We commend Dr Humphrey1 on an insightful and well-written editorial on infant underweight malnutrition and thank her for her interest in our study on this topic.2 In our trial, provision of fortified spread, a novel lipid-based nutrient supplement, to Malawian infants was associated with a markedly reduced incidence of severe stunting between 6 and 18 months of age. Yet, there was a large decrease in mean height-for-age, indicating that even the infants given supplementation often failed to maintain normal growth during this critical age. Dr Humphrey proposes 2 explanations for how this might be linked to insufficient dietary intakes: breast-milk displacement and increased energy and nutrient needs due to high rates of disease. Whereas the former has been documented in other settings, we found little evidence supporting this theory in our study area.3 Diarrhea, malaria, and respiratory infections, on the other hand, are common and associated with infant stunting in this population.4,5 Malaria incidence has recently declined, apparently owing to the frequent use of bed nets, but other childhood infections may well have contributed to the growth faltering of our study participants.
Ashorn P, Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ. Undernutrition Malnutrition in Infants in Developing Countries. Arch Pediatr Adolesc Med. 2009;163(2):186. doi:10.1001/archpediatrics.2008.544