Eggs are a good source of nutrients for growth and development. We hypothesized that introducing eggs early during complementary feeding would improve child nutrition.
A randomized controlled trial was conducted in Cotopaxi Province, Ecuador, from March to December 2015. Children ages 6 to 9 months were randomly assigned to treatment (1 egg per day for 6 months [n = 83]) and control (no intervention [n = 80]) groups. Both arms received social marketing messages to encourage participation in the Lulun Project (lulun meaning “egg” in Kichwa). All households were visited once per week to monitor morbidity symptoms, distribute eggs, and monitor egg intakes (for egg group only). Baseline and end point outcome measures included anthropometry, dietary intake frequencies, and morbidity symptoms.
Mothers or other caregivers reported no allergic reactions to the eggs. Generalized linear regression modeling showed the egg intervention increased length-for-age z score by 0.63 (95% confidence interval [CI], 0.38–0.88) and weight-for-age z score by 0.61 (95% CI, 0.45–0.77). Log-binomial models with robust Poisson indicated a reduced prevalence of stunting by 47% (prevalence ratio [PR], 0.53; 95% CI, 0.37–0.77) and underweight by 74% (PR, 0.26; 95% CI, 0.10–0.70). Children in the treatment group had higher dietary intakes of eggs (PR, 1.57; 95% CI, 1.28–1.92) and reduced intake of sugar-sweetened foods (PR, 0.71; 95% CI, 0.51–0.97) compared with control.
The findings supported our hypothesis that early introduction of eggs significantly improved growth in young children. Generally accessible to vulnerable groups, eggs have the potential to contribute to global targets to reduce stunting.
Egg complementary feeding could be an interesting strategy for Latin-American malnourished hospitalized children
Iannotti et al. showed the positive impact of early 6-month complementary feeding with eggs on growth indices and dietary intake in rural Ecuadorian infants.1 In this randomized controlled trial, daily egg consumption allowed increasing length-for-age (LAZ) and body mass index z-score (zBMI), and reduced prevalence of stunting and thinness.
We have been performing an annual survey of nutritional status in hospitalized children for 8 years, since 2010 in France and internationally since 2012.2,3 Among the participating centers, Colombia, which has a common border with Ecuador, participated in 2013, 2014, and 2015. We computed data from this country, involving urban tertiary hospitals (6 centers in Bogotá, 1 in Medellín, 1 in Barranquilla) and compared our population data to the baseline population of Iannotti et al. article. Within the 491 Colombian children, 35 were between 6 and 9 month-old and 242 had less than 2 years. Using World Health Organization (WHO) references, LAZ was -0.42 ± 1.77 in the 6-9-month-old group and -0.86 ± 1.81 in the 0-2-year-old population. zBMI was -1.02 ± 1.74 in the 6-9-month-old group and -0.61 ± 1.86 in the 0-2-year-old population. The frequency of LAZ <-2 SD (stunting) and z-BMI <-2 SD (thinness) were respectively 11% and 29% in the 6-9-month-old population ,25% and 20% in the 0-2-year-old population.
Our results for stunting are consistent with the literature4 and lower than the 38% observed in Ecuador, suggesting that population of Ecuador is more exposed to chronic malnutrition. z-BMI was lower in Colombian children suggesting higher prevalence of acute malnutrition in hospitalized children from urban areas. In our population, the frequency of thinness was significantly higher in the 6-9 month-old patients compared to 0-6, 9-24, and 24-60 month-old patients, respectively 24%, 14%, and 8% (p<0.01). The higher frequency in the 6-9 month-old children may be partly explained by weaning, introduction of complementary feeding and growth rate at this age.5
The 0-2 years and particularly the 6-9 month-old children are a population at high risk of malnutrition. This early nutritional approach with egg complementary feeding could be beneficial also to hospitalized children in Latin-American countries and requires further research.
1. Iannotti LL, Lutter CK, Stewart CP, et al. Eggs in Early Complementary Feeding and Child Growth: A Randomized Controlled Trial. Pediatrics. June 2017. doi:10.1542/peds.2016-3459.
2. Sissaoui S, De Luca A, Piloquet H, et al. Large scale nutritional status assessment in pediatric hospitals. E-SPEN J. 2013;8(2):e68-e72. doi:10.1016/j.clnme.2013.02.002.
3. De Luca A, Piloquet H, Mansilla M, et al. [Multicenter nutritional screening in hospitalized children]. Arch Pediatr. 2012;19(5):545-546. doi:10.1016/j.arcped.2012.02.019.
4. Sarmiento OL, Parra DC, González SA, González-Casanova I, Forero AY, Garcia J. The dual burden of malnutrition in Colombia. Am J Clin Nutr. 2014;100(6):1628S-35S. doi:10.3945/ajcn.114.083816.
5. Ruel MT, Menon P. Child feeding practices are associated with child nutritional status in Latin America: innovative uses of the demographic and health surveys. J Nutr. 2002;132(6):1180-1187.