(P17-037-23) Effects of Multiple Micronutrient Fortified Beverage and Responsive Caregiving on Early Childhood Development, Hemoglobin, and Ferritin Among Infants in Rural Guatemala

Objectives: Undernutrition and lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a cluster-randomized trial to assess the effects of multiple micronutrient (MM) fortified beverage and responsive caregiving interventions on early childhood development and nutritional status among infants in southwest Guatemala.

Methods: We enrolled 386 infants 6-18 months (prioritizing infants with length-for-age Z < -1) from 72 community sectors. Using a 2x2 design, sectors were randomly allocated to corn-soy beverage fortified with 21 micronutrients vs. no fortification and responsive caregiving intervention vs. no intervention, delivered at 3-week intervals for 6 months. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development-III), socioemotional development (Brief Infant Toddler Socio-Emotional Assessment), and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models.

Results: At baseline, mean age (SD) was 13.0 (4.6) months, with 49% males, 32% stunted, 55% anemic, and 58% iron deficient. At endline (n = 328/386, 85% retention), socioemotional competence improved in the fortified beverage groups, with no intervention effects on cognitive, language, or motor development, socioemotional problems, ferritin, or hemoglobin.

Conclusions: The finding that a MM fortified beverage improved socioemotional development is consistent with other MM trials, warranting further investigations into nutrient-socioemotional mechanisms. The lack of overall or synergistic effects of combining MM fortified beverages and responsive caregiving suggests further implementation research on integrating interventions considering household constraints and cultural context. Trial registration: clinicaltrials.gov, NCT02302729.

Funding Sources: University of Maryland Baltimore, Institute for Clinical and Translational Research, The Mathile Institute for the Advancement of Human Nutrition, New York Academy of Sciences