To revisit seasonality by assessing how household diets vary across agricultural seasons in rural and urban Ethiopia. The role of seasonality on the sources and intake of energy (per capita) and household dietary diversity score (HDDS) was analysed.

The use of nationally representative household-level data collected each month over one year to study the seasonal changes in the sources and intake of energy and HDDS.

Eleven regions of Ethiopia, including rural and urban settings.

Total of 27 835 households were interviewed between July 2010 and July 2011 in all eleven regions of the country. On average each month saw 2300 household interviews, yielding nationally representative data for each calendar month.

For rural households, the mean daily per capita energy intake was 10 288 kJ (2459 kcal) in February (post-harvest period) and lower in the lean season: 9703 kJ (2319 kcal) in June (P<0·05) and 9552 kJ (2283 kcal) in July (P<0·001). HDDS for rural households was highest in February (6·73) and lowest in June (5·98; P<0·001) but high again in July (6·57). Urban energy intake was also lower in the lean season but HDDS varied less by season. Considerable seasonal variation was also found in energy sources in rural areas, less so in urban areas.

Household diets in Ethiopia remain subjected to significant seasonal stress. HDDS and food security measured using energy intake do not always agree. Preferably, HDDS and energy intake data should be used together to assess food security.

The present study is the first to use nationally representative data to compare rates of food insecurity among households with veterans of the US Armed Forces and non-veteran households.

We used data from the 2005–2013 waves of the Current Population Survey – Food Security Supplement to identify rates of food insecurity and very low food security in veteran and non-veteran households. We estimated the odds and probability of food insecurity in veteran and non-veteran households in uncontrolled and controlled models. We replicated these results after separating veteran households by their most recent period of service. We weighted models to create nationally representative estimates.

Nationally representative data from the 2005–2013 waves of the Current Population Survey – Food Security Supplement.

US households (n 388 680).

Uncontrolled models found much lower rates of food insecurity (8·4 %) and very low food security (3·3 %) among veteran households than in non-veteran households (14·4 % and 5·4 %, respectively), with particularly low rates among households with older veterans. After adjustment, average rates of food insecurity and very low food security were not significantly different for veteran households. However, the probability of food insecurity was significantly higher among some recent veterans and significantly lower for those who served during the Vietnam War.

Although adjusting eliminated many differences between veteran and non-veteran households, veterans who served from 1975 and onwards may be at higher risk for food insecurity and should be the recipients of targeted outreach to improve nutritional outcomes.

Health and nutritional information for many countries in the South-East Asian region is either lacking or no longer up to date. The present study aimed to calculate length/height percentile values for the South-East Asian Nutrition Survey (SEANUTS) populations aged 0·5–12 years, examine the appropriateness of pooling SEANUTS data for calculating common length/height percentile values for all SEANUTS countries and whether these values differ from the WHO growth references.

Data on length/height-for-age percentile values were collected. The LMS method was used for calculating smoothened percentile values. Standardized site effects (SSE) were used for identifying large or unacceptable differences (i.e. $\mid\! \rm SSE \!\mid$ >0·5) between the pooled SEANUTS sample (including all countries) and the remaining pooled SEANUTS samples (including three countries) after weighting sample sizes and excluding one single country each time, as well as with WHO growth references.

Malaysia, Thailand, Vietnam and Indonesia.

Data from 14202 eligible children were used.

From pair-wise comparisons of percentile values between the pooled SEANUTS sample and the remaining pooled SEANUTS samples, the vast majority of differences were acceptable (i.e. $\mid\! \rm SSE \!\mid$ ≤0·5). In contrast, pair-wise comparisons of percentile values between the pooled SEANUTS sample and WHO revealed large differences.

The current study calculated length/height percentile values for South East Asian children aged 0·5–12 years and supported the appropriateness of using pooled SEANUTS length/height percentile values for assessing children’s growth instead of country-specific ones. Pooled SEANUTS percentile values were found to differ from the WHO growth references and therefore this should be kept in mind when using WHO growth curves to assess length/height in these populations.

According to most prospective studies, being underweight (BMI<18·5 kg/m2) is associated with significantly higher mortality than being of normal weight, especially among smokers. We aimed to explore in a generally lean population whether being underweight is significantly associated with increased all-cause mortality.

Prospective cohort study.

Korea Medical Insurance Corporation study with 14 years of follow-up.

After excluding deaths within the first 5 years of follow-up (1993–1997) to minimize reverse causation and excluding participants without information about smoking and health status, 94 133 men and 48 496 women aged 35–59 years in 1990 were included.

