Early Life Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial

Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting. Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blendþþ, WSBþþ) compared with Plumpy’doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ< 2), weight-for-length z-score (WLZ) and wasting (WLZ< 2) in children 6–18 months of age. Children (n1⁄45536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year. Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02–0.04/month) in the Plumpy’doz (P1⁄4 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy’doz and chickpea groups. WSBþþ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5–6% (P 0.01) in those receiving Plumpy’doz and chickpea. Mean length and LAZ at 18 months VC The Author 2015. Published by Oxford University Press on behalf of the International Epidemiological Association 1862 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] International Journal of Epidemiology, 2015, 1862–1876 doi: 10.1093/ije/dyv155 Advance Access Publication Date: 14 August 2015