Phuka John C, Maleta Kenneth, Thakwalakwa Chrissie, Cheung Yin Bun, Briend André, Manary Mark J, Ashorn Per
College of Medicine, University of Malawi, Blantyre, Malawi.
Am J Clin Nutr. 2009 Jan;89(1):382-90. doi: 10.3945/ajcn.2008.26483. Epub 2008 Dec 3.
Therapeutic feeding with micronutrient-fortified lipid-based nutrient supplements (LNSs) has proven useful in the rehabilitation of severely malnourished children. We recently reported that complementary feeding of 6-18-mo-old infants with an LNS known as FS50 was associated with improved linear growth and a reduction in the incidence of severe stunting during the supplementation period.
Our objective was to assess whether a reduction in stunting seen with 12-mo LNS supplementation was sustained over a subsequent 2-y nonintervention period.
One hundred eighty-two 6-mo-old healthy rural Malawian infants were randomly assigned to receive daily supplementation for 12 mo with 71 g of maize-soy flour [likuni phala (LP); control group, 282 kcal] or either 50 g of FS50 (264 kcal; main intervention group), or 25 g of FS25 (130 kcal). Main outcome measures were incidence of severe stunting and mean z score changes in weight-for-age, length-for-age, and weight-for-length during a 36-mo follow-up period.
The cumulative 36-mo incidence of severe stunting was 19.6% in LP, 3.6% in FS50, and 10.3% in FS25 groups (P = 0.03). Mean weight-for-age changes were -1.09, -0.76, and -1.22 (P = 0.04); mean length-for-age changes were -0.47, -0.37, and -0.71 (P = 0.10); and mean weight-for-length changes were -1.52, -1.18, and -1.48 (P = 0.27). All differences were more marked among individuals with baseline length-for-age below the median. Differences in length developed during the intervention at age 10-18 mo, whereas weight differences continued to increase after the intervention.
Twelve-month-long complementary feeding with 50 g/d FS50 is likely to have a positive and sustained impact on the incidence of severe stunting in rural Malawi. Half-dose intervention may not have the same effect. This trial was registered at (clinicaltrials.gov) as NCT00131209.
使用富含微量营养素的脂质基营养补充剂（LNS）进行治疗性喂养已被证明对重度营养不良儿童的康复有益。我们最近报告称，对6至18个月大的婴儿补充名为FS50的LNS进行辅食喂养，与补充期内线性生长改善及严重发育迟缓发生率降低有关。
我们的目的是评估12个月LNS补充期内观察到的发育迟缓减少情况在随后2年的非干预期内是否持续存在。
182名6个月大的马拉维农村健康婴儿被随机分配，每天补充71克玉米 - 大豆粉[利库尼法拉（LP）；对照组，282千卡]，或50克FS50（264千卡；主要干预组），或25克FS25（130千卡），为期12个月。主要结局指标为36个月随访期内严重发育迟缓的发生率以及年龄别体重、年龄别身长和身长别体重的平均z评分变化。
LP组、FS50组和FS25组36个月累积严重发育迟缓发生率分别为19.6%、3.6%和10.3%（P = 0.03）。年龄别体重平均变化分别为-1.09、-0.76和-1.22（P = 0.04）；年龄别身长平均变化分别为-0.47、-0.37和-0.71（P = 0.10）；身长别体重平均变化分别为-1.52、-1.18和-1.48（P = 0.27）。所有差异在基线年龄别身长低于中位数的个体中更为明显。身长差异在10至18个月龄干预期间出现，而体重差异在干预后持续增加。
每天50克FS50进行为期12个月的辅食喂养可能对马拉维农村严重发育迟缓的发生率产生积极且持续的影响。半剂量干预可能没有相同效果。该试验在（clinicaltrials.gov）注册为NCT00131209。
