Poster Topical Area: Global Nutrition

Location: Hall D

Poster Board Number: 592

P12-102 - Body Composition among 2½-4 Year Old Malawian Children Exposed to Lipid-based Nutritional Supplements (LNS) and Feeding and Hygiene Messaging from 6-23 Months of Age

Monday, Jun 11
8:00 AM – 3:00 PM

Objective: Where stunting prevails, feeding interventions may improve linear growth, but sustained effects on child growth and body composition are rarely assessed. In rural Malawi where daily exposure to LNS and child feeding and hygiene social behavior change communication (SBCC) from 6-23 months of age increased weight and length (+0.32 and +0.34 Z-scores, respectively, both p<0.05), we determined program effects on body composition at 31-48 months of age in a quasi-experimental study.


Methods: Baseline data was collected in cohorts of infants enrolled in January 2013 or 2014 at 6-9 months of age in a program (n=209) or adjacent comparison (n=179) district. Households were assessed for food security, water and sanitation practices, and socioeconomic and demographic characteristics. Infant weight, length, and mid-upper arm circumference (MUAC) were measured. At follow-up (31-48 months of age), weight, length, MUAC, triceps (TSF) and subscapular (SSF) skinfolds and bioelectrical impedance analysis (BIA) were assessed. Anthropometry was expressed as Z-scores (Z) relative to the WHO growth standard. MUAC and TSF enabled calculation of arm muscle (AMA) and fat (AFA) area, and BIA allowed partitioning of weight into fat free mass (FFM) and percent body fat (BF%). In analysis, we accounted for baseline differences in household variables, infant nutritional status, duration of and time since program exposure.


Results: At 31-48 months, program children tended to be fatter, evident in SSFZ (+0.325, p=0.004), and supported by larger TSFZ (+0.147, p=0.10), BF% (+0.84%, p=0.13) and AFA (+18.4 mm2, p=0.17), with less total FFM (-0.21 kg, p = 0.07), than the comparison group. Despite consistency in direction of fat and FFM, differences in BMIZ (+0.095), prevalence of BMIZ >1 (+34%), MUACZ (+0.032), HAZ (-0.053), and AMA (-3.3 mm2) were not significant (all p ≥ 0.30).


Conclusion: Malawian children who participated in a program offering LNS and SBCC from 6-23 months of age were fatter and may have had less total FFM at 2½ to 4 years of age than neighboring district comparison children. Transient benefits of program exposure on height may have been supplanted by gains in fat when children transitioned back to nutritionally lacking household diets after program cessation.



Funding Source: The Children's Investment Fund Foundation (CIFF) funded this study.

CoAuthors: Audrey Buckland – Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health; Yunhee Kang – Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health; Lee Wu – Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health; Maithilee Mitra – Center for Human Nutrition, Department of International Health, The Johns Hopkins University Bloomberg School of Public Health; John Phuka – University of Malawi; Julie Ruel-Bergeron – World Bank; Rolf Klemm – Helen Keller International; Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health; Keith West – Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health; Parul Christian – The Bill and Melinda Gates Foundation; Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health; Kristen Hurley – Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health

Kerry J. Schulze

Associate Scientist
Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland