Abstract
OBJECTIVES: Lipid-based nutritional supplements (LNS) and fortified blended flours (FBF) are widely used to increase the nutrient density of children's diets and improve their health, but studies of supplementation have shown relatively modest improvements in linear growth. One mediating factor could be displacement of other foods. This study used food frequency data from a supplementation trial that compared FBF to a lipid-based product. We hypothesized that FBFs, which are typically boiled and fed to the infant as porridge, would displace starchy staples more often than lipid-based supplements, which can be eaten directly by the child. METHODS: We re-analyzed data from a cost-effectiveness trial designed to compare impacts on anthropometry among infants aged 6–23 months in Burkina Faso of three FBFs versus one LNS. Using food frequency dietary data from a single 24-hour recall period from the original study (n = 1612 children, observed once over 18-month study period), we fit logistic regression models to estimate differences in intake of each food group (grains, legumes and nuts, dairy, flesh foods, fruits and vegetables, vitamin A rich foods, and eggs), and used linear models to test for differences in a diet diversity score between children who received FBF and those who received LNS. We also tested for differences in breastfeeding time using the sub-sample for which that outcome was observed (n = 193). RESULTS: Children who consumed FBF were 54% less likely to consume the family's cereal grains than those who were fed LNS (OR = 0.46; 95% CI: 0.29, 0.73). Intake of other foods, diet diversity and breastfeeding time did not differ significantly between the two study arms. CONCLUSIONS: Fortified blended flours displaced the household's own cereal grains more than lipid-based supplements did, with no difference in the child's consumption of other more nutrient-rich family foods. Given limited stomach capacity and feeding time, providing fortified cereals can help improve children's overall diet quality in settings where children would otherwise be fed nutrient-poor starchy staples. FUNDING SOURCES: United States Agency for International Development, Office of Food for Peace. SUPPORTING TABLES, IMAGES AND/OR GRAPHS: