Evidence on the effect of small-quantity lipid-based nutrient supplements (SQ-LNSs) on early child growth and development is mixed. This study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth (primary outcome), psychomotor development, iron status (secondary outcomes), and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet. Infants (n = 750) were randomly assigned to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNS products contained micronutrients and essential fatty acids. SQ-LNS-plus contained, in addition, docosahexaenoic acid, arachidonic acid (important for brain and eye development), lysine (limiting amino acid in maize), phytase (enhances iron absorption), and other nutrients. Infants' weight and length were measured bimonthly. At age 6 and 12 mo, psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin, plasma ferritin, C-reactive protein, and α1-acid glycoprotein were assessed. WHO Motor Milestone outcomes, adherence, and morbidity were monitored weekly through home visits. Primary analysis was by intention-to-treat, comparing each SQ-LNS group with the control. SQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo (mean difference: 0.11; 95% CI: 0.01, 0.22; P = 0.032) and 10 mo (0.16; 95% CI: 0.04, 0.27; P = 0.008) but not at 12 mo (0.09; 95% CI: -0.02, 0.21; P = 0.115), locomotor development score (2.05; 95% CI: 0.72, 3.38; P = 0.003), and Parent Rating Score (1.10; 95% CI: 0.14, 2.07; P = 0.025), but no effect for weight-for-age zscore. Both SQ-LNS (P = 0.027) and SQ-LNS-plus (P = 0.005) improved hemoglobin concentration and reduced the risk of anemia, iron deficiency, and iron-deficiency anemia. Both SQ-LNS products reduced longitudinal prevalence of fever, coughing, and wheezing but increased incidence and longitudinal prevalence of diarrhea, vomiting, and rash/sores. Point-of-use fortification with SQ-LNS-plus showed an early transient effect on linear growth and improved locomotor development. Both SQ-LNS products had positive impacts on anemia and iron status. This trial was registered at clinicaltrials.gov as NCT01845610.

Appropriate feeding practices are protective against malnutrition and poor growth. We compared feeding practices and growth in HIV-exposed-uninfected (HEU) and HIV-unexposed-uninfected (HUU) between 6-12 months of age in urbanized African infants in South Africa. A repeated cross-sectional analysis was used to determine differences in infant feeding practices and anthropometric measures by HIV exposure status at 6, 9, and 12 months in the Siyakhula study. The study included 181 infants (86 HEU; 95 HUU). Breastfeeding rates were lower in HEU vs. HUU infants at 9 (35.6% vs. 57.3%; p = 0.013) and 12 months (24.7% vs. 48.0%; p = 0.005). Introduction to early complementary foods was common (HEU = 16.2 ± 11.0 vs. HUU = 12.8 ± 9.3 weeks; p = 0.118). Lower weight-for-age Z-scores (WAZ) and head circumference-for-age Z-scores (HCZ) were found in HEU infants at birth. At 6 months, WAZ, length-for-age Z-scores (LAZ), HCZ, and mid-upper-arm circumference-for-age Z-scores (MUACAZ) were lower in HEU vs. HUU infants. At 9 months, lower WAZ, LAZ, and MUACAZ were found in HEU vs. HUU infants. At 12 months, lower WAZ, MUACAZ, and weight-for-length Z-scores (−0.2 ± 1.2 vs. 0.2 ± 1.2; p = 0.020) were observed. HEU infants had lower rates of breastfeeding and poorer growth compared to HUU infants. Maternal HIV exposure affects the feeding practices and growth of infants.

Maternal HIV exposure and intrauterine growth restriction (IUGR) due to placental insufficiency both carry major risks to early child growth. We compared the growth outcomes of children aged 18 months who had abnormal umbilical artery resistance indices (UmA-RI), as a marker of placental insufficiency, with a comparator group of children with normal UmA-RI during pregnancy, as mediated by maternal HIV infection. The cross-sectional study included 271 children, grouped into four subgroups based on HIV exposure and history of normal/abnormal UmA-RI, using available pregnancy and birth information. Standard procedures were followed to collect anthropometric data, and z-scores computed as per World Health Organization growth standards. Lower length-for-age z-scores (LAZ) were observed in children who were HIV-exposed-uninfected (CHEU) (−0.71 ± 1.23; p = 0.004) and who had abnormal UmA-RI findings (−0.68 ± 1.53; p < 0.001). CHEU with abnormal UmA-RI had lower LAZ (−1.3 ± 1.3; p < 0.001) and weight-for-age z-scores (WAZ) (−0.64 ± 0.92; p = 0.014) compared to the control group. The prevalence of stunting was 40.0% in CHEU with abnormal UmA-RI and 16.0% in CHEU with normal UmA-RI (p < 0.001; p = 0.016, respectively). In conclusion, maternal HIV exposure and placental insufficiency are independent risk factors for childhood stunting, with this risk potentiated when these two risk factors overlap.

