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Lipids and cardiovascular/metabolic health

Effect of 12-month intervention with lipid-based nutrient supplements on physical activity of 18-month-old Malawian children: a randomised, controlled trial

European Journal of Clinical Nutrition volume 69, pages 173–178 (2015)Cite this article

Subjects

Abstract

Background/objectives:

This study measured the effects of dietary supplementation with lipid-based nutrient supplements (LNSs) on 18-month-old children’s physical activity.

Subjects/methods:

In a randomised, controlled, outcome-assessor blinded trial 1932 six-month-old children from Malawi received one of five interventions daily from 6–18 months of age: 10-g milk-LNS, 20-g milk-LNS, 20-g non-milk-LNS, 40-g milk-LNS or 40-g non-milk-LNS, or received no intervention in the same period (control). The control group received delayed intervention with corn–soy blend from 18–30 months. Physical activity was measured over 1 week by ActiGraph GT3X+ accelerometer at 18 months. Main outcome was mean vector magnitude accelerometer counts/15 s. Analyses were restricted to children with valid accelerometer data on at least 4 days with minimum 6 h of wearing time per day.

Results:

Of the 1435 children recruited to this substudy, 1053 provided sufficient data for analysis. The mean (s.d.) vector magnitude accelerometer counts in the total sample were 307 (64). The difference (95% CI) in mean accelerometer counts, compared with the control group, was 8 (−6 to 21, P=0.258) in 10-g milk-LNS, 3 (−11 to 17, P=0.715) in 20-g milk-LNS, 5 (−8 to 19, P=0.445) in 20-g non-milk-LNS, 10 (−3 to 23, P=0.148) in 40-g milk-LNS and 2 (−12 to 16, P=0.760) in 40-g non-milk-LNS groups.

Conclusions:

Provision of 10–40 g doses of LNS daily for 12 months did not increase physical activity of Malawian toddlers.

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References

  1. Briend A . Highly nutrient-dense spreads: a new approach to delivering multiple micronutrients to high-risk groups. Br J Nutr 2001; 85: S175–S179.

    Article  CAS  PubMed  Google Scholar 

  2. Arimond M, Zeilani M, Jungjohann S, Brown KH, Ashorn P, Allen LH et al. Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the International Lipid-Based Nutrient Supplements (iLiNS) Project. Matern Child Nutr 2013; e-pub ahead of print 6 May 2013; doi:10.1111/mcn.12049.

  3. Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A . Management of severe acute malnutrition in children. Lancet 2006; 368: 1992–2000.

    Article  PubMed  Google Scholar 

  4. Manary MJ, Sandige HL . Management of acute moderate and severe childhood malnutrition. BMJ 2008; 337: a2180.

    Article  PubMed  Google Scholar 

  5. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013; 382: 452–477.

    Article  PubMed  Google Scholar 

  6. Dewey KG, Adu-Afarwuah S . Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 2008; 4: 24–85.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dewey KG, Yang Z, Boy E . Systematic review and meta-analysis of home fortification of complementary foods. Matern Child Nutr 2009; 5: 283–321.

    Article  PubMed Central  Google Scholar 

  8. Huybregts L, Houngbe F, Salpeteur C, Brown R, Roberfroid D, Ait-Aissa M et al. The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity: a cluster-randomized controlled trial. PLoS Med 2012; 9: e1001313.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mangani C, Maleta K, Phuka J, Cheung YB, Thakwalakwa C, Dewey K et al Effect of complementary feeding with lipid-based nutrient supplements and corn-soy blend on the incidence of stunting and linear growth among 6–18-month-old infants and children in rural Malawi. Matern Child Nutr 2013; doi:10.1111/mcn.12068.

  10. Manary MJ, Ndkeha MJ, Ashorn P, Maleta K, Briend A . Home based therapy for severe malnutrition with ready-to-use food. Arch Dis Child 2004; 89: 557–561.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Beckett C, Durnin JV, Aitchison TC, Pollitt E . Effects of an energy and micronutrient supplement on anthropometry in undernourished children in Indonesia. Eur J Clin Nutr 2000; 54: S52–S59.

    Article  CAS  PubMed  Google Scholar 

  12. Jahari AB, Saco-Pollitt C, Husaini MA, Pollitt E . Effects of an energy and micronutrient supplement on motor development and motor activity in undernourished children in Indonesia. Eur J Clin Nutr 2000; 54: S60–58.

