evidence-based blog of Filippo Dibari

Posts Tagged ‘LNS’

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

In Under-nutrition on November 7, 2014 at 6:08 pm

by Thakwalakwa CM, Ashorn P, Phuka JC, Cheung YB, Briend A, Maleta KM

from Matern Child Nutr. 2014 Feb 17



Nutrition interventions have an effect on growth, energy and nutrient intake, and development, but there are mixed reports on the effect of supplementation of energy-dense foods on dietary intake.

This substudy aimed at assessing the effect of supplementation with corn-soy blend (CSB) or lipid-based nutrient supplement (LNS) on energy and nutrient intake in moderately underweight children participating in a clinical trial. A total of 188 children aged 8-18 months participated and received daily either 284 kcal from CSB or 220 kcal from LNS and no supplements (control).

An interactive 24-h recall method was used to estimate energy and nutrient intakes in the groups. Total mean energy intake was 548 kcal, 551 kcal and 692 kcal in the control, CSB and LNS groups, respectively (P = 0.011). The mean (95% confidence interval) intake of energy and protein were 144 (37-250; P < 0.001) and 46 (1.5-7.6; P < 0.001) larger, respectively, in the LNS group than among the controls. No significant differences were observed between the control and CSB groups. Energy intake from non-supplement foods was significantly lower in the CSB group compared with the control group, but not in the LNS group, suggesting a lower displacement of non-supplement foods with LNS. Both CSB and LNS supplementation resulted in higher intakes of calcium, iron, zinc and vitamin C compared with controls (all P ≤ 0.001).

This study indicates that LNS might be superior to CSB to supplement underweight children as it results in higher energy intake, but this requires confirmation in other settings.

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

In Under-nutrition on September 28, 2014 at 7:03 am

by Charles Mangani, Per Ashorn, Kenneth Maleta, John Phuka,Chrissie Thakwalakwa,Kathryn Dewey, Mark Manary, Taneli Puumalainen, and Yin Bun Cheung

from J. Nutr. November 1, 2014



Background: There is evidence to support the use of lipid-based nutrient supplements (LNSs) to promote child growth and development in low-income countries, but there is also a concern regarding the safety of using iron-fortified products in malaria-endemic areas.

Objective: The objective of this study was to test the hypothesis that 6- to 18-mo-old rural Malawian children receiving iron-containing (6 mg/d) LNSs would not have excess morbidity compared with infants receiving no supplementation.

Methods: A randomized controlled trial allocated 840 children to receive daily supplementation with 54 g/d LNS with milk protein base (milk-LNS), 54 g/d LNS with soy protein base (soy-LNS), 71 g/d corn-soy blend (CSB), or no supplementation from 6 to 18 mo of age. Morbidity was compared using a non-inferiority margin set at 20% excess morbidity in supplemented groups compared with the nonsupplemented group.

Results: Baseline characteristics were similar across groups. The proportion of days with febrile illness between 6 and 18 mo was 4.9%, and there were no differences between the groups: 4.9% (95% CI: 4.3, 5.5%), 4.5% (95% CI: 3.9, 5.1%), 4.7% (95% CI: 4.1, 5.3%), and 5.5% (95% CI: 4.7–6.3%) in the milk-LNS, soy-LNS, CSB, and control groups, respectively. The proportion of days with respiratory problems and diarrhea between 6 and 18 mo also did not differ between groups. Compared with controls, the incident rate ratio (95% CI) for clinical malaria was 0.80 (0.59, 1.09), 0.77 (0.56, 1.06), and 0.79 (0.58, 1.08) in milk-LNS, soy-LNS, and CSB, respectively, with 95% CIs confirming non-inferiority. The incidence of febrile episodes, diarrhea, respiratory problems or admission to hospital, prevalence of malaria parasitemia throughout the follow-up, and mean change in hemoglobin concentration from baseline were also similar between the groups.

Conclusions: Daily supplementation with 54 g of milk-based or soy protein–based LNS or 71 g of CSB did not result in increases in malaria or respiratory morbidity in children in a malaria-endemic setting. However, we could not conclude whether LNSs did or did not increase diarrheal morbidity. This trial was registered at clinicaltrials.gov as NCT00524446.

– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

A Lipid-Based Nutrient Supplement but Not Corn-Soy Blend Modestly Increases Weight Gain among 6- to 18-Month-Old Moderately Underweight Children in Rural Malawi

In Under-nutrition on April 19, 2014 at 9:07 am

by Thakwalakwa C, Ashorn P, Phuka J, Cheung YB, Briend A, Puumalainen T, Maleta K.

J. Nutr. November 1, 2010 vol. 140 no. 11 2008-2013



Although widely used, there is little information concerning the efficacy of corn-soy blend (CSB) supplementation in the treatment of moderate underweight in African children. Lipid-based nutrient supplements (LNS), which have proven to be beneficial treatment for severely wasted children, could offer benefits to less severely affected individuals.

We conducted a clinical randomized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children. A total of 182 underweight [weight-for-age Z-score (WAZ) < −2] 6- to 15-mo-old children were randomized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB, providing 1189 and 921 kJ, respectively, or no supplementation (control). The primary outcome was weight change; secondary outcomes included changes in anthropometric indices, hemoglobin levels, and morbidity.

The body weight increases (mean ± SD) did not differ and were 620 ± 470, 510 ± 350, and 470 ± 350 g in the LNS, CSB, and control groups, respectively (P = 0.11). Compared with controls, infants and children in the LNS group gained more weight [mean (95% CI) = 150 g (0–300 g); P = 0.05] and had a greater increase in WAZ [0.33 (−0.02–0.65); P = 0.04]. Weight and WAZ changes did not differ between the control and CSB groups. In exploratory stratified analysis, the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [250 g (60–430 g; P = 0.01].

Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ.



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.

– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Iron bioavailability from a lipid-based complementary food fortificant mixed with millet porridge can be optimized by adding phytase and ascorbic acid but not by using a mixture of ferrous sulfate and sodium iron EDTA

In Under-nutrition on March 22, 2014 at 9:14 am

by Cercamondi CI, Egli IM, Mitchikpe E, Tossou F, Hessou J, Zeder C, Hounhouigan JD, Hurrell RF

J Nutr. 2013 Aug;143(8):1233-9


Home fortification with lipid-based nutrient supplements (LNSs) is a promising approach to improve bioavailable iron and energy intake of young children in developing countries.

To optimize iron bioavailability from an LNS named complementary food fortificant (CFF), 3 stable isotope studies were conducted in 52 young Beninese children. Test meals consisted of millet porridge mixed with CFF and ascorbic acid (AA).

Study 1 compared iron absorption from FeSO4-fortifed meals with meals fortified with a mixture of FeSO4 and NaFeEDTA. Study 2 compared iron absorption from FeSO4-fortifed meals without or with extra AA. Study 3 compared iron absorption from FeSO4-fortified meals with meals containing phytase added prior to consumption, once without or once with extra AA. Iron absorption was measured as erythrocyte incorporation of stable isotopes.

In study 1, iron absorption from FeSO4 (8.4%) was higher than that from the mixture of NaFeEDTA and FeSO4 (5.9%; P < 0.05). In study 2, the extra AA increased absorption (11.6%) compared with the standard AA concentration (7.3%; P < 0.001). In study 3, absorption from meals containing phytase without or with extra AA (15.8 and 19.9%, respectively) increased compared with meals without phytase (8.0%; P < 0.001). The addition of extra AA to meals containing phytase increased absorption compared with the test meals containing phytase without extra AA (P < 0.05).

These findings suggest that phytase and AA, and especially a combination of the two, but not a mixture of FeSO4 and NaFeEDTA would be useful strategies to increase iron bioavailability from a CFF mixed with cereal porridge.

– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

The Effect of Adding Ready-to-Use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-Randomized Controlled Trial

In Under-nutrition on February 5, 2014 at 11:18 am

by Lieven Huybregts, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, Patrick Kolsteren.

PLOS Medicine | 1 September 2012 | Volume 9 | Issue 9

(download the paper)




Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program.

Methods and Findings

We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p<0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (−29.3%; 95% CI: 20.5, 37.2; p<0.001) and fever episodes (−22.5%; 95% CI: 14.0, 30.2; p<0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions.


Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity.


– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Hybrid public/private delivery of preventative Lipid-based Nutrient Supplement products

In Under-nutrition on November 14, 2013 at 11:31 am

If you are interested in the implications of the delivery mechanisms of the LNS products, do not miss this paper published on the SCN News Bullettin, by Travis J.Lybbert, UCDAVIS.


– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Formative assessment to design the packaging of a lipid-based nutrient supplement for a home fortification program to improve the nutritional status of young children in the Democratic Republic of Congo

In Under-nutrition on September 7, 2013 at 1:35 pm


From the  Home Fortification Technical Advisory Group (HF-TAG)



The Democratic Republic of Congo (DRC) is a vast country with more than 66 million inhabitants. Despite being one of largest reserves of natural resources in the world, child survival remains of concern in DRC. Based upon the preliminary results of the 2010 MICS Survey (Multiple Indicators Cluster Survey), National rates of malnutrition are high: wasting (9%), stunting (43%) and underweight (24%). In an effort to combat malnutrition UNICEF has implemented a 3- year Infant and Young Child Feeding IYCF strategy that integrates IYCF counseling (based on the WHO Ten Guiding Principles) in the Minimum Health Package. An important component of the DRC UNICEF 3-year IYCF strategy is a pilot program that will provide counseling to pregnant women, IYCF counseling, community messages, and a small quantity (20g per day) lipid based nutrient supplement (LNS) for infants (daily for children 6-12 months of age), using the existing health care infrastructure. The pilot program will be implemented in Kasenga health zone (HZ) and pending the results of the pilot program, the enhanced IYCF program will be scaled up to other HZ’s in DRC.

The goal of the program is to improve the nutritional status of children aged 0-12 months of age in Kasenga Health zone by reducing the prevalence of anemia, vitamin A deficiency and improving infant and young child feeding practices through the delivery of key messages and the distribution of lipid based nutritional supplements (LNS) (for children 6-12 months of age). The purpose of this present document is to describe the process to design the packaging of the LNS product that will be distributed as part of the pilot project.

In October 2010 an initial formative assessment was conducted to guide the design of the proposed packaging of an LNS product, to be used in in the pilot program. A second formative assessment, conducted in June 2011, re-tested the design elements of the packaging and tested the concept of providing the LNS in a multi sachet strip. The results of this second formative study were used to finalize the package and branding of the LNS. This report presents the results of the second formative study.

The specific aim of the second formative assessment was to determine which name, color, general style, and images communicate important product-related messages and would maximize the appropriate use of the product in an area with low literacy levels.

A study protocol was developed by CDC and Nutriset describing the methodology and tools that would be used in the formative assessment. Focus group discussions (FGD) and key interviews (KI) were the primary methods chosen to collect the data.

Data was collected in two locations of Lubumbashi, Katanga region: Mabaya, a rural village and Kipushi, a peri-urban area.

Results show that the majority of the study participants read the different images on the multi sachet strip as a story line. The images were interpreted as a series of events that must happen in a child’s life to ensure that the child stays healthy and develops well. The messages of washing the child’s hands, feeding the child with breastmilk and enriching complementary foods are seen as necessary elements in order to have a playful and active child. Participants retained

the main messages that the strip should convey: child care, product use, target group, as well as potential product benefits.

All participants recognized the mother and the children in the images as “Congolese” and “African”. Green and brown were identified as suitable colors for the LNS packaging and were associated with qualities such as health, growth, and development of the child. White could add a positive association by making a link to the milk content of the product.

The participants preferred the names Kulazuri (eating well) and Afiabora (good health) for the LNS. After further discussion of the name options with the field team and UNICEF staff a combination of the first two name proposals was found “Kulabora” (eating better).

The results from this formative study were used to finalize the design of the LNS product, which is currently being distributed in Kasenga health zone.

– See more at: http://hftag.gainhealth.org/resources/formative-assessment-design-packaging-lipid-based-nutrient-supplement-home-fortification-p#sthash.MvLVxabW.dpuf

– – –

NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).
%d bloggers like this: