Sayyad-Neerkorn Jessica, Langendorf Céline, Roederer Thomas, Doyon Stéphane, Mamaty Abdoul-Aziz, Woi-Messe Lynda, Manzo Mahamane L, Harouna Souley, de Pee Saskia, Grais Rebecca F
Epicentre, Paris, France;
Doctors without Borders (MSF), Paris, France;
J Nutr. 2015 Nov;145(11):2596-603. doi: 10.3945/jn.115.213157. Epub 2015 Sep 30.
In nutritional crises, large-scale preventive distributions of specialized nutritious foods are recommended to prevent acute and chronic malnutrition in young children. Among the available specialized nutritious foods, the World Food Programme and UNICEF recommend lipid-based nutrient supplements (LNSs) and Super Cereal Plus (SC+). Although the effectiveness of short-term distributions for prevention of severe acute malnutrition (SAM) is well documented, evidence for long-term strategies and the role of distribution of specialized nutritious foods for prevention of stunting is weaker.
The objective of this study was to compare long-term supplementation of LNSs and SC+ on the incidence of acute malnutrition and stunting in young children.
We conducted two 15-mo-long supplementation interventions with the use of LNSs (500 kcal/d) and SC+ (810 kcal/d) and half rations during 5 mo of the nonlean season, for the prevention of acute malnutrition and stunting in children aged 6-23 mo. The study was designed as a prospective cohort in 11 villages in Madarounfa, Niger. We compared the incidence of acute malnutrition and stunting with the use of Cox proportional hazards models and report on sharing and use of these food supplements.
Characteristics of children at baseline were similar across groups. A total of 1967 children were included in the analysis (845 in the SC+ group and 1122 in the LNS group). No significant differences in the incidence of moderate acute malnutrition (SC+ compared with LNS: adjusted HR: 0.79; 95% CI: 0.61, 1.02) or SAM (HR: 0.84; 95% CI: 0.52, 1.34) were found. No difference in the incidence of stunting (HR: 1.08; 95% CI: 0.95, 1.24) or severe stunting (HR: 0.94; 95% CI: 0.71, 1.22) over the follow-up period were found.
These findings in young children in Niger suggest that both products should be considered when planning preventive distributions and choice of long-term supplementation should be guided by context-specific factors such as acceptability, cost, and operational feasibility, among others. Additional research is essential to improving child health. The study was registered at clinicaltrials.gov as NCT01828814.
在营养危机期间，建议大规模预防性分发专门的营养食品，以预防幼儿的急性和慢性营养不良。在现有的专门营养食品中，世界粮食计划署和联合国儿童基金会推荐基于脂质的营养补充剂（LNS）和强化谷物（SC+）。虽然短期分发预防重度急性营养不良（SAM）的有效性已有充分记录，但关于长期策略以及专门营养食品分发在预防发育迟缓方面作用的证据则较为薄弱。
本研究的目的是比较长期补充LNS和SC+对幼儿急性营养不良和发育迟缓发生率的影响。
我们进行了两项为期15个月的补充干预，在非旱季的5个月期间使用LNS（500千卡/天）和SC+（810千卡/天）以及半量口粮，以预防6至23个月大儿童的急性营养不良和发育迟缓。该研究设计为在尼日尔马达鲁恩法的11个村庄进行的前瞻性队列研究。我们使用Cox比例风险模型比较急性营养不良和发育迟缓的发生率，并报告这些食品补充剂的分发和使用情况。
各组儿童的基线特征相似。共有1967名儿童纳入分析（SC+组845名，LNS组1122名）。在中度急性营养不良发生率（SC+组与LNS组相比：调整后风险比：0.79；95%置信区间：0.61，1.02）或SAM发生率（风险比：0.84；95%置信区间：0.52，1.34）方面未发现显著差异。在随访期间，发育迟缓发生率（风险比：1.08；95%置信区间：0.95，1.24）或重度发育迟缓发生率（风险比：0.94；95%置信区间：0.71，1.22）也未发现差异。
在尼日尔幼儿中的这些发现表明，在规划预防性分发时应考虑这两种产品，长期补充剂的选择应根据可接受性、成本和操作可行性等具体情况因素来指导。开展更多研究对于改善儿童健康至关重要。该研究已在clinicaltrials.gov注册，注册号为NCT01828814。
