Preventing undernutrition in Cambodia: Assessing the effects of improved local complementary food on growth

Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandling

Jutta Kloppenborg Heick Skau

The first 1000 days (from conception to 24 months) of a child’s life are critical for long-term mental and physical development. This period is clearly marked as the optimal period of preventing malnutrition and named the “window of opportunity”. The first phase of complementary feeding (about 6-12 months) is the most critical. This is the transitional phase when solid foods gradually start to replace breast milk. The typical diet of complementary food in low-income countries is dominated by a single starch-rich staple, with little vegetables and fruits and few or no animal source foods (ASF). This complementary food diet is low in energy, nutrient-density, has poor vitamin and low mineral bioavailability.
To better understand the consequences or impact of nutrition interventions on growth more reliable measurement techniques are required. Researchers have argued that measuring body composition is an ideal means for studying the long-term consequences of growth and nutrition in early age.
The aim of the this thesis was therefore to assess the nutritional impact of formulated and locally produced complementary food products on body composition and linear growth in 6-15 months old Cambodian children; to assess nutritional status in association to body composition in 6 and 15 months old Cambodian children; and the ability of local food items to prevent undernutrition and highlight the challenges in preventing undernutrition in Cambodia.
In Paper I, we evaluated the efficacy of two new, rice-based complementary foods with local ASF: WinFood (WF) containing small fish and edible spiders (total 14% by dry weight); WinFood-Lite (WF-L) containing less ASF (10% fish) and fortified, against two conventional fortified corn-soy-blend products CSB+ and CSB++. CSB++ also contained 8% skimmedmilk powder. 419 infants six months of age were enrolled in this randomised single-blinded study for a nine month period, designed primarily to assess increments in fat-free body mass (FFM) by deuterium dilution techniques. Secondary endpoints were changes in standard anthropometric growth parameters, including knee-heel length. Gains in FFM did not differ between the food groups. The two fortified food products, WF-L and CSB++ both containing ASF (fish or milk) improved linear growth marginally better than the equally fortified, but plant-based product (CSB+) and also better than the non-fortified product containing 14% ASF (WF).

The second paper assessed the association of stunting, wasting, breastfeeding and sex as correlates of FFM and fat mass (FM) in Cambodian children at 6 and 15 months of age. 389 infants were included in this study. FFM and FM were measured at 6 and 15 months of age by deuterium dilution technique. Linear regression was used to assess the association of sex, breastfeeding, stunting and wasting as correlates of fat-free mass index (FFMI), fat mass index (FMI) and body mass index (BMI). This study showed that boys had a higher FFMI at 6 and 15 months of age. Stunted infants aged 6 months had a deficit in FMI, but not in FFMI, though no association with either FFMI or FMI was observed at age 15 months. Wasting at 6 and 15 months had a deficit in FFMI and FMI. Longer breastfeeding was associated with FMI. These findings give a perspective on the traditional understanding of undernutrition and propose a need for further studies from low-income countries on how nutrition intake influence body composition, but also how changes in body composition in early life influence growth, development and long term health.

In Paper III, we assessed the possibilities of using linear programming (LP) to determine if four formulated complementary food products could ensure adequate nutrients for 6-11 months old Cambodian infants. Dietary data were collected by 24-hour recall in a crosssectional survey of 6-11-month-old Cambodian infants (n=78). LP model parameters were derived from these data, including a list of foods, their median serving sizes and dietary patterns for the target population. Five series of LP analyses were carried out to model the target population’s baseline diet and plus one of four specially formulated complementary products The formulated complementary food products were shown to improve the nutrient adequacy of complementary feeding diets, but they could not entirely cover the nutrient gaps.

Together, these findings contribute with knowledge on different aspects of preventing undernutrition in the complementary feeding age in Cambodia. The findings address several components, which on their own is important in preventing undernutrition. This thesis links these components together by assessing the capability of local nutrient-dense food to meet nutrient requirements during complementary feeding (Paper III) and subsequent assessing these foods impact on growth, and hereby the potential for preventing undernutrition (Paper I) while providing a better understanding of nutritional status and optimal growth in this critical period of life (Paper II).
ForlagDepartment of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen
Antal sider130
ISBN (Trykt)978 87 7611 633 0
StatusUdgivet - 2013

Bibliografisk note

CURIS 2014 NEXS 389
Forsvaret 13. januar 2014

ID: 107147436