Dr. Kathryn Dewey, UC Davis Distinguished Professor in the Department of Nutrition and Director of the Program in International and Community Nutrition, has long been engaged in research regarding maternal health and infant nutrition. Her research is valuable to many Foods for Health Institute researchers because, in her hundreds of publications, Dr. Dewey offers rich data on how to understand and prevent childhood malnutrition. This research is critical as FFHI researchers continue their work as part of a multi-million dollar Gates Foundation Grant to address childhood malnutrition in the developing world.
Dr. Dewey currently leads the International Lipid-Based Nutrient Supplements (iLiNS) Project, which developed at the intersection of two lines of previous research conducted by Dr. Dewey’s collaborators in Ghana and another group of researchers in Malawi. Both groups of researchers tested the efficacy of lipid(fat)-based nutrient supplements (LNS) that deliver micronutrients and essential fatty acids to improve infant nutrition, and both saw positive impacts. Dr. Dewey and her Ghanaian colleagues were particularly excited to observe that in addition to improving infant growth, the supplements also improved infant motor development. The UC Davis, Ghana, and Malawi teams joined together and brought in another research organization in Burkina Faso with the intent of replicating and extending their positive results. Dr. Dewey and colleagues sought and received funding from the Bill & Melinda Gates Foundation, and the iLiNS Project was born.
iLiNS Project researchers are currently studying the efficacy and impact of the supplements in larger research trials with infants in the three different research settings – Ghana, Malawi and Burkina Faso. Micronutrient deficiencies, stunted growth, and delayed development are common in all three countries. But available foods, child feeding practices, the level of food insecurity and the burden of infectious disease differ. The iLiNS Project seeks to develop a body of evidence about the efficacy of the supplements under these varying conditions. iLiNS Project Manager Mary Arimond explains that it is important to analyze the supplements in more than one setting and with varying circumstances to understand where the supplements can contribute to healthy growth and development.
Historically, nutrition research and public health interventions have often focused on single micronutrients - including iron, vitamin A and iodine - which are related to specific deficiency diseases. But for healthy growth and development, infants need a wide range of nutrients, including vitamins, minerals and essential fatty acids. The iLiNS Project joins a growing number of studies focused on prevention, and providing a wide range of nutrients to infants to prevent growth faltering and promote healthy development. It has also developed an LNS product for pregnant and lactating women (under evaluation in Ghana and Malawi), which is designed to prevent maternal nutrient deficiencies and hence, together with the LNS for infants, cover both the prenatal and postnatal periods.
Ms. Arimond explains that infants need very nutrient-rich foods, because they are growing and developing quickly. But in settings of great poverty, it is very common for children’s complementary foods (foods that infants start to eat along with their mother’s milk) to be a very poor source of nearly all micronutrients. In the three research sites, as in many poor communities globally, the most common complementary foods are watery porridges made with grains or roots. Although many mothers in developed nations also give cereals as a first infant food, those cereals are commonly already fortified with micronutrients. In addition, in wealthy countries infant diets rapidly diversify to include meats, fruits and vegetables.
The iLiNS Project seeks to help mothers in Ghana, Malawi and Burkina Faso “home-fortify” their infant’s household food by adding micronutrients in the form of the lipid-based nutrient supplements. These offer a range of micronutrients, but also provide energy and protein as well as essential fatty acids that cannot be produced within the body. It is important for these products to enrich and not replace locally available foods, and these products are intended to complement consistent breastfeeding for children up to two years old. Ms. Arimond stresses that the supplement is not an alternative to breastfeeding. Rather, all children around 6 months of age should begin to receive complementary foods and iLiNS researchers want to ensure that these complementary foods are nutrient-rich – especially in hard-to-get nutrients like iron and zinc – to contribute to healthy growth and development.
Ms. Arimond describes how the iLiNS Project operates in Burkina Faso where families are faced with seasonal, acute food insecurity. Families in Burkina Faso are given small sachets that contain the lipid-based nutrient supplements (which goes by a local name), and the mothers are advised to mix that into the infant’s porridge each day. Children can also eat it “as is,” since it is a tasty mixture of soy-bean oil, dry skim milk, peanut, sugar, and a vitamin/mineral pre-mix. The soy-bean oil is important because it provides essential fatty acids. Appropriate amounts of fat (and certain kinds of fats) are crucial for growth and development. The skim-milk powder provides high-quality protein, while the peanuts and a small amount of sugar offer fat and flavoring and help ensure that the infants will like to eat the supplements. Ms. Arimond notes that this is especially important, because in places where infants are often ill and the local diet is very monotonous, poor appetite and refusal of food is a big challenge to mothers.
The iLiNS Project does not attempt to provide a “magic bullet” that will solve childhood under-nutrition, but instead seeks to understand if lipid-based nutrient supplements can be one part of the solution. Anywhere that kids are getting a poor complementary diet, public health programs can: 1) promote breastfeeding 2) identify local foods that could improve the diet and 3) “home-fortify” local diets where they lack sufficient micronutrients, essential fatty acids, and calories.
Project Manager Arimond and Dr. Dewey highlight that this work would be impossible without the participation of the local institutions and universities in Ghana, Malawi, and Burkina Faso, who have developed positive relationships with community members. This important work relies on the perseverance of young researchers in these African countries who care deeply about their communities.