Objective: To evaluate the efficacy of a community-based dietary intervention to
reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian
diets.
Design: Quasi-experimental post-test design with a non-equivalent control group.
Setting: Four villages in Mangochi District, Southern Malawi.
Participants: Households with children aged 3–7 years in two intervention (n ¼ 200)
and two control (n ¼ 81) villages participated in a 6-month intervention employing
dietary diversification, changes in food selection patterns, and modifications to food
processing to reduce the phytate content of maize-based diets. Baseline comparability
between the groups was confirmed via assessment of sociodemographic
characteristics, anthropometry, knowledge and practices, morbidity, haemoglobin
and hair zinc. After 12 months, knowledge and practices and dietary intakes were
assessed by interactive 24-hour recalls, one during the food plenty and a second
during the food shortage season. Nutrient adequacy for the two groups was
compared via dietary quality indicators and predicted prevalence of inadequate
intakes using the probability approach.
Results: Intervention children had diets that were significantly more diverse and of a
higher quality than those of controls. Median daily intakes of protein, calcium, zinc
(total and available), haem iron, vitamin B12 and animal foods (grams; % of total
energy) were higher (P , 0.05) whereas phytate intakes, phytate/zinc and
phytate/iron molar ratios were lower (P , 0.01) in the intervention group; some
spread of knowledge and practices to controls occurred.
Conclusions: Our community-based dietary strategies reduced the predicted
prevalence of inadequate intakes of protein, calcium, zinc and vitamin B12, but not
iron, in children from Malawian households with very limited resources.