We tested a locally-produced, fish-based multiple micronutrient fortified lipid-based nutrient supplement (LNS) snack as a ready-to-use supplementary food (RUSF) to prevent undernutrition in Cambodian children under 2 years.
Our first trial assessed the RUSF’s acceptability as a snack or mixed with borbor (white rice porridge) compared to Corn-Soy Blend Plus Plus (CSB++), and micronutrient powders (MNP) with borbor. The second assessed its effectiveness in reducing growth faltering compared to CSB++, MNP, and an unsupplemented control group.
The acceptability trial with 92 children aged 9-23 months assessed children’s consumption, caregivers’ assessment of children’s preferences and caregivers’ ranking of foods. The cluster-randomised controlled effectiveness trial allocated 485 healthy children aged 6-17 months to RUSF, CSB++, MNP or control groups for 6 months. Outcomes were weight-for-age (WAZ), height-for-age (HAZ), weight- for-height (WHZ), and mid-upper arm circumference (MUAC).
In acceptability testing, odds of children consuming >50% were greatest for MNP-borbor versus RUSF snack. Caregivers reported that children had the highest preference for MNP-borbor, then for the RUSF snack. Caregivers ranked the RUSF snack highest.
In the effectiveness trial, growth faltered from baseline to endline, with no significant differences between interventions and control. In unadjusted analysis, the RUSF group had greater increases in MUAC than CSB++ or the control. For other outcomes, the RUSF did not differ significantly from the control, which had decreased WAZ and HAZ and no significant change in WHZ. In adjusted analysis, high consumers of RUSF had increased MUAC compared to control, but no statistically significant differences to CSB++ or MNP. Low consumers of RUSF had increased WAZ, WHZ and MUAC.
Our trials demonstrated that the novel RUSF is acceptable and slowed, but did not prevent, growth faltering.