Prevention of Linear Growth Failure in Infants and Young Children With Lipid-based Nutrient Supplements (iLiNS-DOSE)

NCT ID: NCT00945698

Last Updated: 2015-05-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

1920 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-11-30

Study Completion Date

2014-08-31

Brief Summary

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The use of lipid-based nutrients (LNS), such as Nutributter or fortified spread (FS), have been associated with improved growth and development outcomes among infants in Ghana and Malawi. Modified versions of such supplements have been developed to improve their nutrient density and quality and to lower their costs. Such modified products have proven acceptable to infants and their guardians in Malawi and Ghana. In the present trial, the investigator aim to identify the lowest growth-promoting daily dose of modified LNS. Additionally, the investigators will test a hypothesis that LNS that does not contain milk promotes growth as well as milk-containing LNS when given for 12 months at a 10-40 g daily dose to 6-18 month old infants in rural Malawi.

Detailed Description

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Six-month old healthy infants are identified through community surveys in the study area. 1920 infants meeting set criteria are randomised into receiving the following intervention between 6 and 18 months of age: 1) standard treatment from 6-18 months (i.e.no supplements, with delayed intervention between 18-30 months of age (ST-DI), 2) 10 g / day milk-containing LNS (LNS-10gM), 3) 20 g / day milk-containing LNS (LNS-20gM), 4) 20 g / day milk-free LNS (LNS-20gNoM), 5) 40 g / day milk-containing LNS, (LNS-40gM) 6) 40 g / day milk-free LNS (LNS-40gNoM). The families receive the food supplements at 2-weekly intervals and the participants undergo a morbidity evaluation weekly, a limited development assessment at 4-weekly intervals and anthropometric evaluation at 26-week intervals and laboratory analyses at enrollment and at 18 months. Growth outcome analyses are done at 18 and at 42 months of age.

Conditions

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Malnutrition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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ST-DI (Delayed intervention)

* 1 kg fortified maize / soy flour (Likuni phala, LP) 2-weekly (71 g / day) between 18 and 30 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Group Type OTHER

Maize-soy flour

Intervention Type DIETARY_SUPPLEMENT

* No food supplement during the primary trial period (6 to 18 months of age)
* 1 kg fortified maize / soy flour (Likuni phala, LP) 2-weekly (71 g / day) between 18 and 30 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

LNS-10gM

* 140 g of milk-containing LNS (LNS-10gM) 2-weekly (10 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Group Type EXPERIMENTAL

Lipid-based nutrient supplement, 10gM

Intervention Type DIETARY_SUPPLEMENT

* 140 g of milk-containing LNS (LNS-10gM) 2-weekly (10 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

LNS-20gM

* 280 g of milk-containing LNS (LNS-20gM) 2-weekly (20 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Group Type EXPERIMENTAL

Lipid-based nutrient supplement, 20gM

Intervention Type DIETARY_SUPPLEMENT

* 280 g of milk-containing LNS (LNS-20gM) 2-weekly (20 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

LNS-20gNoM

* 280 g of milk-free LNS (LNS-20gNoM) 2-weekly (20 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Group Type EXPERIMENTAL

Lipid-based Nutrient Supplement, 20gNoM

Intervention Type DIETARY_SUPPLEMENT

* 280 g of milk-free LNS (LNS-20gNoM) 2-weekly (20 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

LNS-40gM

* 560 g of milk-containing LNS (LNS-40gM) 2-weekly (40 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Group Type EXPERIMENTAL

Lipid-based nutrient supplement, 40gM

Intervention Type DIETARY_SUPPLEMENT

* 560 g of milk-containing LNS (LNS-40gM) 2-weekly (40 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

LNS-40gNoM

* 560 g of milk-free LNS (LNS-40gNoM) 2-weekly (40 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Group Type EXPERIMENTAL

Lipid-based Nutrient Supplement, 40gNoM

Intervention Type DIETARY_SUPPLEMENT

* 560 g of milk-free LNS (LNS-40gNoM) 2-weekly (40 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Interventions

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Lipid-based nutrient supplement, 10gM

* 140 g of milk-containing LNS (LNS-10gM) 2-weekly (10 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Intervention Type DIETARY_SUPPLEMENT

