Effect of fortified complementary food supplementation on child growth in rural Bangladesh: A cluster-randomized trial

Parul Christian, Saijuddin Shaikh, Abu Ahmed Shamim, Sucheta Mehra, Lee Wu, Maithilee Mitra, Hasmot Ali, Rebecca D. Merrill, Nuzhat Choudhury, Monira Parveen, Rachel D. Fuli, Md Iqbal Hossain, Md Munirul Islam, Rolf Klemm, Kerry Schulze, Alain Labrique, Saskia De Pee, Tahmeed Ahmed, Keith P. West

Research output: Contribution to journalArticlepeer-review

67 Scopus citations


Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40-50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting. Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy'doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < -2), weight-for-length z-score (WLZ) and wasting (WLZ < -2) in children 6-18 months of age. Children (n=5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year. Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02-0.04/month) in the Plumpy'doz (P=0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy'doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5-6% (P ≤ 0.01) in those receiving Plumpy'doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27-0.30cm and 0.07-0.10 (all P < 0.05), respectively, in all four food groups relative to the control. Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.

Original languageEnglish (US)
Pages (from-to)1862-1876
Number of pages15
JournalInternational journal of epidemiology
Issue number6
StatePublished - Dec 1 2015


  • Bangladesh
  • Complementary food
  • Growth
  • Micronutrients
  • Stunting
  • Supplementation

ASJC Scopus subject areas

  • Epidemiology


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