Project Details

Nutritional interventions in infancy to improve neurodevelopment outcomes

Sunita Taneja, MBBS, PhD

Summary

BACKGROUND: Infants from low resource settings often have complementary feeds of low quality, especially in terms of protein and micronutrients. This may adversely affect their neurodevelopment. GAP: Our understanding is limited on the effect of supplementing balanced protein energy micronutrient enriched complementary feeds to infants on their neurodevelopment. Further, evidence is lacking on the effect of supplementing infants with higher amounts and quality of protein on their neurodevelopment. HYPOTHESIS: 1) Infant cereal mix given daily, starting from 6 months till 12 months of infant age, that provides balanced energy, protein, fat and micronutrients will improve neurodevelopment at 12 and 24 months of age in comparison to routine care (counseling only). 2) Daily supplementation with higher amount of protein and increased amount of protein from animal source for six months will lead to higher neurodevelopmental scores at 12 and 24 months compared to daily supplementation with relatively lower protein amount and amount of protein from animal source METHODS: The study is an extended follow up of the infants enrolled in a primary trial (CTRI/2018/04/012932). The infants received either of the two nutritional supplements (similar in energy, fats and micronutrient content but varying in amount of protein and amount of protein from animal source) or only counselling, daily from 6 to 12 months of age. The study followed up these infants and tested the effect on cognitive, motor, language, socio-emotional and behavioral scores at 12 and 24 months of age. RESULTS: The study was conducted in urban Delhi, India and the infants were randomized in a 1:1:1 ratio to the three study groups. At 12 and 24 months of age, 1134 and 1214 children were available, respectively. At 12 months of age, compared to no supplement group, an increase in the motor scores (mean difference, MD 1.52, 95% CI: 0.28, 2.75) and a decrease in the infant temperament scores (mean difference, MD -2.76, 95% CI: -4.23, -1.29) in the modest protein group was observed. Those in the high protein group had lower socio-emotional scores (MD -1.40, 95% CI: -2.43, -0.37) and higher scores on infant temperament scale (MD 2.05, 95% CI: 0.62, 3.48) when compared to modest protein group. At 24 months, no significant differences in any of the neurodevelopment scores between the three study groups was found. IMPACT: The supplementation with modest amount of protein and multiple micronutrients may lead to short term small improvements in motor function and infant temperament. There appears no advantage of supplementing with high protein, rather negative effects on infant behaviour were observed. The findings will guide the design of nutritional program for infants in low-middle-income settings and would be readily scalable by incorporation into existing recommendations for complementary feeding.

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