Lipid-based nutrient supplement, 20gM

* 280 g of milk-containing LNS (LNS-20gM) 2-weekly (20 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Intervention Type DIETARY_SUPPLEMENT

Lipid-based Nutrient Supplement, 20gNoM

* 280 g of milk-free LNS (LNS-20gNoM) 2-weekly (20 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Intervention Type DIETARY_SUPPLEMENT

Lipid-based nutrient supplement, 40gM

* 560 g of milk-containing LNS (LNS-40gM) 2-weekly (40 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Intervention Type DIETARY_SUPPLEMENT

Lipid-based Nutrient Supplement, 40gNoM

* 560 g of milk-free LNS (LNS-40gNoM) 2-weekly (40 g / day) between 6 and 18 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Intervention Type DIETARY_SUPPLEMENT

Maize-soy flour

* No food supplement during the primary trial period (6 to 18 months of age)
* 1 kg fortified maize / soy flour (Likuni phala, LP) 2-weekly (71 g / day) between 18 and 30 months of age
* Normal under-five clinic follow-up, including EPI-vaccinations, vitamin A supplementation, and growth monitoring

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Signed informed consent from at least one guardian
* Age 5.50 months to 6.49 months
* Availability during the period of the study.
* Permanent resident of Mangochi District Hospital or Namwera Health Centre catchment area

Exclusion Criteria

* Weight for length Z score (WLZ) \< -2.0
* Presence of oedema
* Severe anaemia (Hb\<50 g / l)
* Severe illness warranting hospital referral
* History of allergy towards peanut
* History of anaphylaxis or serious allergic reaction to any substance, requiring emergency medical care
* Concurrent participation in any other clinical trial
Minimum Eligible Age

167 Days

Maximum Eligible Age

197 Days

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Kamuzu University of Health Sciences

OTHER

Sponsor Role collaborator

University of California, Davis

OTHER

Sponsor Role collaborator

Bill and Melinda Gates Foundation

OTHER

Sponsor Role collaborator

Tampere University

OTHER

Sponsor Role lead

Responsible Party

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Per Ashorn

Professor of International Health

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Per Ashorn, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Tampere Medical School

Kenneth Maleta, MBBS, PhD

Role: PRINCIPAL_INVESTIGATOR

Kamuzu University of Health Sciences

Locations

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University of Malawi, College of Medicine

Mangochi, , Malawi

Site Status

Countries

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Malawi

References

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Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Am J Clin Nutr. 2008 Apr;87(4):929-38. doi: 10.1093/ajcn/87.4.929.

Reference Type BACKGROUND
PMID: 18400716 (View on PubMed)

Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Arch Pediatr Adolesc Med. 2008 Jul;162(7):619-26. doi: 10.1001/archpedi.162.7.619.

Reference Type BACKGROUND
PMID: 18606932 (View on PubMed)

Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. Am J Clin Nutr. 2009 Jan;89(1):382-90. doi: 10.3945/ajcn.2008.26483. Epub 2008 Dec 3.

Reference Type BACKGROUND
PMID: 19056572 (View on PubMed)

Bendabenda J, Patson N, Hallamaa L, Ashorn U, Dewey KG, Ashorn P, Maleta K. Does anthropometric status at 6 months predict the over-dispersion of malaria infections in children aged 6-18 months? A prospective cohort study. Malar J. 2019 Apr 22;18(1):143. doi: 10.1186/s12936-019-2778-y.

Reference Type DERIVED
PMID: 31010435 (View on PubMed)

Bendabenda J, Patson N, Hallamaa L, Mbotwa J, Mangani C, Phuka J, Prado EL, Cheung YB, Ashorn U, Dewey KG, Ashorn P, Maleta K. The association of malaria morbidity with linear growth, hemoglobin, iron status, and development in young Malawian children: a prospective cohort study. BMC Pediatr. 2018 Dec 28;18(1):396. doi: 10.1186/s12887-018-1378-2.

Reference Type DERIVED
PMID: 30593271 (View on PubMed)

Kumwenda C, Hemsworth J, Phuka J, Ashorn U, Arimond M, Maleta K, Prado EL, Haskell MJ, Dewey KG, Ashorn P. Association between breast milk intake at 9-10 months of age and growth and development among Malawian young children. Matern Child Nutr. 2018 Jul;14(3):e12582. doi: 10.1111/mcn.12582. Epub 2018 Jan 19.

