 0.37, n=1,486, 4 studies; stunting: risk ratio (RR) 0.72; 95% CI: 0.57, 0.93, n=1445, 2 studies)and weight (weight-for-age [WAZ]Z scores: SMD 0.20; 95%CI: 0.07, 0.33, n=1673, 4 studies). On the other hand, we found fourtrials in which children were provided with complementary feeding with orwithout nutrition education. We found that complementary feeding with or without education had a non-significant impact on HAZ scores (SMD 0.46; 95% CI: -0.24, 1.17, 4 studies, n=500), and WAZ(SMD 0.15; 95% CI: -0.09, 0.40, 2 studies, n=262).We also performed a meta-analysis based on the type of food, but we are unable to conclude which types of foods are the most effective in preventing undernutrition because the numbers of studies in each subtype were few.

We found that these interventions had a significant impact on reducing the prevalence of respiratory illness (RR 0.68; 95% CI: 0.48, 0.97, 2 studies, n=629). However, there was no difference in fever and diarrhoea episodes.

We also attempted to gather data on cost of the interventions, food products, and complementary feeding strategies used in the included studies. Most papers did not mention estimates of cost and thus, we contacted the authors with the request to provide us with cost data. We have also included cost estimates of various complementary foods that were not used in any of the interventions included in this review but can potentially have an impact in reducing undernutrition. The cost of different baby food products, including cereals, porridge, and biscuits produced by different manufacturers were identified via web search.

The scarcity of available studies and their heterogeneity as well as the variety in complementary feeding interventions make it difficult to determineone particular type of complementary feeding intervention as the most effective. Nonetheless, the results of this review indicate that effectively implemented provision of complementary feedingand education on complementary feedinghave a potential to prevent undernutrition in children. Our review also found that nutritional education and complementary feeding (either individually or combined) both have the potential to reduce morbidity from respiratory infections. However, further high-quality studies need to be conducted which report consistent outcome measures and similar interventions in order to accurately map out which interventions, if scaled up, can be effective.Moreover, these trials should consider using standardised types of food inthe intervention so that evidence can be formulated on which type of food is most effective. It is ideal to keep the duration of intervention for at least six months since anthropometric improvements are gradual. Trials should report consistent outcomes and also include morbidity outcomes. Despite clear evidence of the disastrous consequences of childhood nutritional deprivation in the short and long terms, nutritional health remains a low priority. Therefore, enhanced and rigorous actions are needed to deliver and scale up nutritional education and complementary feeding interventions.

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Food allowance optmization model

In Under-nutrition on February 5, 2014 at 12:11 pm

by Viesturs Rozenbergs, Imants Skrupskis, Dace Skrupska, Ērika Rozenberga




Possibility of food allowance optimization by using MS Solver tool is analysed in the research. The model is developed by balancing 22 food products and 30 constraints – 8 nutrients and 22 minimum amounts of food products. The new method differs from the applications of linear programming described in the special literature on nutrition science not only with increased nutritional constraints, but also the minimum amount of every product is introduced as constraints, which does not essentially change costs, but provide quality, for example, for tea or coffee it is recommended to define not x≥0, but x≥3. By modifying minimum amounts of tea, coffee, sugar, spices, it is possible to obtain up to 70% economy from the initial rate. Application of the model is approbated in the computer class during practical classes for students of nutrition science.

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The use of linear programming to determine whether a formulated complementary food product can ensure adequate nutrients for 6- to 11-month-old Cambodian infants

In Under-nutrition on February 5, 2014 at 11:46 am

Jutta KH Skau, Touch Bunthang, Chhoun Chamnan, Frank T Wieringa, Marjoleine A Dijkhuizen, Nanna Roos, and Elaine L Ferguson

Am J Clin Nutr January 2014 vol. 99 no. 1 130-138


Background: A new software tool, Optifood, developed by the WHO and based on linear programming (LP) analysis, has been developed to formulate food-based recommendations.

Objective: This study discusses the use of Optifood for predicting whether formulated complementary food (CF) products can ensure dietary adequacy for target populations in Cambodia.

Design: Dietary data were collected by 24-h recall in a cross-sectional survey of 6- to 11-mo-old infants (n = 78). LP model parameters were derived from these data, including a list of foods, median serving sizes, and dietary patterns. Five series of LP analyses were carried out to model the target population’s baseline diet and 4 formulated CF products [WinFood (WF), WinFood-Lite (WF-L), Corn-Soy-Blend Plus (CSB+), and Corn-Soy-Blend Plus Plus (CSB++)], which were added to the diet in portions of 33 g/d dry weight (DW) for infants aged 6–8 mo and 40 g/d DW for infants aged 9–11 mo. In each series of analyses, the nutritionally optimal diet and theoretical range, in diet nutrient contents, were determined.

Results: The LP analysis showed that baseline diets could not achieve the Recommended Nutrient Intake (RNI) for thiamin, riboflavin, niacin, folate, vitamin B-12, calcium, iron, and zinc (range: 14–91% of RNI in the optimal diets) and that none of the formulated CF products could cover the nutrient gaps for thiamin, niacin, iron, and folate (range: 22–86% of the RNI). Iron was the key limiting nutrient, for all modeled diets, achieving a maximum of only 48% of the RNI when CSB++ was included in the diet. Only WF and WF-L filled the nutrient gap for calcium. WF-L, CSB+, and CSB++ filled the nutrient gap for zinc (9- to 11-mo-olds).

Conclusions: The formulated CF products improved the nutrient adequacy of complementary feeding diets but could not entirely cover the nutrient gaps. These results emphasize the value of using LP to evaluate special CF products during the intervention planning phase.

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Designing large-scale programs to improve infant and young child feeding in Asia and Africa: Methods and lessons of Alive & Thrive

In Under-nutrition on September 28, 2013 at 3:19 pm

from Food & Nutrition Bulletin, ISSN 0379-5721, Online ISSN: 1564-8265

Documenting large-scale programs to improve infant and young child feeding is key to facilitating progress in child nutrition
pp. 143S-145S(3)
Authors: Piwoz, Ellen; Baker, Jean; Frongillo, Edward A.

Authors: Baker, Jean; Sanghvi, Tina; Hajeebhoy, Nemat; Martin, Luann; Lapping, Karin

 Strengthening systems to support mothers in infant and young child feeding at scale pp. 156S-168S(13)Authors: Sanghvi, Tina; Martin, Luann; Hajeebhoy, Nemat; Abrha, Teweldebrhan Hailu; Abebe, Yewelsew; Haque, Raisul; Tran, Ha Thi Thu; Roy, Sumitro

pp. 169S-180S(12)
Authors: Sanghvi, Tina; Jimerson, Ann; Hajeebhoy, Nemat; Zewale, Medhanit; Nguyen, Giang Huong

Developing evidence-based advocacy and policy change strategies to protect, promote, and support infant and young child feeding
pp. 181S-194S(14)
Authors: Hajeebhoy, Nemat; Rigsby, Andrew; McColl, Alyson; Sanghvi, Tina; Abrha, Teweldebrhan Hailu; Godana, Andenet; Roy, Sumitro; Phan, Linh Thi Hong; Vu, Ha Thi Thu; Sather, Megan; Uddin, Belal

pp. 212S-225S(14)
Authors: Rawat, Rahul; Nguyen, Phuong H.; Ali, Disha; Saha, Kuntal; Alayon, Silvia; Kim, Sunny S.; Ruel, Marie; Menon, Purnima

Authors: Baker, Jean; Sanghvi, Tina; Hajeebhoy, Nemat; Abrha, Teweldebrhan Hailu

pp. 141S-230S(90)


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