The effect of bovine colostrum/egg supplementation compared with corn/soy flour in young Malawian children: A randomized, controlled clinical trial

Authors: BIERUT, TATIANA - Washington University; DUCKWORTH, LAURA - Washington University; GRABOWSKY, MARK - Consultant; ORDIZ, M ISABEL - Washington University; LAURY, MARIE - Washington University; CALLAGHAN-GILLESPIE, MEGHAN - Washington University; MALETA, KEN - University Of Malawi; MANARY, MARK - Washington University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/14/2020
Publication Date: 12/17/2020
Citation: Bierut, T., Duckworth, L., Grabowsky, M., Ordiz, M., Laury, M.L., Callaghan-Gillespie, M., Maleta, K., Manary, M.J. 2020. The effect of bovine colostrum/egg supplementation compared with corn/soy flour in young Malawian children: A randomized, controlled clinical trial. American Journal of Clinical Nutrition. 113(2):420-427. https://academic.oup.com/ajcn/article/113/2/420/6040576.
DOI: https://doi.org/10.1093/ajcn/nqaa325

Interpretive Summary: Young children in rural Africa often have poor linear growth and poor gut health. A group of vulnerable, rural African children aged 9-18 months were given a specialized food made from cow's milk collected soon after birth of calves called colostrum and egg and they grew taller and had better gut health. This special food supplement can be used more widely in this population, knowing it will have beneficial effects in children.

Technical Abstract: Bovine colostrum with egg powder (BC/egg) is rich in essential amino acids and immunoactive compounds. This trial tested the hypothesis that a daily supplement of BC/egg would reduce linear growth faltering and environmental enteric dysfunction (EED) in Malawian infants when compared with an isoenergetic ration of corn/soy flour used as a control. EED was defined by a lactulose permeability test This was a prospective, randomized, blinded, placebo-controlled clinical trial in which 9-mo-old infants received BC/egg or a control for 3 mo. The primary outcomes were change in length-for-age z-score (deltaLAZ) and urinary lactulose excretion (%L) at 12-mo-old. Secondary outcomes included episodes of diarrhea, stunting, EED, and the 16S configuration of the fecal microbiota. Of the 277 children enrolled, 267 completed the inter-vention phase of the study. LAZ decreased in all children from 9 to 17 mo, although deltaLAZ was less in children receiving BC/egg from 9 to 12 mo (difference = 0.12 z-scores; P = 0.0011). This difference persisted after feeding was completed, with less deltaLAZ (difference = 0.09 z-scores). A lower prevalence of stunting was seen in the intervention group (n = 47/137) than the control group (n = 62/127) at 17 mo (RR = 0.70; 95% CI: 0.52, 0.94). The median %L at 12 mo of age in the children receiving BC/egg was 0.14%, compared with 0.17% in the control group (P = 0.74). In children with %L >0.45% at enrollment (severe EED), the BC/egg group had Bovine colostrum with egg powder (BC/egg) is rich in essential amino acids and immunoactive compounds. This trial tested the hypothesis that a daily supplement of BC/egg would reduce linear growth faltering and environmental enteric dysfunction (EED) in Malawian infants when compared with an isoenergetic ration of corn/soy flour used as a control. EED was defined by a lactulose permeability test. This was a prospective, randomized, blinded, placebo-controlled clinical trial in which 9-mo-old infants received BC/egg or a control for 3 mo. The primary outcomes were change in length-for-age z-score (deltaLAZ) and urinary lactulose excretion (%L) at 12-mo-old. Secondary outcomes included episodes of diarrhea, stunting, EED, and the 16S configuration of the fecal microbiota. Of the 277 children enrolled, 267 completed the inter-vention phase of the study. LAZ decreased in all children from 9 to 17 mo, although deltaLAZ was less in children receiving BC/egg from 9 to 12 mo (difference = 0.12 z-scores; P = 0.0011). This difference persisted after feeding was completed, with less deltaLAZ (difference = 0.09 z-scores). A lower prevalence of stunting was seen in the intervention group (n = 47/137) than the control group (n = 62/127) at 17 mo (RR = 0.70; 95% CI: 0.52, 0.94). The median %L at 12 mo of age in the children receiving BC/egg was 0.14%, compared with 0.17% in the control group (P = 0.74). In children with %L >0.45% at enrollment (severe EED), the BC/egg group had more children with normal %L at 12 mo of age (10/20, 50%) than was seen in controls (2/15, 13%; P = 0.024). Episodes of diarrhea and B-diversity of the 16S configuration of fecal microbiota did not differ between the 2 groups. Addition of BC/egg to complementary feeding in Malawian infants resulted in less linear growth faltering.