Development of Acute Malnutrition Despite Nutritional Supplementation in Malawi

Malnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from two prospective, randomized control trials of complimentary feeding with supplemental legumes (n = 693, ages 6-24 months) in two Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by cox-regression analysis, include study village (Hazard ratio (HR) 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1.89). Comparison of Masenjere to Limera demonstrate adequate and similar nutritional intake yet an increased rate of AM in Masenjere, 56/400(14.0%) vs 14/293(4.8%), as well as stunting, 140/400(35%) vs 80/293(27%), environmental enteric dysfunction 246/400(71%) vs 181/293(67%), and infectious symptoms (cough and diarrhea). Masenjere did have cleaner water and less food insecurity 200/399 (50.5%) vs 204/293 (69.6%). These findings suggest adequate complementary nutrient intake does not protect young children against AM.