We documented 5411 (5·7 %) deaths in men and 762 (1·6 %) in women. Among never smokers, hazard ratios (HR) for underweight individuals were not significantly higher than those for normal-weight individuals (BMI=18·5–22·9 kg/m2): HR=0·87 (95 % CI 0·41, 1·84, P=0·72) for underweight men and HR=1·12 (95 % CI 0·76, 1·65, P=0·58) for underweight women. Among ex-smokers, HR=0·86 (95 % CI 0·38, 1·93, P=0·72) for underweight men and HR=3·77 (95 % CI 0·42, 32·29, P=0·24) for underweight women. Among current smokers, HR=1·60 (95 % CI 1·28, 2·01, P<0·001) for underweight men and HR=2·07 (95 % CI 0·43, 9·94, P=0·36) for underweight women.

The present study does not support that being underweight per se is associated with increased all-cause mortality in Korean men and women.

In many countries of the world millions of people are not registered at birth. However, in order to assess children’s nutritional status it is necessary to have an exact knowledge of their age. In the present paper we discuss the effects of insufficient or imprecise age data on estimates of undernutrition prevalence.

Birth registration rates and levels of stunting, underweight and wasting were retrieved from Multiple Indicator Cluster Surveys and Demographic and Health Surveys of thirty-seven sub-Saharan African countries, considering the subdivision in wealth quintiles. The composition of the cross-sectional sample used for nutritional evaluation was analysed using a permutation test. Logistic regression was applied to analyse the relationship between birth registration and undernutrition. The 95 % probability intervals and Student’s t test were used to evaluate the effect of age bias and error.

Heterogeneous sampling designs were detected among countries, with different percentages of children selected for anthropometry. Further, registered children were slightly more represented within samples used for nutritional analysis than in the total sample. A negative relationship between birth registration and undernutrition was recognized, with registered children showing a better nutritional status than unregistered ones, even within each wealth quintile. The over- or underestimation of undernutrition in the case of systematic over- or underestimation of age, respectively, the latter being more probable, was quantified up to 28 %. Age imprecision was shown to slightly overestimate undernutrition.

Selection bias towards registered children and underestimation of children’s age can lead to an underestimation of the prevalence of undernutrition.

Poor adherence to recommended intake protocols is common and a top challenge for micronutrient powder (MNP) programmes globally. Identifying modifiable predictors of intake adherence could inform the design and implementation of MNP projects.

We assessed high MNP intake adherence among children who had received MNP ≥2 months ago and consumed ≥1 sachet (n 771). High MNP intake adherence was defined as maternal report of child intake ≥45 sachets. We used logistic regression to assess demographic, intervention components and perception-of-use factors associated with high MNP intake.

Four districts of Nepal piloting an integrated infant and young child feeding and MNP project.

Children aged 6–23 months were eligible to receive sixty MNP sachets every 6 months with suggested intake of one sachet daily for 60 d. Cross-sectional surveys representative of children aged 6–23 months were conducted.

Receiving a reminder card was associated with increased odds for high intake (OR=2·18, 95 % CI 1·14, 4·18); exposure to other programme components was not associated with high intake. Mothers perceiving ≥1 positive effects in their child after MNP use was also associated with high intake (OR=6·55, 95 % CI 4·29, 10·01). Perceiving negative affects was not associated; however, the child not liking the food with MNP was associated with lower odds of high intake (OR=0·12, 95 % CI 0·08, 0·20).

Behaviour change intervention strategies tailored to address these modifiable predictors could potentially increase MNP intake adherence.

To examine the growth of infants and toddlers in a population that is both under-represented in the literature and at high risk for childhood obesity.

Weight and height measurements were extracted from all visits for a sample of 0–4-year-old, low-income, Latino and non-Latino patients of an urban, academic general paediatric practice. Early growth was characterized as change in weight-for-length Z-score (WLZ) from birth to 3 years. The outcome of interest was BMI Z-score (BMIZ) at age 3 years. Mixed-effects models and multivariate linear regression were used to analyse the association between infant growth and early childhood obesity.

Baltimore, MD, USA.

Latino (n 210) and non-Latino (n 253) children, born in 2003–2004.

An increase in WLZ from birth to 2 years was observed for this cohort as well as a high incidence of overweight and obesity. WLZ at birth and change in WLZ from birth to 2 years were both significantly and positively associated with increases in BMIZ at 3 years of age. The effect of the change in WLZ was twofold higher than the effect of WLZ at birth.