Reference Type DERIVED
PMID: 29349922 (View on PubMed)

Adams KP, Ayifah E, Phiri TE, Mridha MK, Adu-Afarwuah S, Arimond M, Arnold CD, Cummins J, Hussain S, Kumwenda C, Matias SL, Ashorn U, Lartey A, Maleta KM, Vosti SA, Dewey KG. Maternal and Child Supplementation with Lipid-Based Nutrient Supplements, but Not Child Supplementation Alone, Decreases Self-Reported Household Food Insecurity in Some Settings. J Nutr. 2017 Dec;147(12):2309-2318. doi: 10.3945/jn.117.257386. Epub 2017 Oct 4.

Reference Type DERIVED
PMID: 28978680 (View on PubMed)

Prado EL, Abbeddou S, Adu-Afarwuah S, Arimond M, Ashorn P, Ashorn U, Brown KH, Hess SY, Lartey A, Maleta K, Ocansey E, Ouedraogo JB, Phuka J, Some JW, Vosti SA, Yakes Jimenez E, Dewey KG. Linear Growth and Child Development in Burkina Faso, Ghana, and Malawi. Pediatrics. 2016 Aug;138(2):e20154698. doi: 10.1542/peds.2015-4698.

Reference Type DERIVED
PMID: 27474016 (View on PubMed)

Bendabenda J, Alho L, Ashorn U, Cheung YB, Dewey KG, Vosti SA, Phuka J, Maleta K, Ashorn P. The effect of providing lipid-based nutrient supplements on morbidity in rural Malawian infants and young children: a randomized controlled trial. Public Health Nutr. 2016 Jul;19(10):1893-903. doi: 10.1017/S1368980016000331. Epub 2016 Mar 9.

Reference Type DERIVED
PMID: 26956611 (View on PubMed)

Hemsworth J, Kumwenda C, Arimond M, Maleta K, Phuka J, Rehman AM, Vosti SA, Ashorn U, Filteau S, Dewey KG, Ashorn P, Ferguson EL. Lipid-Based Nutrient Supplements Increase Energy and Macronutrient Intakes from Complementary Food among Malawian Infants. J Nutr. 2016 Feb;146(2):326-34. doi: 10.3945/jn.115.215327. Epub 2016 Jan 6.

Reference Type DERIVED
PMID: 26740684 (View on PubMed)

Maleta KM, Phuka J, Alho L, Cheung YB, Dewey KG, Ashorn U, Phiri N, Phiri TE, Vosti SA, Zeilani M, Kumwenda C, Bendabenda J, Pulakka A, Ashorn P. Provision of 10-40 g/d Lipid-Based Nutrient Supplements from 6 to 18 Months of Age Does Not Prevent Linear Growth Faltering in Malawi. J Nutr. 2015 Aug;145(8):1909-15. doi: 10.3945/jn.114.208181. Epub 2015 Jun 10.

Reference Type DERIVED
PMID: 26063066 (View on PubMed)

Ashorn U, Alho L, Arimond M, Dewey KG, Maleta K, Phiri N, Phuka J, Vosti SA, Zeilani M, Ashorn P. Malawian Mothers Consider Lipid-Based Nutrient Supplements Acceptable for Children throughout a 1-Year Intervention, but Deviation from User Recommendations Is Common. J Nutr. 2015 Jul;145(7):1588-95. doi: 10.3945/jn.114.209593. Epub 2015 May 20.

Reference Type DERIVED
PMID: 25995276 (View on PubMed)

Kumwenda C, Dewey KG, Hemsworth J, Ashorn P, Maleta K, Haskell MJ. Lipid-based nutrient supplements do not decrease breast milk intake of Malawian infants. Am J Clin Nutr. 2014 Mar;99(3):617-23. doi: 10.3945/ajcn.113.076588. Epub 2013 Dec 24.

Reference Type DERIVED
PMID: 24368436 (View on PubMed)

Related Links

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http://www.medcol.mw/

College of Medicine homepage

Other Identifiers

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iLiNS-DOSE

Identifier Type: -

Identifier Source: org_study_id

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