Could this novel supplementary food help slash Cambodia's childhood stunting and malnutrition problem?
A study led by the University of Sydney is aiming to test the efficacy of a novel RUSF formulation on malnourished Cambodian children.
In Cambodia, 32% of children under five — and 40% of three- to four-year-olds — are stunted, 24% underweight, and 10% wasted.
Poor infant feeding practices, especially insufficient complementary feeding, have led to low energy and nutrient levels in children. The result is inadequate growth and micronutrient status, and thus, childhood malnutrition.
Current RUSFs have not been entirely effective or well-accepted in the country, which has hindered the treatment and prevention of child malnutrition.
To counter this, a lipid-based nutrient supplement (LNS) containing multiple micronutrients was developed as a new type of RUSF. Unlike most RUSFs, the LNS' animal protein source is fish instead of milk.
Researchers at the University of Sydney, University of Queensland and University of Copenhagen, along with UNICEF and Cambodia's Ministry of Agriculture, Forestry and Fisheries, will assess the LNS' effectiveness in preventing growth faltering, and improving micronutrient status in Cambodian children.
This will follow an acceptability trial conducted on the LNS in June 2015, which showed that caregivers are willing to feed it to children, who are in turn willing to eat it.
The researchers will recruit 540 healthy children aged six to 11 months from peri-urban Phnom Penh for the six-month prospective, non-blinded RCT.
The effects of the LNF will be compared against that of two alternatives: Corn-Soy Blend Plus Plus (CSB++) and Sprinkles micronutrient powders, with a non-supplemented diet as the control.
In addition, the researchers will collect data at baseline, then every month for the rest of the trial. The allocated food will be provided monthly.
Meeting an urgent need
In a paper published in Nutrition Journal, the researchers highlighted "an urgent need to develop locally produced and culturally acceptable RUSFs, and to compare these with existing options in terms of their potential for preventing malnutrition, in Cambodia and elsewhere".
They added that the trial was expected to provide necessary data on the effectiveness of RUSFs with animal-sourced proteins besides milk by comparing the LNF to a RUSF with milk (CSB++).
Additionally, the LNF, which contains multiple micronutrients, will not only be compared with CSB++, which contains macro- and micronutrients, but also to Sprinkles, which contains no macronutrients.
They concluded: "From a programmatic point of view, if the novel RUSF proves successful, not only would it provide an acceptable, effective product for preventing childhood malnutrition, it might also simplify interventions in maternal and child nutrition in Cambodia and in countries where similar products could be produced, since, because of its composition, it could be used with pregnant and lactating women as well as children aged six months to two years."
Source: Nutrition Journal
"Randomised controlled trial to test the effectiveness of a locally-produced readyto-use supplementary food (RUSF) in preventing growth faltering and improving micronutrient status for children under two years in Cambodia: a study protocol"
Authors: Bindi Borg, et al.