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Fortified blended flour supplements displace plain cereals in feeding of young children

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Research snapshot1

Growth faltering often occurs during the period of complementary feeding, from six to 20 months of age, when the child is transitioning from exclusive breastfeeding to a family diet. In the Sahel, most complementary foods are composed of cereals that are often combined with sugar and water to make a porridge. This may provide sufficient dietary energy but lacks the protein, fats and micronutrients needed for optimum child growth and development. Lipid-based nutritional supplements (LNS) and fortified blended flours (FBF) are widely used to increase the nutrient density of children's diets in supplementary feeding programmes but their effectiveness can be modified by the displacement of other foods: if supplements replace plain household cereals but not more nutrient-dense family foods, the nutrient-density of the diet would improve; if, however, supplements displace nutrient-dense foods, the diet quality could worsen.

To explore this issue, the authors reanalysed data from a trial comparing the cost-effectiveness of three FBFs and one LNS in the prevention of stunting and wasting among infants aged seven to 23 months in Burkina Faso. Using logistic regression, the differential effects of these supplementary foods on the displacement of breastfeeding or household complementary foods were explored and which specific food groups were displaced was investigated.

Supplementation with FBFs displaced household cereal consumption significantly when compared to supplementation with LNS. The relationship was strongest for two of the three FBFs tested (CSB+ w/oil and CSWB w/oil). While there was some evidence that the third FBF tested (SC+) may also displace more vitamin A-rich fruits and vegetables than the LNS product tested, children who consumed SC+ were also more likely to eat other fruits and vegetables indicating that those who consumed SC+ consumed similar amounts of fruits and vegetables as those in the other study arms, although of different types. Consumption of other foods, dietary diversity and breastfeeding did not differ significantly.

Evidence from this study that FBFs displace household cereals but not other more nutrient-dense foods may assuage concerns that supplementary foods have limited effectiveness due to the displacement of household foods. Given the small stomach size and limited feeding time of infants, this displacement of unfortified household cereals by fortified flours may be beneficial for infants in the meeting of their nutrient needs.

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1Cliffer, I R,  Masters, W A,  Rogers,  B L  (2020) Fortified blended flour supplements displace plain cereals in feeding of young children. Matern Child Nutr. e13089. https://doi.org/10.1111/mcn.13089

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Fortified blended flour supplements displace plain cereals in feeding of young children. Field Exchange 65, May 2021. p73. www.ennonline.net/fex/65/fortifiedblendedflour

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