    Article  CAS  PubMed  Google Scholar 

  13. Timmons BW, Naylor PJ, Pfeiffer KA . Physical activity for preschool children–how much and how? Can J Public Health 2007; 98: S122–S134.

    PubMed  Google Scholar 

  14. Timmons BW, Leblanc AG, Carson V, Connor Gorber S, Dillman C, Janssen I et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37: 773–792.

    Article  PubMed  Google Scholar 

  15. Ekelund U, Luan J, Sherar L, Esliger D, Griew P, Cooper A et al. Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA 2012; 307: 704–712.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Oliver M, Schofield GM, Kolt GS . Physical activity in preschoolers: understanding prevalence and measurement issues. Sports Med 2007; 37: 1045–1070.

    Article  PubMed  Google Scholar 

  17. Reilly JJ, Penpraze V, Hislop J, Davies G, Grant S, Paton JY . Objective measurement of physical activity and sedentary behaviour: review with new data. Arch Dis Child 2008; 93: 614–619.

    Article  CAS  PubMed  Google Scholar 

  18. Pate RR, O'Neill JR, Mitchell J . Measurement of physical activity in preschool children. Med Sci Sports Exerc 2010; 42: 508–512.

    Article  PubMed  Google Scholar 

  19. Rowlands AV . Accelerometer assessment of physical activity in children: an update. Pediatr Exerc Sci 2007; 19: 252–266.

    Article  PubMed  Google Scholar 

  20. Cliff DP, Reilly JJ, Okely AD . Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0-5 years. J Sci Med Sport 2009; 12: 557–567.

    Article  PubMed  Google Scholar 

  21. Van Cauwenberghe E, Gubbels J, De Bourdeaudhuij I, Cardon G . Feasibility and validity of accelerometer measurements to assess physical activity in toddlers. Int J Behav Nutr Phys Act 2011; 8: 67.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Trost SG, Fees BS, Haar SJ, Murray AD, Crowe LK . Identification and validity of accelerometer cut-points for toddlers. Obesity (Silver Spring) 2012; 20: 2317–2319.

    Article  Google Scholar 

  23. Pulakka A, Cheung Y, Ashorn U, Penpraze V, Maleta K, Phuka J et al. Feasibility and validity of the ActiGraph GT3X accelerometer in measuring physical activity of Malawian toddlers. Acta Paediatr 2013; 102: 1192–1198.

    Article  CAS  PubMed  Google Scholar 

  24. National Statistical Office (NSO) and ICF Macro. Malawi Demographic and Health Survey 2010. NSO and ICF Macro: Zomba, Malawi; Calverton, MD, USA, 2011.

  25. Kumwenda C, Dewey KG, Hemsworth J, Ashorn P, Maleta K, Haskell MJ . Lipid-based nutrient supplements do not decrease breast milk intake of Malawian infants. Am J Clin Nutr 2014; 99: 617–623.

    Article  CAS  PubMed  Google Scholar 

  26. John D, Freedson P . ActiGraph and Actical physical activity monitors: a peek under the hood. Med Sci Sports Exerc 2012; 44: S86–S89.

    Article  PubMed  PubMed Central  Google Scholar 

  27. WHO Multicentre Growth Reference Study Group WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. World Health Organization: Geneva, Switzerland, 2006.

  28. Coates J, Swindale A, Bilinsky P Household Food Insecurity Access Scale (HIFAS) for Measurement of Household Food Access: Indicator Guide (v.3). Food and Nutrition Technical Assistance Project, FHI 360: Washington, DC, USA, 2007.

    Google Scholar 

  29. Penpraze V, Reilly JJ, MacLean C, Montgomery C, Kelly L, Paton JY et al. Monitoring of physical activity in young children: how much is enough? Arch Dis Child 2006; 18: 483–491.

    Google Scholar 

  30. Hnatiuk J, Ridgers ND, Salmon J, Campbell K, McCallum Z, Hesketh K . Physical activity levels and patterns of 19-month-old children. Med Sci Sports Exerc 2012; 44: 1715–1720.

    Article  PubMed  Google Scholar 

  31. Hnatiuk J, Salmon J, Campbell K, Ridgers N, Hesketh K . Early childhood predictors of toddlers' physical activity: longitudinal findings from the Melbourne InFANT Program. Int J Behav Nutr Phys Act 2013; 10: 123.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wijtzes AI, Kooijman MN, Kiefte-de Jong JC, de Vries SI, Henrichs J, Jansen W et al. Correlates of physical activity in 2-year-old toddlers: the generation R study. J Pediatr 2013; 163: 791–9.e1-2.