An increase in WLZ during the first 2 years of life increased the risk of early childhood obesity. Latino children had a higher incidence of early childhood obesity than non-Latino children in this low-income sample.

To adapt and evaluate a nutrient-based diet quality index (PANDiet) for UK young children and to determine the nutritional adequacy of their diets according to consumption of young child formula (YCF) and commercial infant foods (CIF).

Content and construct validity of the PANDiet were assessed by studying associations between the PANDiet and its components, energy intake, food intakes, and child and maternal characteristics. Four groups of children were defined according to their intake of YCF and CIF: (i) no consumption; (ii) consumption of YCF; (iii) consumption of CIF; and (iv) consumption of YCF and CIF. Child and maternal characteristics, PANDiet scores and food intakes of these four groups were compared.

Secondary analysis of data from the UK Diet and Nutrition Survey of Infants and Young Children (DNSIYC, 2011).

Young children (n 1152) aged 12–18 months.

The PANDiet was adapted to the UK based on twenty-five nutrients. A lower PANDiet score was linked to lower intakes of YCF, CIF, vegetables and fruits. Determinants of having a lower score were being older, having siblings and having a younger mother with a lower educational level. Compared with children consuming neither YCF nor CIF, PANDiet scores were higher in children consuming CIF (+1·4), children consuming YCF (+7·2) and children consuming YCF and CIF (+7·8; all P<0·001).

The PANDiet is a valid indicator of the nutrient adequacy of the diet of UK young children. Consuming CIF was not found to be associated with lower nutritional adequacy whereas consuming YCF was associated with higher nutritional adequacy.

To investigate associations of maternal periconceptional shellfish, lean fish and fatty fish intake with risk of pregnancy complications.

In this prospective cohort study, we collected information on intake of seafood subtypes using FFQ. We categorized seafood intake into frequencies of <0·2 servings/month, 0·2 servings/month–<0·5 servings/week, 0·5–1·0 servings/week and >1 servings/week. We ascertained gestational hypertension, pre-eclampsia, gestational diabetes and preterm birth diagnoses from medical records. Using generalized linear models with a log link, the Poisson family and robust standard errors, we estimated risk ratios and 95 % confidence intervals across seafood intake categories.

The Omega study, a study of risk factors for pregnancy complications among women recruited from prenatal clinics in Washington State, USA, 1996–2008.

The current study included 3279 participants from the Omega study.

Median (interquartile range) shellfish, lean fish and fatty fish intake was 0·3 (0–0·9), 0·5 (0–1·0) and 0·5 (0·1–1·0) servings/week, respectively. Lean fish intake of >1 servings/week (v. <0·2 servings/month) was associated with a 1·55-fold higher risk of preterm birth (95 % CI 1·04, 2·30) and was not associated with the other pregnancy complications. Higher intake of seafood (total or other subtypes) was not associated with pregnancy complications (separately or combined).

Higher intake of lean fish, but not fatty fish or shellfish, was associated with a higher risk of preterm birth; these findings may have significance for preterm birth prevention. Studies of mechanisms and potential contributing factors (including seafood preparation and nutrient/contaminant content) are warranted.

The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance.

Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered.

Canadian International Polar Year Inuit Health Survey (2007–2008).

Inuit adults (n 777).

Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08).

The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.

The Mediterranean diet (MD) pattern has important health benefits; however, it seems that Spanish school-aged children have been abandoning this healthy pattern recently. We aimed to identify psychopathological, anthropometric and sociodemographic factors that may influence the risk of low MD adherence.

Longitudinal study in three phases. MD adherence was assessed using the Krece Plus food questionnaire and psychopathological symptoms using the Screen for Childhood Anxiety Related Emotional Disorders, Children’s Depression Inventory, Youth’s Inventory-4 and Eating Disorder Inventory-2. Anthropometric data were collected in the first and third phases.

All five representative areas in Reus, Spain.

Adolescents (n 241).

Regardless of past and current BMI, socio-economic status was a protective factor for low MD adherence (OR=0·805, P=0·003) and a risk factor for high BMI (OR=0·718, P=0·002; OR=0·707, P=0·001). Regardless of socio-economic status, depression was involved with risk of low adherence (OR=1·069, P=0·021). Girls with lower MD adherence presented significantly higher scores for eating disorders measured using the Eating Disorder Inventory-2 (low adherence, mean 18·9 (sd 13·5); high adherence, mean 8·9 (sd 9·0), P=0·020) and the Youth Inventory-4 (low adherence, mean 5·2 (sd 4·3); medium adherence, mean 3·6 (sd 3·2), P=0·044). They also presented higher depression symptoms (low adherence, mean 17·7 (sd 9·6); medium adherence, mean 12·3 (sd 7·2), P=0·01) than girls with high adherence.