Poor nutrition during the first two years of life has long term consequences, but resource-poor households often do not have the means to access nutrient-dense and diverse diets. Pooled data of 24-h dietary recalls (n = 3336) and 2019 retail food prices were analyzed to determine associations of retail cost and energy cost (per 100 kcal) with diet quality indicators for diets of 6–24-month-old South African children who were breastfed (BF-diet) and not breastfed (NBF-diet) during the 24-h recall period. Compared to the BF-diet, retail cost for the NBF-diet was three times higher for age 6–11 months, and double for age 12–17 months. Higher retail cost and energy cost were both associated with higher mean adequacy ratios and dietary diversity scores for BF and NBF diets, except energy cost for the NBF-diet for age 6–11 months. Overall, inclusion of flesh foods, vitamin A-rich fruits and vegetables, and other fruit and vegetables increased from the lowest to the highest retail cost tertile. The higher cost of more nutritious diets highlights the importance of the affordability of diets in interventions aimed at improving diet quality. Possible strategies include: identifying the most-affordable foods within each food group, focusing on foods that provide multiple key micronutrients, and the inclusion of locally available indigenous foods.

Objectives: A study was undertaken to determine whether benefits gained by providing small-quantity lipid-based nutrient supplements (SQ-LNS) from age 6-12 months were maintained at age 18 months compared with a delayed intervention. Design: Children who completed a randomised controlled trial were enrolled at age 12 months (n = 392) and followed-up until age 18 months (n = 252; dropout rate 35.7%). Two previously exposed (PE and PE-plus) groups (received SQ-LNS from 6-12 months, but no supplement from 12-18 months) were compared with the delayed intervention (DI) group (received no supplement from 6-12 months, but received SQ-LNS from 12-18 months). Methods and outcome measures: At age 12 and 18 months, weight, length, haemoglobin (Hb) and psychomotor development were measured. Setting: The study was carried out in peri-urban Jouberton area, Klerksdorp, South Africa. Subjects: Children aged 12-18 months. Results: Compared with DI, negative effects (either a trend or statistically significant) were observed for PE and PE-plus for length-for-age Z-scores (LAZ) (p = 0.091 and p = 0.075, respectively), PE-plus for weight-for-age Z-scores (WAZ) (p = 0.027), and PE and PE-plus for Hb (p = 0.080 and p = 0.033, respectively); and a positive effect for PE-plus for eye-hand coordination (p = 0.086). The odds for anaemia were higher for PE-plus compared with DI (OR = 1.68; 95% CI 0.91, 3.09). Regardless of group, prevalence of anaemia and stunting increased from age 12 to age 18 months. Conclusions: Benefits of providing SQ-LNS from age 6-12 months were not sustained at age 18 months, compared with providing SQ-LNS from age 12-18 months. Studies to determine the optimum supplementary period to achieve sustainable benefits of SQ-LNS on linear growth and iron status are warranted.

Between 702 and 828 million people around the world were affected by hunger in 2021. The prevalence of undernourishment relentlessly continues to affect the world, and particularly Sub-Saharan Africa (23.2% in 2021). Exacerbated inequalities across and within countries are undermining the nutritional adequacy and affordability of diets and threatening vulnerable groups including children under five years of age and women of reproductive age. This research presents a diet optimization approach where the objective is to evaluate the nutritional adequacy and affordability of diets across 4 African countries, namely Ethiopia, Kenya, South Africa and Uganda. The targeted population includes dyads of women of reproductive age and their children between 6 and 24 months. The mathematical programming approach allows for the theoretically contrasting of optimal outcomes of the model with data from food consumption surveys in primary and secondary cities of each country. Based on the observed food intake patterns and the nutrient deficiencies, these outcomes propose new diets modifying food intake (organized in food groups) in order to achieve nutritional adequacy while minimizing food intake changes, or, if applicable, the outcomes indicate which nutrient recommendations are unattainable under the current model setup. On average, our results show that nutritional adequacy can be attained by increasing the intake of legumes, vegetables and fruits, while reducing the intake of cereals. We include a discussion on the assessment of diet affordability and show the practical implications of evaluating healthier diets’ viability. Conclusions include paths for future research on diet optimization modelling and its implications as a means of support for designing future dietary guidelines.