International Nutrition and Health

We conduct research among children with chronic and acute malnutrition and we investigate the associations between diet, nutrient intake, early child growth and development, and later health and risk of chronic diseases.

We participate in development of therapeutic foods, nutritional supplements and sustainable diets and focus our work on micronutrients, essential fatty acids and different sources and qualities of protein.

We investigate novel utilization of traditional food sources such as indigenous fish and edible insects, as well as renewed uses of processed dairy and plant-based protein.

We measure how these foods affect growth, body composition, cognitive and motor development, micronutrient status and markers of cardio-metabolic health. In addition, we examine if these foods affect gut function and gut microbiota, and how gut health impacts nutrition and health.

We conduct our research in collaboration with universities and other research institutions in Africa and Asia, as well as with international research collaborators and humanitarian organizations.

Our research includes inter-disciplinary health and food system approaches to provide sustainable solutions to alleviate child malnutrition. 

Our research contributes to several Sustainable Development Goals (SDGs), particularly: Zero hunger (SDG2) and Ending Poverty (SDG1). Improving the health of children is also a contribution to Gender Equality (SDG5).

The study is a birth cohort study among 600 newborn children born at term at Jimma University Specialised Hospital in Ethiopia.

About iABC

Body composition was measured using an air-plethysmography (PeaPod) within the first 48 hours and several times during the first half year of life (iABC-1).

Recruitment took place between 2008-12. Subsequently, children have been followed up at 2, 3, 4-5 and 8-10 years, for anthropometry, body composition (BodPod), child development, markers of cardio-metabolic health, educational outcomes, and kidney size and function.

Status

The 8-10 year follow-up data are expected to be published in 2022-23.

The study has so far provided data for 4 Ethiopian (incl. 2 ongoing) and 2 Danish PhD-students, and for 14 papers (see publications).

