Fortified spreads v CSB in supplementary feeding in Malawi

A child eating fortified spread made using skimmed milk
Summary of published research1
A study conducted in rural Malawi has compared the recovery rates of moderately wasted children fed fortified spreads to those fed corn soy blend (CSB). Fortified spreads are energy-dense, lipid-based pastes with added powdered micronutrients.
The study was a randomised clinical effectiveness trial where recovery rates were compared among children with moderate wasting who received either milk/peanut- fortified spread, soy/peanut fortified spread or CSB. The children were aged 6-60 months and were selected from 12 sites between July 2007 and February 2008, having undergone eligibility screening. Children were randomly allocated to one of the three diets and received iso-energetic quantities of food, 314 kj (75kcal) per kg per day for up to 8 weeks, with biweekly follow up. The primary outcome was recovery, defined as having a weight-for-height z score (WHZ) > -2. Time-event analysis was used to compare the recovery rate. A total of 1462 children were enrolled in the study.
Children receiving soy/peanut fortified spread had a similar recovery rate to those receiving milk/peanut fortified spread. Children in either of the fortified spread groups were more likely to recover than those receiving CSB (80% in both fortified spread groups versus 72% in the CSB group, P <0.01). The rate of weight gain in the first two weeks was greater among children receiving milk/peanut fortified spread (2.6 g/kg/day, n=465) or children receiving soy/peanut fortified spread (2.4 g/kg/day, n=450) than among children receiving CSB (2.0 g/kg/day, n=447), P = < 0.05). Rates of length gain did not differ between the three groups. Eight per cent of children in each feeding group developed oedema, indicative of severe malnutrition, while receiving supplemental feeding. Only 4.3% of children were lost to follow up.

A case of oedematous malnutrition admitted to the programme
The authors speculate that better outcomes with the fortified spreads may relate to less sharing with other family members as it was unfamiliar, and their greater energy density so that malnourished children have to consume smaller volumes. The 72% recovery rate among children receiving CSB was higher than expected and it was postulated that this may be due to mothers' increased compliance and vigilance, prompted by the health professionals delivering the care. The data also suggest that the inclusion of milk in supplementary foods for wasted children does not result in better linear growth.
The authors concluded that fortified spreads are superior supplementary foods to CSB for moderately wasted Malawian children. However, the major limitation is their high costs. At the time of the study, locally manufactured soy/peanut fortified spread cost half that of milk/peanut spread and twice that of CSB. At the same time, children treated with CSB required 20% more food, lessening the difference in costs of the foodstuffs.
One limitation of the trial was that it was conducted in agrarian, rural Malawi where corn is the staple food. Results may therefore differ in urban settings or in non-African populations. Further research is needed to determine whether soy/peanut fortified spreads are effective in other settings and operational contexts.
1Matilsky. D (2009). Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Journal of Nutrition, volume 139, pp 773-778, February 2009
More like this
en-net: RUSF and Supercereals
Hi, Kindly advise whether Ready to Use Supplementary Foods (RUSF) are more efficient, effiective and more nutritious as compared to Supercereals/ Unimix/ Corn/wheat Soya Blend...
FEX: CSB versus fortified spread in wasted HIV infected adults in Malawi
Summary of published research1 Eating ready-to-use fortified spread in Malawi The prevalence of wasting, defined as a Body Mass Index (BMI) <18.5, in adults with advanced...
FEX: WHO/UNICEF/WFP/UNHCR informal consultation on moderate malnutrition management in U5’s
Summary of meetinga The World Health Organisation (WHO) convened a meeting in Geneva (September 30th - October 3rd, 2008) with the overall aim of answering the question, 'What...
FEX: Recovery rate of children with moderate acute malnutrition treated with ready-to-use supplementary food (RUSF) or improved corn-soya blend (CSB+)
Summary of research * Location: Cameroon. What we know: A wide range of nutritional products are currently used to treat MAM; there is no definitive consensus on the most...