The results highlight the influence of psychosocial factors on levels of MD adherence. These factors need to be taken into account when developing prevention and health promotion initiatives.

Dietary practices in Kenya often fail to provide adequate nutrition during the first 1000 days of life, from conception to 2 years of age. We developed and qualitatively assessed the acceptability of easy-to-use dietary tools consisting of a marked bowl, slotted spoon and illustrated counselling card to support appropriate dietary practices during pregnancy, exclusive breast-feeding and complementary feeding of children aged 6–24 months.

We conducted qualitative research to assess community acceptability and obtain feedback on the design of the dietary tools.

This research took place in urban and rural communities in Western Kenya.

We conducted twelve focus group discussions with community members (mothers, husbands, mothers-in-law, community leaders) and five interviews with government nutritionists to assess acceptability and obtain recommendations on design and delivery of the tools. We conducted 24–28 d of user testing with fourteen pregnant women, fourteen breast-feeding women and thirty-two mothers with infants aged 6–18 months.

Tools were positively received by communities. Mothers perceived improvements in their own and their children’s food intakes including quantity, frequency, consistency and diversity. Many attributed perceived own and child’s weight gain and/or increased energy to tool use. A minority reported using the bowl for other activities (n 9) or not using the bowl due to food insecurity (n 5).

Results suggest that such tools have the potential to positively impact maternal and child dietary practices. Future work should quantitatively assess the impact on diet and nutrition outcomes and the underlying behavioural domains associated with changes.

Children from low-income countries consuming predominantly plant-based diets but little animal products are considered to be at risk of Fe deficiency. The present study determined the Fe status of children from resource-limited rural households.

A cross-sectional study.

Twenty six kebeles (the smallest administrative unit) from six zones of the Amhara region, Ethiopia.

Children aged 54–60 months (n 628).

Grain, roots or tubers were the main dietary components consumed by 100 % of the study participants, followed by pulses, legumes or nuts (66·6 %). Consumption of fruit and vegetables (19·3 %) and meat, poultry and fish (2·2 %) was low. Children had a mean dietary diversity score of 2·1 (sd 0·8). Most children (74·8 %, n 470) were in the lowest dietary diversity group (1–2 food groups). Rate of any morbidity in the preceding 14 d was 22·9 % (n 114). Infection or inflammation (α1-acid glycoprotein >1·2 g/l) was present in 30·2 % (n 184) of children. Children had a high rate of stunting (43·2 %). Of the total sample, 13·6 % (n 82) of children were anaemic, 9·1 % (n 57) were Fe deficient and 5·3 % (n 32) had Fe-deficiency anaemia. Fe-deficiency erythropoiesis was present in 14·2 % (n 60) of children.

Despite consuming a predominantly plant-based diet and little animal-source foods, there was a low prevalence of Fe-deficiency anaemia. This illustrates that dietary patterns can be inharmonious with Fe biochemical status; thus, Fe-related interventions require biochemical screening.

Undernutrition is prevalent among pregnant women in Cambodia. The provision of fortified dietary supplements is one strategy to help pregnant women meet their nutritional needs. Corn Soya Blend Plus (CSBP) is a widely used prenatal dietary supplement in areas with high rates of undernutrition and food insecurity. However, little is known about its acceptability during pregnancy. The present study aimed to identify factors that affected the acceptability and consumption of CSBP supplements among pregnant women.

Women completed a structured interview designed to provide information on facilitators of and barriers to utilization. In addition, six focus groups were conducted with a subset of women (n 70) to further explore attitudes, perceptions and experiences related to CSBP use.

Two districts in Kampong Chhnang Province, Cambodia.

Pregnant women (n 288) participating in a cluster-randomized trial of CSBP.

The acceptability of CSBP was influenced by sensory attributes, family support, peer influences, and attitudes related to diet, nutritional status and weight gain in pregnancy. Attaining adequate nutrition was considered less important than other concerns during pregnancy, particularly anxiety related to the costs of delivery and postpartum care. Acceptance was lower among new mothers due to fears of weight gain. Health benefits were common reasons for continued use and minor side-effects, such as nausea, were not major barriers to consumption.

