The University of Copenhagen demonstrate that LNS, when compared to corn-soy porridge—the first line method of tackling malnutrition—resulted in greater weight gain, which was made up of healthy lean tissue.
“Previous studies of nutritional supplements have mainly looked at the effect on weight gain,” explained lead author Dr Christian Fabiansen, who is based at the Department of Nutrition, Exercise and Sports at the University of Copenhagen.
“It has been a concern that LNS, with its very high fat content, would result mainly in weight gain composed of fat. But by using a method based measurement of heavy water in the child's body we have found that LNS mainly increase lean mass that is muscles and organs, which are important for immune function, survival and development."
The severity of malnutrition, especially in the early years has prompted the World Health Organisation (WHO) to call for research identifying the most optimal foods for treatment of children with moderate acute malnutrition.
Supplementary foods are created using either corn-soy blend (CSB) or lipid-based nutrient supplement (LNS).
The differences between the two product types are substantial with nutritional composition, cost, consumption method and delivery logistics all factors influencing final choice.
A key protein source in CSB is dehulled soy, which contains higher levels of compounds impairing absorption of minerals compared to more expensive soy isolate (SI).
The first LNS product developed to treat severe acute malnutrition (SAM) was based on the nutritional composition of the therapeutic milk F-100, containing high amounts of dairy products and no soy.
This product type is also known as ready-to-use therapeutic food (RUTF). More recently, a range of LNS products, some containing soy, has been developed for moderate acute malnutrition (MAM).
The inclusion of dry skimmed milk in supplements improves the amino acid profile, provides minerals with high bioavailability when it replaces vegetable protein sources, but also increases costs.
Based on international market prices (October 2016) and calculated per gram protein, the cost of SI is about 80% of the price of DSM, and the cost of DS is 33% of the price of DSM.
A rough estimate based on information from UNICEF (October 2016) places LNS at around twice the cost of CSB per daily ration given.
Dr Fabiansen’s team at the University of Copenhagen worked with the Institut de Recherche en Sciences de la Santé in rural Northern Burkina Faso, an area with high acute malnutrition.
Here, more than 1600 children aged 6- to 23-months with acute malnutrition were given either LNS or CSB for 12 weeks.
These food supplements contained either SI or DS (as a measure of soy quality) and 0%, 20%, or 50% of protein obtained from milk.
The study found that children who received LNS experienced a weight gain of 0.083 kilograms per metres squared (kg/m2) compared to children who received CSB.
In addition, LNS resulted in 128 grams (g) greater weight gain if both LNS and CSB contained SI, but there was no difference between LNS and CSB if both contained DS (mean difference 22 grams (g))
Higher bioavailability of growth nutrients
"Acute malnutrition is still a major global health problem. So, I hope we can use the results to provide the best possible treatment for more vulnerable children,” said the general director of the Danish section of Médecins Sans Frontières (MSF), Jesper Brix.
“If we can treat children with moderate acute malnutrition with the scientifically proven most effective food aid product, and thereby prevent severe acute malnutrition, then many lives can be saved"
The team attributed the benefits of LNS to higher bioavailability of growth nutrients, such as zinc and phosphorus, compared to CSB, or a relatively higher intake.
Regarding weight, the findings between matrix and soy quality reflected that LNS with SI resulted in an 89 g (approximately 10% total gain) greater weight gain than did LNS with DS.
“The soy quality had no effect on weight for CSB,” the study explained.
“This was unexpected as SI compared to DS contains fewer anti-nutrients, which should lead to better absorption of minerals.
“Interestingly, we previously found a similar strong interaction between matrix and soy quality with respect to a supplement appreciation score, which indicated that children liked DS better than SI in CSB, but not in LNS.”
Published online ahead of print: doi.org/10.1371/journal.pmed.1002387
“Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso.”
Authors: Christian Fabiansen et al.