Publications

1. Abera M, Tesfaye M, Girma T, Hanlon C, Andersen GS, Wells JC, et al. Relation between body composition at birth and child development at 2 years of age: a prospective cohort study among Ethiopian children. Eur J Clin Nutr. 2017;71: 1411–1417. doi:10.1038/ejcn.2017.129
2. Abera M, Tesfaye M, Admassu B, Hanlon C, Ritz C, Wibaek R, et al. Body composition during early infancy and developmental progression from 1 to 5 years of age: the Infant Anthropometry and Body Composition (iABC) cohort study among Ethiopian children. Br J Nutr. 2018;119: 1263–1273. doi:10.1017/S000711451800082X
3. Abera M, Tesfaye M, Hanlon C, Admassu B, Girma T, Wells JC, et al. Body Composition during Early Infancy and Mental Health Outcomes at 5 Years of Age: A Prospective Cohort Study of Ethiopian Children. The Journal of Pediatrics. 2018;200: 225–231. doi:10.1016/j.jpeds.2018.04.055
4. Admassu B, Ritz C, Wells JC, Girma T, Andersen GS, Belachew T, et al. Accretion of Fat-Free Mass Rather Than Fat Mass in Infancy Is Positively Associated with Linear Growth in Childhood. The Journal of Nutrition. 2018;148: 607–615. doi:10.1093/jn/nxy003
5. Admassu B, Wells JCK, Girma T, Andersen GS, Owino V, Belachew T, et al. Body composition at birth and height at 2 years: a prospective cohort study among children in Jimma, Ethiopia. Pediatr Res. 2017;82: 209–214. doi:10.1038/pr.2017.59
6. Admassu B, Wells JCK, Girma T, Belachew T, Ritz C, Owino V, et al. Body composition during early infancy and its relation with body composition at 4 years of age in Jimma, an Ethiopian prospective cohort study. Nutr & Diabetes. 2018;8: 46. doi:10.1038/s41387-018-0056-7
7. Andersen GS, Girma T, Wells JCK, Kæstel P, Michaelsen KF, Friis H. Fat and Fat-Free Mass at Birth: Air Displacement Plethysmography Measurements on 350 Ethiopian Newborns. Pediatr Res. 2011;70: 501–506. doi:10.1203/PDR.0b013e31822d7470
8. Andersen GS, Girma T, Wells JC, Kæstel P, Leventi M, Hother A-L, et al. Body composition from birth to 6 mo of age in Ethiopian infants: reference data obtained by air-displacement plethysmography. The American Journal of Clinical Nutrition. 2013;98: 885–894. doi:10.3945/ajcn.113.063032
9. Andersen GS, Wibaek R, Kaestel P, Girma T, Admassu B, Abera M, et al. Body Composition Growth Patterns in Early Infancy: A Latent Class Trajectory Analysis of the Ethiopian iABC Birth Cohort: Body Composition Growth Patterns in Early Infancy. Obesity. 2018;26: 1225–1233. doi:10.1002/oby.22197
10. Grijalva-Eternod CS, Wells JC, Girma T, Kæstel P, Admassu B, Friis H, et al. Midupper arm circumference and weight-for-length z scores have different associations with body composition: evidence from a cohort of Ethiopian infants. The American Journal of Clinical Nutrition. 2015;102: 593–599. doi:10.3945/ajcn.114.106419
11. Wibæk R, Kæstel P, Skov SR, Christensen DL, Girma T, Wells JCK, et al. Calibration of bioelectrical impedance analysis for body composition assessment in Ethiopian infants using air-displacement plethysmography. Eur J Clin Nutr. 2015 [cited 16 Jul 2015]. doi:10.1038/ejcn.2015.51
12. Wibaek R, Girma T, Admassu B, Abera M, Abdissa A, Geto Z, et al. Higher Weight and Weight Gain after 4 Years of Age Rather than Weight at Birth Are Associated with Adiposity, Markers of Glucose Metabolism, and Blood Pressure in 5-Year-Old Ethiopian Children. The Journal of Nutrition. 2019; nxz121. doi:10.1093/jn/nxz121
13. Wibaek R, Vistisen D, Girma T, Admassu B, Abera M, Abdissa A, et al. Body mass index trajectories in early childhood in relation to cardiometabolic risk profile and body composition at 5 years of age. Am J Clin Nutr. 2019;110: 1175–1185. doi:10.1093/ajcn/nqz170
14. Wibaek R, Vistisen D, Girma T, Admassu B, Abera M, Abdissa A, et al. Associations of fat mass and fat-free mass accretion in infancy with body composition and cardiometabolic risk markers at 5 years: The Ethiopian iABC birth cohort study. PLOS Medicine. 2019;16: e1002888. doi:10.1371/journal.pmed.1002888.

Partners

iABC was initiated in collaboration between Jimma University and University of Copenhagen. Later, researchers from Steno Diabetes Centre Copenhagen, and University College London and London School of Hygiene and Tropical Medicine joined.

Involved in the project

Associate Professor Mette Frahm Olsen

PhD student Bikila Soboka Megersa

Funded by

• Danida
• University of Copenhagen
• Novo Nordisk Foundation
• GSK

Period: 2008 - 2023.

Contact

Professor Henrik Friis

COMPLETED PROJECT

Period: 2013 - 2014.

Treatfood was a 2x2x3 factorial randomized trial among 6-24 months old children with moderate acute malnutrition (MAM) in Burkina Faso.

Background

While children with MAM were at risk of deteriorating to severe acute malnutrition and death, there was no consensus on what foods to give. In fact, there was no WHO recommendation to treat children with MAM, partly due to concerns that children might accumulate too much fat tissue. Instead, WHO recommended more research on food supplements for children with MAM.

Objectives

To assess the effects of food matrix, soy quality and milk content in food supplements on fat-free mass, weight, total and knee-heel length, nutritional recovery, hemoglobin and iron status, and child development among children with MAM.

Methods

The study was a 2×2×3 factorial randomized trial. The children were all given a daily food supplement providing 500 kcal/d for three months.

The three experimental factors were matrix (LNS vs CSB), soy quality (isolate vs dehulled), and milk (20% and 50% versus 0% of total protein). This combination of factors resulted in 12 different supplements.

The trial was double-blinded with respect to soy quality and milk content, but not matrix. Children were followed-up every 2 weeks.

The primary outcome was increase in fat-free mass measured using the deuterium dilution technique. Other outcomes included increase in fat-mass, weight, total and knee-heel length, MUAC, triceps skinfold, and nutritional recovery, child development.

Results

The data has resulted in 4 PhD degrees, and 18 papers (see publications). Several papers are in preparation.

In the main paper, we showed that children with MAM during 3 months of supplementation – irrespective of type and composition - predominantly gained fat-free mass.

LNS resulted in higher fat-free mass accretion, but there were no effects of soy quality and milk (Fabiansen C, Plos Med, 2017).

In a couple of other papers we showed that even short children responded well to supplementation both in terms of growth (Fabiansen C, AJCN, 2016) and accretion of fat-free mass (Fabiansen C, Pediatrics, 2018).

Publications

1. Cichon B, Fabiansen C, Yaméogo CW, Rytter MJH, Ritz C, Briend A, et al. Children with moderate acute malnutrition have inflammation not explained by maternal reports of illness and clinical symptoms: a cross-sectional study in Burkina Faso. BMC Nutrition. 2016;2: 57. doi:10.1186/s40795-016-0096-0
2. Cichon B, Fabiansen C, Iuel-Brockdorf A-S, Yaméogo CW, Ritz C, Christensen VB, et al. Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso. The American Journal of Clinical Nutrition. 2018;107: 278–286. doi:10.1093/ajcn/nqx050
3. Cichon B, Ritz C, Fabiansen C, Christensen VB, Filteau S, Friis H, et al. Assessment of Regression Models for Adjustment of Iron Status Biomarkers for Inflammation in Children with Moderate Acute Malnutrition in Burkina Faso. J Nutr. 2017;147: 125–132. doi:10.3945/jn.116.240028
4. Fabiansen C, Cichon B, Yaméogo CW, Iuel-Brockdorf A-S, Phelan KPQ, Wells JC, et al. Association between admission criteria and body composition among young children with moderate acute malnutrition, a cross-sectional study from Burkina Faso. Sci Rep. 2020;10: 13266. doi:10.1038/s41598-020-69987-9
5. Fabiansen C, Phelan KPQ, Cichon B, Yaméogo CW, Iuel-Brockdorff A-S, Kurpad A, et al. Short Malnourished Children and Fat Accumulation With Food Supplementation. Pediatrics. 2018;142. doi:10.1542/peds.2018-0679
6. Fabiansen C, Phelan KP, Cichon B, Ritz C, Briend A, Michaelsen KF, et al. Short children with a low midupper arm circumference respond to food supplementation: an observational study from Burkina Faso. Am J Clin Nutr. 2016;103: 415–421. doi:10.3945/ajcn.115.124644
7. Fabiansen C, Yaméogo CW, Devi S, Friis H, Kurpad A, Wells JC. Deuterium dilution technique for body composition assessment: resolving methodological issues in children with moderate acute malnutrition. Isotopes Environ Health Stud. 2017;53: 344–355. doi:10.1080/10256016.2017.1295043
8. Fabiansen C, Yaméogo CW, Iuel-Brockdorf A-S, Cichon B, Rytter MJH, Kurpad A, et al. Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso. PLoS Med. 2017;14: e1002387. doi:10.1371/journal.pmed.1002387
9. Iuel-Brockdorf A-S, Dræbel TA, Fabiansen C, Cichon B, Christensen VB, Yameogo C, et al. Acceptability of new formulations of corn-soy blends and lipid-based nutrient supplements in Province du Passoré, Burkina Faso. Appetite. 2015;91: 278–286. doi:10.1016/j.appet.2015.04.058
10. Iuel-Brockdorf A-S, Draebel TA, Ritz C, Fabiansen C, Cichon B, Brix Christensen V, et al. Evaluation of the acceptability of improved supplementary foods for the treatment of moderate acute malnutrition in Burkina Faso using a mixed method approach. Appetite. 2016;99: 34–45. doi:10.1016/j.appet.2015.12.030
11. Iuel-Brockdorf A-S, Ouedraogo A, Ritz C, Draebel TA, Ashorn P, Filteau S, et al. Feeding behaviors during home-based treatment of moderate acute malnutrition using corn-soy blends or lipid-based nutrient supplements. Matern Child Nutr. 2017;13. doi:10.1111/mcn.12399
12. Kjaer TW, Grenov B, Yaméogo CW, Fabiansen C, Iuel-Brockdorff A-S, Cichon B, et al. Correlates of serum IGF-1 in young children with moderate acute malnutrition: a cross-sectional study in Burkina Faso. The American Journal of Clinical Nutrition. 2021 [cited 19 May 2021]. doi:10.1093/ajcn/nqab120
13. Olsen MF, Iuel-Brockdorff A-S, Yaméogo CW, Cichon B, Fabiansen C, Filteau S, et al. Early development in children with moderate acute malnutrition: A cross-sectional study in Burkina Faso. Matern Child Nutr. 2020;16: e12928. doi:10.1111/mcn.12928
14. Olsen MF, Iuel-Brockdorff A-S, Yaméogo CW, Cichon B, Fabiansen C, Filteau S, et al. Impact of food supplements on early child development in children with moderate acute malnutrition: A randomised 2 x 2 x 3 factorial trial in Burkina Faso. PLOS Medicine. 2020;17: e1003442. doi:10.1371/journal.pmed.1003442
15. Rytter MJH, Cichon B, Fabiansen C, Yameogo CW, Windinmi SZ, Michaelsen KF, et al. Thymus size in children with moderate malnutrition: a cohort study from Burkina Faso. Pediatr Res. 2021;89: 1732–1741. doi:10.1038/s41390-020-1057-5
16. Yaméogo CW, Cichon B, Fabiansen C, Rytter MJH, Faurholt-Jepsen D, Stark KD, et al. Correlates of whole-blood polyunsaturated fatty acids among young children with moderate acute malnutrition. Nutr J. 2017;16. doi:10.1186/s12937-017-0264-3
17. Yaméogo CW, Cichon B, Fabiansen C, Iuel-Brockdorf A-S, Shepherd S, Filteau S, et al. Correlates of Physical Activity among Young Children with Moderate Acute Malnutrition. J Pediatr. 2017;181: 235–241. doi:10.1016/j.jpeds.2016.10.073
18. Friis H, Cichon B, Fabiansen C, Iuel-Brockdorff A-S, Yaméogo CW, Ritz C, et al. Serum cobalamin in children with moderate acute malnutrition in Burkina Faso: Secondary analysis of a randomized trial. PLoS Med. 2022;19: e1003943. doi:10.1371/journal.pmed.1003943

PhD thesis

Ann-Sophie Iuel-Brockdorff
Acceptability of supplementary foods for children with moderate acute malnutrition and feeding behaviours during home-based treatment.

Christian Fabiansen
Nutritional supplementation of children with moderate acute malnutrition.

Bernardette Cichon
Morbidity, iron and anaemia in children with moderate acute malnutrition

Partners

Treatfood started as a collaboration between Médicins Sans Frontièrs (MSF, Denmark) and our research group, and was conducted in Burkina Faso in collaboration with the non-governmental organization Alliance for International Medical Action (ALIMA, Senegal).

Funded by

• Danish International Development Agency
• Médecins Sans Frontières (Denmark, Norway)
• Arvid Nilsson's Foundation
• Merete and Mogens Brix Christensen
• The World Food Program/USAID
• ALIMA and the European Union's humanitarian aid funds, in partnership with Action Contre la Faim.

Contact

Professor Henrik Friis