Randomized controlled trial in South Africa comparing the efficacy of complementary food products on child growth (TSWAKA)

Primary Investigator

  • Cornelius Smuts

Study Period

September 2013 - December 2016

Study Description

Complementary food supplements (CFS), fortified products that are mixed with the infant's usual complementary foods, have the potential to improve nutrition among infants. In Africa, maize is a major staple food used for complementary feeding. Compared to rice or wheat, maize has higher levels of phytates, which bind trace elements such as iron and zinc, and inhibit their absorption. The impact of CFS products in the context of a maize-based diet has not been well investigated. This study will test two newly developed fat-based CFS products made from soy.

The first product is a fortified fat-based spread that contains essential fatty acids with added docosahexaenoic acid (DHA) and arachidonic acid (ARA), and phytase to improve iron and zinc bioavailability. The second product is a fortified fat-based product containing essential fatty acids. Both products contain soy. The enrichment of the products with essential fatty acids is of particular interest in the South African context, as consumers are exposed to higher linoleic acid (LA) diets due to the inclusion of mostly high LA-containing sunflower oil during food preparation. The CFS products could contribute towards restoring the balance between LA and alpha-linolenic acid (ALA) intake.

The results of this study will provide evidence on whether or not two types of fortified CFS have the potential to address malnutrition (linear growth) and improve psychomotor development in infants. If proven effective, this approach of providing multiple nutrients can be made available to infants in the developing world and may lead to sustainable actions.

Study Arms

  • Experimental: Fortified fat-based paste with EFAs, DHA, ARA and phytase
  • Experimental: Fortified fat-based paste with essential fatty acids
  • No Intervention: Control group

Primary Outcomes

  • Linear growth by measuring length

Study Interventions

  • Fortified blended foods (FBF)
  • Lipid-based nutrient supplements (LNS)
  • Plant-source protein

Research Gaps

  • Acceptability

    Which food products do recipients enjoy eating and have the fewest side effects?

  • Composition

    Which ingredients offer the best prevention or treatment for undernutrition?

  • Effectiveness

    How well do different food compositions and interventions prevent or treat undernutrition, when implemented "on the ground"?

  • Innovation

    What novel food-based products and programming methods effectively prevent and treat undernutrition?

Study Population