Effectiveness of supplementary blended flour based on chickpea and cereals for the treatment of infants with moderate acute malnutrition in Iran
A randomized clinical trial
Keywords:
Malnutrition, Children, Supplementary food, Chickpea, CerealsAbstract
Background: Despite the decreasing rate of under nutrition children in recent years overall, the negative affect in growth and development make it as a main concern in the world. Applying an available and appropriate supplementary food is a major approach in treating children with Moderate Acute Malnutrition (MAM). Objective: To compare the effectiveness of a new supplementary blended flour (containing chickpea, rice, wheat and barley, named Shadameen) in combination with multivitamin/mineral supplement and nutritional counseling versus multivitamin/mineral supplement and nutritional counseling alone, in the treatment of children with MAM. Methods: This randomized controlled trial study was conducted at Heshmatiyeh Hospital in Sabzevar city in Iran, from January 2016 to December 2016. Seventy infants, aged 9 to 24 months with MAM who were referred from urban health centers to the hospital clinic were included. They were randomly assigned to receive, for about 3 months, either multivitamin / mineral supplement and nutritional counseling alone or in combination with an extra supplementary blended food. We analyzed weight, length, weight for length Z score (WLZ), weight for age Z score (WAZ) and length for weight Z score (LAZ), along with recovery rate and adverse events among the two groups. The data were analyzed using SPSS version 16. We used statistics, Chi-square, independent t-test, and Fisher's exact test for the analyses of primary and secondary outcomes. Results: The food supplementation infant's mean weight and WLZ and WAZ were greater compared with the other group (0.81±0.29 gr and 0.55±0.33 gr, p=0.002), (0.36±0.36 and 0.02±0.52, p=0.003), (0.40±0.33 and 0.09±0.37, p=0.001). The recovery rate in the food supplemented group was significantly higher than the other group (68.4%, 31.6%, p=0.001). No adverse reactions were observed. There were no significant differences in LAZ at the end of the study between the two groups (p=0.53). Conclusion: This study showed that Shadameen in combination with multivitamin/mineral and counselling therapy can be more effective in decreasing the wasting rate of children with MAM than vitamin/mineral and counseling therapy alone. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015040921670N1. Funding: This study was financially supported by the vice chancellor for research office, Mashhad University of Medical Sciences.
References
Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney L, et al. Defining pediatric malnutrition:
a paradigm shift toward etiology-related definitions. Journal of J Parenter Enteral Nutr. 2013; 37(4): 460- 81. doi: 10.1177/0148607113479972. PMID: 23528324.
Amsalu S, Tigabu Z. Risk factors for severe acute malnutrition in children under the age of five: A case- control study. Ethiop j health dev. 2016; 22(1). doi: 10.4314/ejhd.v22i1.10058.
UNICEF-WHO-The World Bank Group. Joint Child Malnutrition Estimates. In United Nations Children’s
Fund. New York, Geneva, Washington DC: UNICEF, WHO,The World Bank; 2015.
Hoseini BL, Emami Moghadam Z, Saeidi M, Rezaei Askarieh M, Khademi G. Child malnutrition at
different world regions in 1990-2013. Int J Pediatr. 2015; 3(5.1): 921-32. doi: 10.22038/ijp.2015.4748.
Sharifzadeh G, Mehrjoofard H, Raghebi S. Prevalence of malnutrition in under 6-year olds in South
Khorasan, Iran. Iran J Pediatr. 2010; 20(4): 435-41. PMID: 23056743, PMCID: PMC3446098.
Schoonees A, Lombard M, Musekiwa A, Nel E, Volmink J. Ready‐to‐use therapeutic food for home‐
based treatment of severe acute malnutrition in children from six months to five years of age. The Cochrane
Library. 2013. doi: 10.1002/14651858.CD009584.pub2.
Lenters L, Wazny K, Bhutta ZA. Management of Severe and Moderate Acute Malnutrition in Children.
Reproductive, Maternal, Newborn, and Child Health. 2016: 205. PMID: 27227221
Lazzerini M, Rubert L, Ronfani L, Pani P, Montico M. Specially formulated foods for treating children
with acute moderate malnutrition in low- and middle-income countries. (Protocol) Cochrane Database of
Systematic Reviews 2012, Issue 1. Art. No.: CD009584. DOI: 10.1002/14651858.CD009584. 9) Ashworth A, Ferguson E. Dietary counseling in the management of moderate malnourishment in children.
