Complementary Food Supplements Fill Energy and Protein Gaps among Children with Dietary Inadequacy in a Complementary Feeding Trial in Rural Bangladesh

Background: Few studies have evaluated the dietary impact of complementary food supplements (CFSs) designed to deliver macro- and micronutrients to children at risk for undernutrition. In a randomized controlled trial in rural Bangladesh, we previously reported that CFSs increased children's micronutrient adequacy.

Objectives: To longitudinally characterize energy and macronutrient intakes and inadequacies and evaluate the extent to which CFSs fill intake gaps.

Methods: Children were enrolled at 6 mo and received 1 of 4 CFSs plus caregiver nutrition counseling or counseling alone for 1 y. A semi-quantitative diet questionnaire was administered at 6, 9, 12, 15, 18, and 24 mo. Energy and macronutrient intakes were estimated by age and arm; protein adequacy was adjusted for protein quality and infection. We estimated the proportion meeting intake requirements set by FAO and the Institute of Medicine and compared group-wise differences using log binomial regression models with generalized estimating equations. We used multivariate analysis of variance models to evaluate if CFSs substituted home foods.

Results: Across groups, most children did not meet energy or protein requirements at enrollment (74.6%-81.3% and 77.4%-79.2%, respectively). Estimated energy and macronutrient intakes from home foods increased from 6 to 24 mo. Energy inadequacy was lower in the supplemented groups compared with the control at all ages (e.g. 10.5%-13.8% compared with 31.4% at 18 mo). In the control group, protein inadequacy dropped from 78.4% at 6 mo to 8.3% at 9 mo to 2.8% by 18 mo; adjusted protein estimates were 25.1% at 9 mo and 7.0% at 18 mo. Protein inadequacy was the highest in the control group at all timepoints. CFSs did not substitute home foods.

Conclusions: CFSs can significantly bridge energy and protein intake gaps. With earlier trial findings that CFSs filled micronutrient gaps and improved growth, these findings strengthen evidence supporting using CFSs for improved health outcomes. This trial was registered at clinicaltrials.gov with registration number NCT01562379 (https://clinicaltrials.gov/ct2/show/NCT01562379).