CSBP was generally well accepted in this population. However, organoleptic factors and perceptions regarding nutrition and weight gain in pregnancy, particularly for first-time mothers, were barriers to increasing acceptance among Cambodian women.

To assess the acceptability and adherence to daily doses of lipid-based nutrient supplement (LNS) among children and micronutrient powder (MNP) among children and pregnant and lactating women.

Household interviews and sachet counting were conducted to measure acceptability and adherence, 15 and 30 d after product distribution. Qualitative information on product acceptability was collected using focus group discussions.

Saharawi refugee camps, Algeria, August–October 2009.

LNS was distributed to 123 children aged 6–35 months (LNS-C), and MNP to 112 children aged 36–59 months (MNP-C) and 119 pregnant or lactating women (MNP-W).

At the end of the test 98·4 % of LNS-C, 90·4 % of MNP-C and 75·5 % of MNP-W participants reported that they liked the product (P<0·05). Other measures of acceptability did not differ. Median consumption of sachets was highest in the LNS-C group (P<0·001). ‘Good’ adherence to the daily regimen (consumption of 75–125 % of recommended dose) was 89·1 % in the LNS-C, compared with 57·0 % in the MNP-C and 65·8 % in the MNP-W groups (P<0·001). Qualitative findings supported the quantitative measures and guided selection of local product names, packaging designs, distribution mechanisms, and the design of the information campaign in the subsequent programme scale-up.

Acceptability, consumption and adherence were higher in participants receiving LNS compared with MNP. However, both products were found to be suitable when compared with predefined acceptability criteria. Acceptability studies are feasible and important in emergency nutrition programmes when the use of novel special nutritional products is considered.

Using data from the national micronutrients survey 2011–2012, the present study explored the determinants of Fe status and Hb levels in Bangladesh with a particular focus on groundwater Fe.

Cross-sectional study conducted at the nationwide scale.

The survey was conducted in 150 clusters, fifty in each of the three strata of rural, urban and slum.

Three population groups: pre-school age children (6–59 months; PSAC), school age children (6–14 years; SAC) and non-pregnant non-lactating women (15–49 years; NPNLW).

National prevalence of Fe deficiency was 10·7 %, 7·1 % and 3·9–9·5 % in PSAC, NPNLW and SAC, respectively. Prevalence of anaemia was 33·1 % (PSAC), 26·0 % (NPNLW) and 17·1–19·1 % (SAC). Multivariate regression analyses showed that the area with ‘predominantly high groundwater Fe’ was a determinant of higher serum ferritin levels in NPNLW (standardized β=0·19; P=0·03), SAC (standardized β=0·22; P=0·01) and PSAC (standardized β=0·20; P=0·03). This area also determined higher levels of Hb in PSAC (standardized β=0·14; P=0·01).

National prevalence of Fe deficiency in Bangladesh is low, contrary to the widely held assumption. High Fe level in groundwater is associated with higher Fe status (all populations) and higher Hb level (PSAC).

To determine the association between household food security and infant complementary feeding practices in rural Bangladesh.

Prospective, cohort study using structured home interviews during pregnancy and 3 and 9 months after delivery. We used two indicators of household food security at 3-months’ follow-up: maternal Food Composition Score (FCS), calculated via the World Food Programme method, and an HHFS index created from an eleven-item food security questionnaire. Infant feeding practices were characterized using WHO definitions.

Two rural sub-districts of Kishoreganj, Bangladesh.

Mother–child dyads (n 2073) who completed the 9-months’ follow-up.

Complementary feeding was initiated at age ≤4 months for 7 %, at 5–6 months for 49 % and at ≥7 months for 44 % of infants. Based on 24 h dietary recall, 98 % of infants were still breast-feeding at age 9 months, and 16 % received ≥4 food groups and ≥4 meals (minimally acceptable diet) in addition to breast milk. Mothers’ diet was more diverse than infants’. The odds of receiving a minimally acceptable diet for infants living in most food-secure households were three times those for infants living in least food-secure households (adjusted OR=3·0; 95 % CI 2·1, 4·3). Socio-economic status, maternal age, literacy, parity and infant sex were not associated with infant diet.

HHFS and maternal FCS were significant predictors of subsequent infant feeding practices. Nevertheless, even the more food-secure households had poor infant diet. Interventions aimed at improving infant nutritional status need to focus on both complementary food provision and education.