FEX: Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition in Burkina Faso
Summary of research1 Location: Burkina Faso What we know: There is no consensus on the effectiveness of lipid-nutrient supplement (LNS) compared to corn-soy blend (CSB) in...
en-net: Impact of individual packaging on food sharing practices?
Dear all, Do you know if studies exist on the impact of the packaging (family vs. individual) on the food/ product sharing practices within the household? Products provided...
FEX: Supplementary feeding using RUTF in Malawi
Summary of published research1 A study has recently been conducted to compare the clinical effectiveness of two supplementary feeding regimens in children at risk of...
FEX: Comparison of milk free v milk containing RUTF in SAM treatment in Zambia
Summary of published research1 Location: Zambia What we know: Global SAM treatment relies on internationally produced RUTF that is expensive. RUTF formulations that exclude...
FEX: TreatFOOD study in Burkina Faso
Summary of presentation1 of published research2 View this article as a pdf By Susan Shepherd Dr Susan Shepherd is Director of Clinical and Operational Research for...
FEX: Home-Based Therapy With RUTF In Malawi
By Dr. Mark Manary and Heidi Sandige Dr. Mark Manary is an Associate Professor of Paediatrics at Washington University School of Medicine and Lecturer at Malawi School of...
FEX: Preparation and presentation of corn-soy blend for moderately malnourished children in Malawi
Summary of published1 and unpublished research By Beatrice Lorge Rogers (Principal Investigator), Patrick Webb (Principal Investigator), Jocelyn Boiteau (Project...
en-net: One week missing doses of Plumpy Nut? What to do?
We have OTP program with SAM kids enrolled. the shipment of Plumpy Nut will take sometime to reach the county? what to do in the meantime? I think that Mark's first link to...
FEX: Response to malnutrition treatment in low weight-for-age children: secondary analyses of ComPAS trial data
View this article as a pdf Research summary1 Location: Kenya and South Sudan What we know: Children who are concurrently wasted and stunted (WaSt) have a very high mortality...
en-net: Ready to Use Supplementary Food
I can't find any research related abstracts on the use of soy based RUSF Vs groundnut based RUSF for management of moderately malnourished children. If someone in the forum has...
FEX: Lipid-Based Nutrient Supplement Research Network Meeting
By Sarah Style Sarah Style is part of the ENN team working with UNHCR on the Anaemia Control, Prevention and Reduction Project In April 2011, the International Lipid-Based...
FEX: Clinical Trial of BP100 vs F100 Milk for Rehabilitation of Severe Malnutrition
Child eating BP100 in Freetown TFC. By Carlos Navarro-Colorado and Stéphanie Laquière Carlos Navarro-Colorado is a medical doctor, with a MSc Epidemiology. He has ten years...
FEX: Early stages of a ‘Food by Prescription’ programme for HIV infected adults
By Elizabeth Bontrager and Kate Sadler Elizabeth Bontrager joined the Feinstein International Centre at Tufts University in 2008, where she coordinates Tufts' involvement in...
FEX: Developing food supplements for moderately malnourished children: lessons learned from RUTF
Summary of research1 Location: Global What we know: RUTF is as effective as F100 in treating SAM, where weight gain is the recovery outcome. Food supplements for moderate...
FEX: UNHCR Technical Workshop on the Operational Guidance on the use of Special Nutritional Products
By Sarah Style and Andrew Seal Sarah Style is an ENN consultant working on the UNHCR/ENN Anaemia Control, Prevention and Reduction Project. Andy Seal is a lecturer and...
FEX: Short children with a low MUAC respond to food supplementation: an observational study from Burkina Faso
By Fabiansen, C., Phelan, Kevin, P.Q., Cichon, B., Ritz, C., Briend, A., Michaelsen, K.F., Friis, H. and Shepherd, S Summary of research: Short children with a low midupper...
Reference this page
Matilsky. D (). Fortified spreads v CSB in supplementary feeding in Malawi. Field Exchange 37, November 2009. p9. www.ennonline.net/fex/37/fortified
(ENN_3964)