Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial

BACKGROUND: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40-50%. Although nutrition counselling has shown modest benefits few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting. METHODS: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++ WSB++) compared with Plumpydoz all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score LAZ) stunting (LAZ < -2) weight-for-length z-score (WLZ) and wasting (WLZ < -2) in children 6-18 months of age. Children (n = 5536) were enrolled at 6 months of age and in the food groups provided with one of the allocated supplements daily for a year. RESULTS: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02-0.04/month) in the Plumpydoz (P = 0.02) rice-lentil (< 0.01) and chickpea (< 0.01) groups relative to control whereas WLZ decline was lower only in Plumpydoz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group but lower by 5-6% (P