Food Nutr Bull. 2009; 30(3_suppl3): S405-33. doi: 10.1177/15648265090303S304. PMID: 19998865.
Lazzerini M, Rubert L, Pani P. Specially formulated foods for treating children with moderate acute
malnutrition in low- and middle-income countries. (Review) Cochrane Database of Systematic Reviews
, Issue 6. Art. No.: CD009584. DOI: 10.1002/14651858
Karakochuk C, van den Briel T, Stephens D, Zlotkin S. Treatment of moderate acute malnutrition with
ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend
in children in southern Ethiopia: an operations research trial. The Am J Clin Nutr. 2012; 96(4): 911-6. doi:
3945/ajcn.111.029744. PMID: 22952175.
Ahmed T, Choudhury N, Hossain MI, Tangsuphoom N, Islam MM, de Pee S, et al. Development and
acceptability testing of ready-to-use supplementary food made from locally available food ingredients in
Bangladesh. BMC pediatr. 2014; 14(1): 164. doi: 10.1186/1471-2431-14-164. PMID: 24972632.
LaGrone LN, Trehan I, Meuli GJ, Wang RJ, Thakwalakwa C, Maleta K, et al. A novel fortified blended
flour, corn-soy blend “plus-plus,” is not inferior to lipid-based ready-to-use supplementary foods for the
treatment of moderate acute malnutrition in Malawian children. Am J Clin Nutr. 2012; 95(1): 212-9. doi:
3945/ajcn.111.022525. PMID: 22170366.
Patel MP, Sandige HL, Ndekha MJ, Briend A, Ashorn P, Manary MJ. Supplemental feeding with ready-to- use therapeutic food in Malawian children at risk of malnutrition. J Health Popul Nutr. 2005: 351-7. PMID:
Ackatia-Armah RS, McDonald CM, Doumbia S, Erhardt JG, Hamer DH, Brown KH. Malian children with
moderate acute malnutrition who are treated with lipid-based dietary supplements have greater weight gains
and recovery rates than those treated with locally produced cereal-legume products: a community-based,
cluster-randomized trial. Am J Clin Nutr. 2015; 101(3): 632-45. doi: 10.3945/ajcn.113.069807. PMID:
Zavoshy R, Noroozi M, Jahanihashemi H, Kiamiri D. Nutritional intervention on malnutrition in 3-6 years
old rural children in Qazvin Province, Iran. Pak J Biol Sci. 2012; 15(7): 347-52. doi:
3923/pjbs.2012.347.352. PMID: 24163961
World Health Organization. Vitamin and mineral requirements in human nutrition: report of a joint
FAO/WHO expert consultation, Bangkok, Thailand, 21-30 September 1998. World Health Organization;
Fats F.A.O. fatty acids in human nutrition. Report of an expert consultation. FAO Food and nutrition paper.
; 91: 1-166.
WHO Guidline. potassium intake for adults and children. World Health Organization. 2012: 2.
World Health Organization. WHO child growth standards: methods and development: length/height-for- age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Geneva: World
Health Organization; 2006.
World Health Organization. WHO Anthro for personal computers, version 3.2.2, 2011: software for
assessing growth and development of the world’s children. Geneva: WHO. 2010.
Dijkhuizen P. Processed complementary foods in the World Food Programme. Food Nutr Bull. 2000;
(1): 62-4. doi: 10.1177/156482650002100110.
Sotelo A, Arenas M, Hernandez M. Use of chickpea (Cicer arietinum L.) in non-dairy formulas. I.
Chemical composition and nutritive quality of chickpeas and a comparison with commercial infant
formulas. Arch Latinoam Nutr. 1987; 37(3): 551-9. PMID: 3506409
Ulloa J, Valencia M, Garcia Z. Protein concentrate from chickpea: nutritive value of a protein concentrate
from chickpea (Cicer arietinum) obtained by ultrafiltration and its potential use in an infant formula. J Food
Sci. 1988; 53(5): 1396-8. doi: 10.1111/j.1365-2621.1988.tb09285.x.