To determine the feasibility of distributing micronutrient powders (MNP) for home fortification during biannual Maternal, Neonatal and Child Health Week (MNCHW) events, as a strategy to improve young child nutrition.

We evaluated the coverage, delivery, use and adherence of MNP, and associated behaviour change communication (BCC) materials and social mobilization, through cross-sectional surveys of caregivers attending health-service distribution events and health workers involved in MNP distribution, facility-based observations of MNP distribution activities and a repeated survey of caregivers in their homes who received MNP for their child.

Four Local Government Areas in Benue State, Nigeria.

Caregivers of children 6–59 months of age attending health-service distribution events.

The 8 million MNP delivered in this pilot during three distribution events were estimated to reach about one-third of eligible children in the area at each event. Programme fidelity was limited by shortages of MNP, BCC materials and inadequate social mobilization, with some limitations in health worker training and engagement. MNP use was consistent with the recommended two or three sachets per week among 51–69 % of caregivers surveyed at home.

MNP coverage was low, but consistent with that typically achieved with other services delivered through MNCHW in Benue. Among caregivers who received MNP, acceptance and use among targeted children was high. While some weaknesses in knowledge and delivery of MNP by health workers were observed, health system strengthening and more extensive social mobilization would be key to achieving higher coverage with MNP and other health services provided through MNCHW.

Safety of home fortificants in children is uncertain in areas where infections are common. We tested the hypothesis that provision of lipid-based nutrient supplements (LNS) containing Fe does not increase infectious morbidity in children.

Randomized controlled trial. Infants were randomised to receive 10, 20 or 40 g LNS/d; or no supplement until age 18 months. All LNS contained 6 mg Fe/d. Morbidity outcomes (serious adverse events, non-scheduled visits and guardian-reported morbidity episodes) were compared between control and intervention groups using a non-inferiority margin of 20 %.

Namwera and Mangochi catchment areas in rural Malawi.

Infants aged 6 months (n 1932).

The enrolled 1932 infants contributed 1306 child-years of follow-up. Baseline characteristics were similar across groups. Compared with the control group, the relative risk (95 % CI) of serious adverse events was 0·71 (0·48, 1·07), 0·67 (0·48, 0·95) and 0·91 (0·66, 1·25) in 10, 20 and 40 g LNS/d groups, respectively. The incidence rate ratio (95 % CI) of non-scheduled visits due to malaria was 1·10 (0·88, 1·37), 1·08 (0·89, 1·31) and 1·21 (1·00, 1·46), and of guardian-reported morbidity episodes was 1·04 (0·96, 1·11), 1·03 (0·97, 1·10) and 1·04 (0·97, 1·10), in the respective LNS groups.

Provision of 10 and 20 g LNS/d containing 6 mg Fe/d did not increase morbidity in the children. Provision of 40 g LNS/d did not affect guardian-reported illness episodes but may have increased malaria-related non-scheduled visits.

The effectiveness of leaf concentrate powder (LCP) as a nutritional supplement was established in trials conducted among adolescent girls and pregnant women in India. Here we evaluate LCP, compared with skimmed milk powder (SMP), as a supplement for antiretroviral-naïve children living with HIV in a sub-Saharan African country.

Randomized controlled, two-arm, 6-month trial comparing effects of isoproteic (5 g) LCP (10 g daily) and SMP (15 g daily) on HIV-1 viral load, CD4+ cell count/percentage, weight/height-for-age, general blood parameters, diarrhoea, respiratory and HIV-related opportunistic infections.

Bujumbura and Kirundo, Burundi.

Eighty-three HIV-positive, antiretroviral-naïve children aged 5–14 years: median (range) CD4+ count, 716 (361–1690) cells/mm3; log10 HIV-1 viral load, 4·39 (1·79–6·00).

LCP was equivalent to SMP in relation to HIV-specific blood parameters and did not demonstrate superiority over SMP in relation to Hb. Three children in each arm (LCP, 7·1 % (3/42); SMP, 7·3 % (3/41)) proceeded to antiretroviral therapy because their CD4+ counts fell below 350 cells/mm3. Children in the LCP group reported higher levels of appetite and overall health at 6 months. There were no differences in clinical events or any other outcome measures. LCP was less palatable than SMP to the children in this population, but there were few negative perceptions of appearance, texture and taste.

LCP appears to be equivalent to SMP as a nutritional supplement in this population, despite slightly lower palatability. In relation to viral load and CD4+ count, equivalence may indicate no effect in either group. Effectiveness relative to no supplementation remains to be determined.