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What is the proper micronutrient composition for supplementation to promote catch up growth in stunted children?

This question was posted the Micronutrients forum area and has 1 replies.

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Yunhee Kang

Normal user

17 Apr 2010, 08:04

According to DHS 2005 of Ethiopia, prevalence of stunting and wasting are 51% and 12%, respectively, showing that both malnutrition should not be neglected. So we are planning to provide 1 RNI of multiple-micronutrients to several thousand children younger than 5 years, with the aim of prevention of infectious diseases and acute malnutrition, and promoting catch up growth. Then, I am skeptical of supplementing to stunted children with micronutrients met for daily nutrient needs for normal children. I think different micronutrient formula for stunted children need to apply to field program, meeting their need of daily nutrient and catch up growth. And I wonder if DHA or other fatty acid, known to be necessary for linear growth, can be included with daily micronutrient supplementation for one year. On the other hand, in our program, wasted children will be given CSB or Plumpy nut, according to their extent of wasting status. However, I wonder, although CSB or Plumpy nut may be effective for weight gain, to what extent, is CSB containing substantial anti-micronutrients or Plumpy nut effective on improvement of micronutrient deficient status which was often times diagnosed in a great number of wasted children.

Andy Seal

Associate Prof. International Nutrition

Normal user

21 Apr 2010, 10:28

Hello Yunhee Kang. You raise important and challenging issues and I think you are right to be sceptical about supplementing stunted children with just micronutrients and expecting to see an impact. Unfortunately, to the best of my knowledge, there is currently no evidence that shows a positive impact of micronutrient powders (MNP) on stunting or wasting. Those trials that showed positive impact on growth used a product containing energy, and protein and fat, as well as micronutrients. Energy and nutrient dense foods, such as Ready to Use Foods or Fortified Blended Foods are likely to be effective against wasting and stunting in a situation such as Ethiopia. There is a useful review by Kathryn Dewey at al. which looks at the use of food supplementation products for fortifying complementary foods for children. "Systematic review and meta-analysis of home fortification of complementary foods" (2009) is published in Maternal and Child Nutrition and should be available to those in developing countries via HINARI if you are interested in looking in more depth at this. Hopefully, we will get some additional comments from other en-net users as its a challenge that many people are facing.

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