Milan-Carrillo J, Valdez-Alarcon C, Gutierrez-Dorado R, Cardenas-Valenzuela OG, Mora-Escobedo R,
Garzon-Tiznado JA, et al. Nutritional properties of quality protein maize and chickpea extruded based
weaning food. Plant Foods Hum Nutr. (Dordrecht, Netherlands). 2007; 62(1): 31-7. doi: 10.1007/s11130- 006-0039-z. PMID: 17243010.
Matilsky DK, Maleta K, Castleman T, Manary MJ. Supplementary feeding with fortified spreads results in
higher recovery rates than with a corn/soy blend in moderately wasted children. J Nutr. 2009; 139(4): 773- 8. doi: 10.3945/jn.108.104018. PMID: 19225128.
Krebs NF, Mazariegos M, Chomba E, Sami N, Pasha O, Tshefu A, et al. Randomized controlled trial of
meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in
diverse settings. Am J Clinl Nutr. 2012; 96(4): 840-7. doi: 10.3945/ajcn.112.041962. PMID: 22952176.
Nackers F, Broillet F, Oumarou D, Djibo A, Gaboulaud V, Guerin PJ, et al. Effectiveness of ready-to-use
therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate
acute malnutrition in Niger. J Trop Pediatr. 2010; 56(6): 407-13. doi: 10.1093/tropej/fmq019. PMID:
John C, Gopaldas T. Evaluation of the Impact on Growth of a Controlled 6-month Feeding Trial on
Children (6–24 Months) Fed a Complementary Feed of a High Energy–Low Bulk Gruel Versus a High
Energy–High Bulk Gruel in Addition to Their Habitual Home Diet. J Trop Pediatr. 1993; 39(1): 16-22.
PMID: 8383208.
Phu PV, Hoan NV, Salvignol B, Treche S, Wieringa FT, Dijkhuizen MA, et al. A six-month intervention
with two different types of micronutrient-fortified complementary foods had distinct short-and long-term
effects on linear and ponderal growth of Vietnamese infants. J Nutr. 2012; 142(9): 1735-40. doi:
3945/jn.111.154211. PMID: 22810985.
Dewey KG, Adu‐Afarwuah S. Systematic review of the efficacy and effectiveness of complementary
feeding interventions in developing countries. Matern Child Nutr. 2008; 4(s1): 24-85. doi: 10.1111/j.1740- 8709.2007.00124.x. PMID: 18289157.
Malunga LN, Bar-El SD, Zinal E, Berkovich Z, Abbo S, Reifen R. The potential use of chickpeas in
development of infant follow-on formula. Nutr J. 2014; 13(1): 8. doi: 10.1186/1475-2891-13-8. PMID:
Phuka J, Thakwalakwa C, Maleta K, Cheung YB, Briend A, Manary M, et al. Supplementary feeding with
fortified spread among moderately underweight 6–18‐month‐old rural Malawian children. Matern
Child Nutr. 2009; 5(2): 159-70. doi: 10.1111/j.1740-8709.2008.00162.x. PMID: 19292750.
Matilsky DK, Maleta K, Castleman T, Manary MJ. Supplementary feeding with fortified spreads results in
higher recovery rates than with a corn/soy blend in moderately wasted children. J Nutr. 2009; 139(4): 773- 8. doi: 10.3945/jn.108.104018. PMID: 19225128.
Locks LM, Manji KP, McDonald CM, Kupka R, Kisenge R, Aboud S, et al. Effect of zinc and
multivitamin supplementation on the growth of Tanzanian children aged 6–84 wk: a randomized, placebo- controlled, double-blind trial. Am J Clin Nutr. 2016; 103(3): 910-8. doi: 10.3945/ajcn.115.120055. PMID:
36) Hess SY, Abbeddou S, Jimenez EY, Some JW, Vosti SA, Ouedraogo ZP, et al. Small-quantity lipid-based
nutrient supplements, regardless of their zinc content, increase growth and reduce the prevalence of
stunting and wasting in young burkinabe children: a cluster-randomized trial. PloS one. 2015; 10(3):
e0122242. doi: 10.1371/journal.pone.0122242. PMID: 25816354.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
