MAGNUS
Milk affecting growth, cognition and the gut in child stunting
- During the 12-week study, children that did not receive any supplement became more stunted and had an unhealthy change in body composition. We found that their height-for-age z-score declined, and relative to their height, these children accumulated fat mass and lost fat-free mass.
- In contrast, the children that received any of the 4 lipid-based nutrient supplements increased in height-for-age z-score and fat-free mass, however not fat mass. There was no difference in catch-up growth between children below and above 2 years.
- In the main analyses of the randomized 2x2 factorial trial, we showed that there were no additional effects of adding milk protein or whey permeate to lipid-based nutrient supplements on linear growth or body composition.
- We conclude that since children on a growth faltering trajectory gain fat at the expense of fat-free mass if they are left untreated, programs using lipid-based nutrient supplements to treat stunting should be considered.
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Lewis, J. I., Friis, H., Mupere, E., Wells, J. C. & Grenov, B. Calibration of Bioelectrical Impedance Analysis Against Deuterium Dilution for Body Composition Assessment in Stunted Ugandan Children. The Journal of Nutrition 153, 426–434 (2023).
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Mbabazi, J., Pesu, H., Mutumba, R., Filteau, S., Lewis, J. I., Wells, J. C., Olsen, M. F., Briend, A., Michaelsen, K. F., Mølgaard, C., Ritz, C., Nabukeera-Barungi, N., Mupere, E., Friis, H. & Grenov, B. Effect of milk protein and whey permeate in large quantity lipid-based nutrient supplement on linear growth and body composition among stunted children: A randomized 2 × 2 factorial trial in Uganda. PLoS Med 20, e1004227 (2023).
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Mbabazi, J., Pesu, H., Mutumba, R., McCray, G., Michaelsen, K. F., Ritz, C., Filteau, S., Briend, A., Mupere, E., Grenov, B., Friis, H. & Olsen, M. F. Effect of Milk Protein and Whey Permeate in Large-Quantity Lipid-Based Nutrient Supplement on Early Child Development among Children with Stunting: A Randomized 2 × 2 Factorial Trial in Uganda. Nutrients 15, 2659 (2023)
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Mbabazi, J., Pesu, H., Mutumba, R., Bromley, K., Ritz, C., Filteau, S., Briend, A., Mupere, E., Grenov, B., Friis, H. & Olsen, M. F. Correlates of early child development among children with stunting: A cross-sectional study in Uganda. Matern Child Nutr e13619 (2024). doi:1111/mcn.13619
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Mutumba, R., Mbabazi, J., Pesu, H., Greibe, E., Olsen, M. F., Briend, A., Mølgaard, C., Ritz, C., Mupere, E., Filteau, S., Friis, H. & Grenov, B. Micronutrient Status and Other Correlates of Hemoglobin among Children with Stunting: A Cross-Sectional Study in Uganda. Nutrients 15, 3785 (2023).
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Mutumba, R., Pesu, H., Mbabazi, J., Greibe, E., Olsen, M. F., Briend, A., Mølgaard, C., Ritz, C., Nabukeera-Barungi, N., Mupere, E., Filteau, S., Friis, H. & Grenov, B. Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda. Nutrients 15, 3429 (2023).
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Mutumba, R., Pesu, H., Mbabazi, J., Greibe, E., Nexo, E., Olsen, M. F., Briend, A., Mølgaard, C., Michaelsen, K. F., Ritz, C., Filteau, S., Mupere, E., Friis, H. & Grenov, B. Effect of lipid-based nutrient supplements on micronutrient status and hemoglobin among children with stunting: secondary analysis of a randomized controlled trial in Uganda. The American Journal of Clinical Nutrition 119, 829–837 (2024).