    Article  PubMed  Google Scholar 

  33. Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S et al. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet 2006; 368: 299–304.

    Article  PubMed  Google Scholar 

  34. Richmond RC, Davey Smith G, Ness AR, den Hoed M, McMahon G, Timpson NJ . Assessing causality in the association between child adiposity and physical activity levels: a Mendelian randomization analysis. PLoS Med 2014; 11: e1001618.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Collings PJ, Brage S, Ridgway CL, Harvey NC, Godfrey KM, Inskip HM et al. Physical activity intensity, sedentary time, and body composition in preschoolers. Am J Clin Nutr 2013; 97: 1020–1028.

    Article  CAS  PubMed  Google Scholar 

  36. Gardner JMM, Grantham-McGregor SM, Chang SM, Himes JH, Powell CA . Activity and behavioral development in stunted and nonstunted children and response to nutritional supplementation. Child Dev 1995; 66: 1785–1797.

    Article  Google Scholar 

  37. Harahap H, Jahari AB, Husaini MA, Saco-Pollitt C, Pollitt E . Effects of an energy and micronutrient supplement on iron deficiency anemia, physical activity and motor and mental development in undernourished children in Indonesia. Eur J Clin Nutr 2000; 54: S114–S119.

    Article  CAS  PubMed  Google Scholar 

  38. Aburto NJ, Ramirez-Zea M, Neufeld LM, Flores-Ayala R . The effect of nutritional supplementation on physical activity and exploratory behavior of Mexican infants aged 8-12 months. Eur J Clin Nutr 2010; 64: 644–651.

    Article  CAS  PubMed  Google Scholar 

  39. Bornstein DB, Beets MW, Byun W, McIver K . Accelerometer-derived physical activity levels of preschoolers: a meta-analysis. J Sci Med Sport 2011; 14: 504–511.

    Article  PubMed  Google Scholar 

  40. Ashorn U, Phiri N, Maleta K, Dewey K, Arimond M, Ashorn P . Long-term acceptability of LNS (lipid-based nutrient supplements) for infants in Malawi: PO1563. Ann Nutr Metab 2013; 63: 1011–1012.

    Google Scholar 

  41. Lenters L, Wazny K, Webb P, Ahmed T, Bhutta Z . Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process. BMC Public Health 2013; 13: S23.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Humphrey JH . Underweight malnutrition in infants in developing countries: an intractable problem. Arch Pediatr Adolesc Med 2008; 162: 692–694.

    Article  PubMed  Google Scholar 

  43. Dewey KG, Mayers DR . Early child growth: how do nutrition and infection interact? Matern Child Nutr 2011; 7: 129–142.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We are grateful to all the children and their families who took part in this study and the data collection teams. The accelerometer data was collected by teams lead by Martin Ndelemani. Lotta Alho provided statistical support. This publication is funded by a grant to the University of California, Davis from the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of University of California, Davis or the Bill & Melinda Gates Foundation. YBC was supported by the National Medical Research Council of the Singapore Ministry of Health under its Clinician Scientist Award.

Author information

Authors and Affiliations

  1. Department for International Health, University of Tampere School of Medicine, Tampere, Finland

    A Pulakka, U Ashorn & P Ashorn

  2. Duke-National University of Singapore Graduate Medical School, Centre for Quantitative Medicine, Singapore, Singapore

    Y B Cheung

  3. Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore

    Y B Cheung

  4. Department of Nutrition, University of California, Davis, Davis, CA, USA

    K G Dewey

  5. Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi

    K Maleta

  6. Department of Agricultural and Resource Economics, University of California Davis, Davis, CA, USA

    S A Vosti

  7. Department of Paediatrics, Tampere University Hospital, Tampere, Finland

    P Ashorn

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  1. A Pulakka
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Correspondence to A Pulakka.

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Pulakka, A., Ashorn, U., Cheung, Y. et al. Effect of 12-month intervention with lipid-based nutrient supplements on physical activity of 18-month-old Malawian children: a randomised, controlled trial. Eur J Clin Nutr 69, 173–178 (2015). https://doi.org/10.1038/ejcn.2014.138

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