Menu ENN Search

Adding proteins to lipid-based nutrient supplements in Uganda: Which was best?

View this article as a pdf

This is a summary of the following paper: Mbabazi J, Pesu H, Mutumba R et al. (2023) Effect of milk protein and whey permeate in large quantity lipid-based nutrient supplement on linear growth and body composition among stunted children: A randomised 2x2 factorial trial in Uganda. PLOS Medicine, 20.

Lipid-based nutrient supplements (LNS) have been shown to effectively treat undernutrition in multiple settings. To improve the nutrient profile and, specifically, raise the protein content, milk powder is often added to LNS as a primary ingredient. However, milk is a costly ingredient that raises the price per unit of LNS and may be less sustainable than alternatives.

To assess the effects of different proteins added to LNS, the researchers analysed secondary data from the Milk Affecting Growth, Cognition, and the Gut in Child Stunting (MAGNUS) trial. MAGNUS used a double-blinded, randomised 2x2 factorial design (Figure 1) (600 participants) with an untreated control group (150 participants). The trial tested the effects of four large quantity LNS formulations (Box 1).

Figure 1: 2 x 2 factorial design

600 participants,

evenly allocated






Height (cm)

Knee–heel length (mm)

Height (cm)

Knee–heel length (mm)

Soy protein


Height (cm)

Knee–heel length (mm)

Height (cm)

Knee–heel length (mm)

Children aged 12–59 months with a height for age Z-score <-2 and weight-for-height ≥-3 were referred for assessment and eligibility screening from two study sites in eastern Uganda.

Box 1: How do the four interventions compare?

The treatment group received one sachet of LNS (100g/day) for 12 weeks. The energy and macronutrient content of each intervention was matched. Each sachet provided 530–535kcal, which is around half the average daily energy requirement for a child. All daily micronutrient requirements were met. Nutrition counselling was offered to all caregivers upon entry to the study.

Milk protein: Dry milk powder, which is the de facto ingredient in many LNS formulations. May support growth and fat-free mass accretion.

Whey permeate: A byproduct of cheese-making, which is significantly cheaper than milk powder. Proposed as an alternative to milk powder, although its protein content is significantly lower.

Soy protein: Non-dairy alternative protein source, which is less expensive and more sustainable than milk protein. Some evidence that soy may be less effective than dairy for growth and recovery1, although further research is required.

Maltodextrin: Carbohydrate-based, inexpensive additive used as a thickening agent and preservative in processed foods. No fat or protein content. No known therapeutic benefit for this population.

Milk protein and whey permeate resulted in no differences in height, but milk protein more readily increased fat-free mass. Adding dairy to LNS did not appear to offer further benefits for linear growth or body composition in this group. Unsupplemented children continued to become more stunted, whereas supplemented children had a 0.17 Z-score recovery in height while also gaining fat-free mass.

“Supplementation with LNS, irrespective of milk, supports linear catch-up growth and accretion of fat-free mass, but not fat mass”

The study assessed numerous secondary outcomes that are beyond the scope of this summary. Given the overall findings, the authors propose that large quantity LNS should be considered in programmes to treat stunting.

The study featured robust methodology and an appropriate sample size based on the effect size estimates. There was a low dropout rate and minimal missing data. Randomisation and double blinding increase the validity of results, so we can interpret these findings with a high degree of confidence. The researchers opted to study children aged 12–59 months to minimise breastfeeding confounding. We should be cautious when extrapolating these findings to other age groups.


More like this

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: 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...

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: 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: 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...

FEX: Effects of nutritional supplementation for HIV patients starting antiretroviral treatment in Ethiopia

Summary of research1 Location: Ethiopia What we know: Poor nutritional status at initiation of ART is associated with impaired treatment outcomes among African patients with...

FEX: Concerns that The Lancet double-burden series may undermine moderate wasting treatment

View this article as a pdf By Mark Manary, Donna Wegner, D Taylor Hendrixson, Rebecca Roediger, Meghan Callaghan Mark Manary is one of the world's foremost experts in...

FEX: A Role for the Knemometer in Emergencies

Summary of research study During emergencies, there is usually more concern about the effect of malnutrition in children, on weight loss rather than on linear growth, i.e....

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: Alternative RUTF formulations (Special Supplement 2)

By Steve Collins & Jeya Henry Developing CTC programmes that use Ready to Use Therapeutic Food (RUTF) made locally, from locally available produce, and used to treat...

en-net: Does Low MUAC treated with RUTF result in children becoming obese?

Using MUAC to identify SAM cases tends to identify more younger and stunted children compared to WHZ. Concerns have been expressed that stunted children with low MUAC may have...

FEX: Micronutrients Supplementation Can Redress Stunting Up to Six Years of Age

Published research1 Research was conducted between May 1998 and January 1999 at Saharawi refugee camps near the town of Tindouf in south west Algeria. After political changes...

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: Chronic disease outcomes after SAM in Malawian children (ChroSAM): A cohort study

Summary of research* Location: Malawi What we know: Little is known about the long-term health effects of survivors of severe acute malnutrition (SAM), particularly risk of...

FEX: Short malnourished children and fat accumulation with food supplementation

Research snapshot1 Supplementary feeding programmes (SFPs) commonly do not to measure the mid-upper arm circumference (MUAC) of children whose length is <67 cm. These...

en-net: Plumpy doz for chronic malnutrition prevention

After the release of the papers from Phuka and Adu-Afarwuah showing the possible effect of LNS in the prevention of chronic malnutrition, some organizations might be thinking...

en-net: Plumpy nut Vis-à-vis Supplementary plumpy

Based on the nutritional information of the two products, there is no difference in nutritional composion (energy,protein, Fat, and micronutritient) except plumy nut has animal...

en-net: Preparation of Soup for treatment of SAM & MAM at emergency sites

I have faced some problem on treatment of SAM & MAM at emergency sites with a preparation of soup. can you give me technical advises about Preparation of soup from different...

en-net: Nutrition RUTF expert needed for consultancy TERMS OF REFERENCE, September 2019 Clinical assessment of alternative...

en-net: Zinc supplementation to SAM and/or MAM with acute diarrhoea?

Can we give zinc supplementation to the severely and/or moderately acute malnourished children with acute diarrhoea? The Unicef and WHO document "Diarrhoea treatment guideline...


Reference this page

Adding proteins to lipid-based nutrient supplements in Uganda: Which was best?. Field Exchange 70, September 2023. p31.



Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.