Development of Acute Malnutrition Despite Nutritional Supplementation in Malawi

Malnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from two prospective, randomized control trials of complimentary feeding with supplemental legumes (n = 693, ages 6–24 months) in two Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by cox-regression analysis, include study village (Hazard ratio (HR) 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1.89). Comparison of Masenjere to Limera demonstrate adequate and similar nutritional intake yet an increased rate of AM in Masenjere, 56/400(14.0%) vs 14/293(4.8%), as well as stunting, 140/400(35%) vs 80/293(27%), environmental enteric dysfunction 246/400(71%) vs 181/293(67%), and infectious symptoms (cough and diarrhea). Masenjere did have cleaner water and less food insecurity 200/399 (50.5%) vs 204/293 (69.6%). These findings suggest adequate complementary nutrient intake does not protect young children against AM. Address correspondence to Mark J. Manary, MD, Dept of Pediatrics. St. Louis Children's Hospital, St. Louis, MO 63110 (e-mail: manary@kids.wustl.edu). Received 27 August, 2018 Accepted 9 November, 2018 Yankho Kaimila and Ryan T Pitman contributed equally to this work Clinical Trial identification numbers: NCT02472262, NCT02472301 Roles of authors in submitted work: Designed the study, KS, SA, IT, KM, MM; collected the data, YK, OD, KS, SA, IT; analyzed the data, YK, RP, DTH, IT, MM; wrote first draft of manuscript, YK, RP, MM. All authors contributed to final draft. Conflict of Interest and Source of Funding: United States Agency for International Development (USAID), as part of Feed the Future, the U.S. Government's global hunger and food security initiative, under the terms of Cooperative Agreement No. EDH-A-00–07–00005–00, and the Children's Discovery Institute of Washington University and St. Louis Children's Hospital. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or the U.S. Government. Authors declare no conflict of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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