The effect of zinc fortification of a therapeutic complementary food on the growth and immune function of severely malnourished children in Malawi
Bibliographic record
Abstract
The objective of this study was to improve the content and bioavailability of zinc in Malawi's national therapeutic food (Likuni Phala) and to assess its impact on the immune and growth recovery of malnourished children. The study was a randomised controlled trial with a stratified block design of 121 hospitalised, malnourished children, with mean (±SD) age, length for age (LAZ) and weight for length (WLZ) of 24 ± 11 months, -3.4 ± 1.5 and -2.3 ± 1.0 z-scores, respectively. Fifty six percent of the children were oedematous; the remaining 44% were non-oedematous. Children were severely immune suppressed; 52% were anergic. Three variations of the therapeutic Likuni Phala (LP) were assessed over a four week period; (1) fortified with micronutrients plus zinc (50 mg Zn/100 g dry weight) and with reduced phytate (ZF), (2) fortified with micronutrients without zinc and with reduced phytate (F), and (3) unfortified and without reduced phytate (UF). Following the intervention, both non-oedematous and oedematous children in the F group were 1.80 and 1.75 times more likely to respond positively to the delayed hypersensitivity skin test than the children in the ZF group (p < 0.05), when controlling for age, gender, initial DHS response, HIV and nutritional status and site of test. Nevertheless, among non-oedematous children, final WLZ scores were higher in the ZF (-1.36) than in the F (-1.99) treatments, as was the rate of weight gain in the ZF (4.6 g/kg/d) than the F (1.4 g/kg/d). In contrast, among oedematous children, final WLZ scores were lower in the ZF (-1.71) than the F (-1.19) treatments, and those in the ZF group had a lower rate of weight gain (2.4 g/kg/d) than those in the F (4.8 g/kg/d) group. Our study suggests that levels of zinc (10 mg/kg/day) in combination with the micronutrient fortification of LP resulted in a suppression of the immune system over that of children receiving the LP fortified with micronutrients without zinc (0.7 mg zinc/kg/day), in both non-oedematous and oedematous children. Nevertheless, there were significant increases in weight and rate of weight gain in these non-oedematous children, while the oedematous children decreased in ponderal growth and body composition indices.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".