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Session: Improving Nutrition for the First 1,000 Days (Poster Theater Flash Session 5)

(PTFS05-04-23) Results From the Mycotoxin Mitigation Trial: Does Aflatoxin Consumption Reduce Linear Growth in Young Children?

Sunday, July 23, 2023

2:17 PM – 2:21 PM ET

Location: Fairfax

Presenting Author(s)

EP

Erica L. Phillips, PhD (she/her/hers)

Assistant Research Professor
University of Wisconsin-Madison
State College, Pennsylvania, United States

Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

FN

Francis Ngure, PhD

Cornell University
Nairobi, Nairobi Area, Kenya
NK

Neema Kassim, PhD

Senior Lecturer
The Nelson Mandela African Institution of Science and Technology (NM-AIST)
Arusha, Arusha, Tanzania
PT

Paul Turner, PhD

Associate Professor
University of Maryland
College Park, Maryland, United States
EM

Edna Makule, PhD

Senior Lecturer
The Nelson Mandela African Institution of Science and Technology (NM-AIST)
Arusha, Arusha, Tanzania
LS

Laura Smith, PhD

Assistant Professor
Cornell University
Ithaca, New York, United States
NM

Nyabasi Makori

Tanzania Food and Nutrition Centre
RN

Rebecca Nelson, PhD

Professor
Cornell University
Ithaca, New York, United States
RS

Rebecca Stoltzfus, PhD

President
Goshen College
Goshen, Indiana, United States

Disclosure(s):

Erica L. Phillips, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: Multiple epidemiologic studies have shown an association between increased aflatoxin (AF) exposure and reduced linear growth, with multiple plausible biological pathways. We hypothesized that frequent AF consumption during the complementary feeding period contributes to reduced length-for-age Z-scores (LAZ) and conducted a cluster-randomized trial (CRT) to test this hypothesis. Our primary research question was whether an intervention to reduce AF consumption from 6 to 18 mo, while maintaining equivalent feeding behavior, would increase mean LAZ at 18 mo.

Methods: The Mycotoxin Mitigation Trial (MMT) was a cluster-randomized community-based two group trial conducted in the Kongwa District of Tanzania between 2018-2020. An infant and young child feeding education intervention was delivered equally in both groups. In the intervention group, low-AF pre-blended porridge flour and separate groundnut flour were provided monthly, while in the control group a skin lotion was distributed monthly. Data were collected at recruitment (between 6 w and 3 mo), and when infants were 6, 12, and 18 mo old. LAZ and secondary anthropometric outcomes were analyzed as intention-to-treat and per-protocol.

Results: Two-thousand eight hundred and forty-two maternal-infant dyads were recruited into the study, 88.9% of whom were retained at 18 mo. Mean LAZ at 18 mo was -1.89 (95%CI -1.94; 1.80) with no difference between groups. Between the 6- and 18-month time points, the proportion of stunted infants doubled, from 20.2% to 45.5%. There were no significant differences in mean weight-for-age Z-scores, weight-for-length Z-scores, or head circumference Z-scores at 12 or 18 mo of age, but mid-upper arm circumference Z-scores were greater in the intervention group (difference of 0.10, 95%CI 0.01; 0.20).

Conclusions: An intervention to reduce aflatoxin exposure from 6 to 18 mo did not increase mean LAZ scores in a low-resource, predominantly rural setting. Stunting was profound in this population, with limited recovery once stunted and mean LAZ decreasing in both groups during the trial period. Post-natal interventions to reduce AF might be too late to effectively alter poor growth trajectories.

Funding Sources: The Bill & Melinda Gates Foundation