Background/Objectives: Inadequate macronutrient intake may affect neurodevelopment in early infancy. In India, government-supplied take-home rations (THRs) attempt to meet this gap but lack adequate fat and protein. This study evaluated the impact of a 3-month macronutrient modified-THR intervention on infant neurodevelopment using event-related potentials (ERPs). Methods: A two-group cluster randomized controlled trial (village clusters = 12/group; N = 67/group) enrolled healthy breastfed infants (6–9 months) in Karnataka, India. The intervention group received a milk–legume-based THR providing ~200 kcal/day (ML-THR, estimated protein:energy (PE) and fat:energy (FE) ratios: 12% and 45%) with the standard government THR (SG-THR, estimated PE and FE ratios: 7% and 4%), while controls received SG-THRs only. All mothers received education on infant and young child feeding practices, water sanitation and hygiene. Auditory, visual and attention processing ERPs were measured using a short, culturally adapted, infant-friendly paradigm. Linear mixed models evaluated intervention effects over time. Results: The intervention was associated with region-specific visual ERP changes: increased fractional latencies in anterior regions for face, nonface (500–750 ms); decreased fractional latencies in the central region for frequent (10–250 ms) and face (500–750 ms) and in the posterior region for frequent–rare difference (250–500 ms). The intervention group also demonstrated a reduced area under the curve for nonface stimuli (250–500 ms). No significant auditory or visual hemifield effects were observed. None of the observed effects remained significant after false discovery rate (FDR) correction. Conclusions: The findings are exploratory and suggest the need to examine the effects of improved protein quality and fat content in THRs on visual–cortical processing in larger samples.

Background/Objectives: Linear growth faltering remains a major public health concern in low- and middle-income countries, wherein sub-optimal complementary feeding and hygiene practices are key modifiable factors. Inadequate complementary feeding is addressed through government-issued Take-Home Ration (THR) for <3-year-old children. This THR is not consumed regularly and does not bridge deficits in protein quality and fat intake among South Indian rural children. The addition of milk and legumes into a reformulated THR would address these gaps, but its efficacy remains unknown. Methods: In this 3-month cluster-randomized controlled trial among rural infants (6–9 months old), the intervention group (12 village clusters; n = 67) received a modified milk-and legume-based THR along with standard government THR, while the control group (12 village clusters; n = 67) received standard government THR alone. Caregivers of both groups were educated on nutrition and hygiene practices. Anthropometry, body composition (BC), morbidity, diet, and compliance data were collected. The primary outcome (length-for-age z-score (LAZ)) and secondary outcomes were analyzed using cluster-adjusted linear mixed models (LMM) in an intention-to-treat analysis. Results: While LAZ did not differ significantly between groups (β = 0.063 LAZ/month, 95%CI: −0.019, 0.145; p = 0.130), adjusted LMM showed significant differences in length (0.213 cm/month, 95%CI: 0.025, 0.400, p = 0.027), weight (0.040 kg/month, 95%CI: 0.001, 0.079, p = 0.044) and head circumference (0.067 cm/month, 95%CI: 0.005, 0.128, p = 0.033). LAZ decreased in both groups, with a significantly lower decline in the intervention group (slope difference: β = 0.05, 95% CI: 0.006, 0.095, p = 0.027). BC did not differ significantly. Conclusions: Improving protein quality and fat content of the government-issued THR showed a favourable LAZ trajectory among infants from rural South India. (Clinical Trial Registry-India: CTRI/2020/06/025825).