Background: Undernutrition in children is still widely prevalent in Malawi and elsewhere in
sub-Saharan Africa and South Asia. In most developing countries, high prevalence of
undernutrition is attributed to inadequate dietary intakes among other causes. Reduced appetite
in children has been shown to markedly contribute to low dietary intakes. Some studies have
documented improvements in child appetite following supplementation with various
micronutrients, some of which, are contained in Lipid-based Nutrient Supplements (LNS). As
such LNS hold a promise to improve appetite in children.
Objective: The objective was to test the hypothesis that infants and young children receiving
complementary foods supplemented with LNS from 6 to 18 months of age would have lower
proportion of days with anorexia reports than infants and young children receiving no
supplements.
Data and methods: The present study is a sub-set of the International Lipid-based Nutrient
Supplements (iLiNS) DYAD-M trial in which 869 pregnant women were randomly assigned
to receive either LNS, Multiple Micronutrients (MMN) or Iron Folic Acid (IFA) in rural
Malawi. Children born to these women formed the sample size for the present study. Children
born to women in LNS group, received two sachets of LNS-20gM (20g of LNS) daily from the
age of 6 to 18 months while those born from women in either IFA or MMN received no
supplements. Independent sample t-test was used in order to compare the proportion of days
during which anorexia was reported between the intervention and control groups.
Results: Maternal and infant baseline characteristics were comparable between the
intervention and the control groups. The mean (SD) proportion of days during which anorexia
was reported throughout the entire follow-up period were 3.21 (14.65) % and 3.66 (15.9) % in
the intervention and control groups respectively (difference -0.45%, 95% CI -0.45 to -0.08,
P=0.02)
The difference (95% CI) in mean proportions of days with anorexia reports between LNS and
control groups for age intervals of Week 27-39, Week 40-52, Week53-65 and Week 66-78 were -0.14%
(95% CI -0.86 to 0.58), -0.47% (95% CI -1.26 to 0.32), 0.01% (95% CI -0.72 to 0.72) and -
1.15% (95% CI -1.84 to -0.47) respectively. However, this result was statistically significant
only in the oldest age interval (P=<0.001). Furthermore, adjustment of the analyses for various
selected baseline variables such as maternal age, education, primiparity, maternal Body Mass
Index (BMI), and household asset index; did not markedly alter the results.
Conclusion: Provision of SQ-LNS to IYC in resource-insecure settings during early life yields
modest improvements in appetite as evidenced by a decrease in the prevalence of anorexia.
This study also suggests that the effect of SQ-LNS in improving child appetite gets significant
as the children grow older.