A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose-response effect in improving linear growth: a 12-month cluster randomised trial.

Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient-micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (-1 center dot 219 (sd 0 center dot 06) KP, -1 center dot 211 (sd 0 center dot 03) MN, -1 center dot 266 (sd 0 center dot 03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0 center dot 043). Mean serum Hb was higher in KP infants free from acute infection (114 center dot 02 (sd 1 center dot 87) g/l) than MN (107 center dot 8 (sd 2 center dot 5) g/l; P = 0 center dot 047) and NE (108 center dot 8 (sd 0 center dot 99) g/l; P = 0 center dot 051). Compliance was 84 center dot 9 % (KP) and 87 center dot 2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0 center dot 2 LAZ; P = 0 center dot 026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose-response effect on LAZ adjusting consumption for delivery.