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Pesu, H., Mbabazi, J., Mutumba, R., Savolainen, O., Olsen, M. F., Mølgaard, C., Michaelsen, K. F., Ritz, C., Filteau, S., Briend, A., Mupere, E., Friis, H. & Grenov, B. Correlates of Plasma Citrulline, a Potential Marker of Enterocyte Mass, among Children with Stunting: A Cross-Sectional Study in Uganda. The Journal of Nutrition 154, 765–776 (2024).
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Pesu, H., Mutumba, R., Mbabazi, J., Olsen, M. F., Mølgaard, C., Michaelsen, K. F., Ritz, C., Filteau, S., Briend, A., Mupere, E., Friis, H. & Grenov, B. The Role of Milk Protein and Whey Permeate in Lipid-based Nutrient Supplements on the Growth and Development of Stunted Children in Uganda: A Randomized Trial Protocol (MAGNUS). Curr Dev Nutr 5, nzab067 (2021).
Stunting, low height-for-age, is associated with delays in cognitive development and risk of chronic disease later in life.
Previous nutrition trials have focused on prevention of stunting by improving complementary diets of young children with corn-soy blend, which is used to prepare porridge, or small-quantity lipid-based nutrient supplements (SQ-LNS), an energy and nutrient dense paste based on peanuts.
However, there have not been any trials which provide supplements with larger amounts of milk or other high-quality proteins to already stunted children.
This may in part be due to previous concerns that stunted children will gain excess fat mass and so increase their risk of chronic disease.
We aim to assess the individual and combined effects of milk protein and whey permeate in large-quantity LNS (LNS-LQ) among stunted children on linear growth and other outcomes.
The study is a randomised, double-blind, two-by-two factorial trial, testing the effects of milk protein and whey permeate in LNS-LQ (100g/510-530 kcal).
An unsupplemented group is included to assess the overall effect of LNS. Children aged 12-59 months, with a height-for-age Z-score of less than -2 will be included from Jinja, Uganda (n=750).
The primary outcomes are change in knee-heel and total length/height over 12 weeks.
Secondary outcomes are child development, body composition, anthropometric indicators (mid-upper arm circumference, weight, head-circumference, weight-for-age, height-for-age and weight-for-height Z scores) and haemoglobin.
In addition, growth factors, markers of micronutrient status, systemic and intestinal inflammation and intestinal function, as well as the microbiota will be explored.
Our findings will contribute to an understanding of the role of specific milk ingredients in linear catch-up growth, and clarify to what extent milk ingredients will benefit important functional outcomes such as cognition.
Involved in the project
Internal
| Name | Title | Phone | |
|---|---|---|---|
| Grenov, Benedikte | Associate Professor | +4520456654 | |
| Mølgaard, Christian | Professor | +4535332516 | |
| Friis, Henrik | Professor | +4535333860 | |
| Olsen, Mette Frahm | Associate Professor | +4528340979 |
| Name | Title | Institution |
|---|---|---|
| André Briend | Affiliate Professor | Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark |
External
| Name | Title | Institution |
|---|---|---|
| Hannah Pesu Jespersen | PhD-student | Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark |
| Ezekiel Mupere | MD, PhD, Head, Ug Principal Investigator | Department of Paediatrics and Child Health, Makerere University & CFU, Uganda |
| Joseph Mbabazi | MSc, PhD-student | Department of Paediatrics and Child Health, Makerere University & CFU, Uganda |
| Rolland Mutumba | MD, PhD-student | Department of Paediatrics and Child Health, Makerere University & CFU, Uganda |
| Suzanne Filteau | MSc, PhD, Prof. | London School of Hygiene and Tropical Medicine, UK |
| Jonathan Wells | MSc, PhD, Prof, | Institute of Child Health, University College London, UK |
Funded by
- AFH Arla Food for Health
- The Danish Dairy Research Foundation
- Nutriset
- Various Danish foundations:
- Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis Legat
- Augustinus Fonden
- P. Møller Fonden til Lægevidenskabens Fremme
Period: 2019 - 2022.
Contact
Benedikte Grenov
Associate Professor