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First Bites: Complementary Feeding - A Global Network Cluster Randomized Controlled Trial (First Bites)

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ClinicalTrials.gov Identifier: NCT01084109
Recruitment Status : Completed
First Posted : March 10, 2010
Last Update Posted : November 25, 2013
Information provided by (Responsible Party):

Study Description
Brief Summary:
The specific aims of this project is to determine the impact of a daily intake of one half ounce of lyophilized meat between 6-18 months of age (0.5 oz for 6-12 mo; 0.75 oz for 12-18 mo) on linear growth velocity, zinc and iron intakes and status, brain growth and neurocognitive development, and infectious disease morbidity in populations traditionally dependent on non-micronutrient fortified plant foods for complementary feeding.

Condition or disease Intervention/treatment Phase
Complementary Feeding Infant Growth Other: Lyophilized meat Other: Cereal Phase 3

Detailed Description:
Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children. Prominent among nutrient inadequacies are those of iron and zinc. While huge campaigns are being mounted to fortify complementary foods and to distribute supplements, the effectiveness of these programs is generally uncertain and they do not reach millions of rural poor. By comparison, little support is being given to local food-based solutions. These not only require diversity of plant foods but appear to require the inclusion of meat to achieve zinc and iron requirements. Local supplies of meat are achievable but only with a concerted international and local effort. To justify this effort requires a multi-site efficacy study, the results of which, if positive, will leave no doubt that the effort required to provide sustainable local sources of meat for complementary feeds is worthwhile. The principal hypothesis to be tested is that daily intake of beef (1 oz/d for 6-12 mo and 1.5 oz/d for 12-18 mo) added to usual primarily plant-derived complementary feeds plus selected repetitive nutrition education messages results in greater linear growth velocity than does a micronutrient (including Zn and Fe) fortified equi-caloric cereal/legume supplement plus the same educational messages. Participants from four sites in the Global Network which have stunting rates > 20%, i.e. Guatemala, Pakistan and Zambia will be randomized by clusters to receive either ½ oz lyophilized beef (equivalent to 1 oz cooked beef)/d or the equi-caloric micronutrient-fortified plant-based supplement (both increasing by 50% at age 1 year). Both groups will receive three repetitive messages delivered by study coordinators and through the local health system as part of integrated health care. These are: provide a thick puree/gruel; feed complementary foods at least three times per day; and maximize dietary diversity. These interventions will be preceded by messages to promote exclusive breast feeding until 6 months and to start complementary feeding promptly at that time as far as possible. The meat or fortified cereal supplement will be provided daily in a group setting for each cluster; as necessary the food intervention and messages will be delivered at home by the assigned community coordinator or alternate. Outcome measures, obtained by a separate group of local, trained assessment workers, include: longitudinal linear growth between 6-18 months (primary outcome); weight and head circumference; assessment of dietary variety and diversity at 6,9,12, and 18 months; indices of iron, zinc and Vitamin B12 status at 18 months; neurocognitive development at 18 months; and incidence of diarrhea and lower respiratory infections. A positive multi-country, multi-culture outcome of this trial will demonstrate the efficacy of a regular intake of meat commencing at age 6 months to achieve nutritionally complete complementary feeding and will provide a strong rationale for global efforts to enhance local supplies of meat and achieve acceptance of meats as complementary food.

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1236 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Official Title: Complementary Feeding - A Global Network Cluster Randomized Controlled Trial
Study Start Date : July 2008
Primary Completion Date : April 2010
Study Completion Date : July 2010
Arms and Interventions

Arm Intervention/treatment
Active Comparator: 1
Daily intake of one half ounce of lyophilized meat between 6-18 months of age (0.5 oz for 6-12 mo; 0.75 oz for 12-18 mo)
Other: Lyophilized meat
Daily intake of one half ounce of lyophilized meat between 6-18 months of age (0.5 oz for 6-12 mo; 0.75 oz for 12-18 mo)
Active Comparator: 2
Daily intake of an equi-caloric fortified cereal as complementary feed from 6 to 18 months.
Other: Cereal
Daily intake of an equi-caloric fortified cereal as complementary feed from 6 to 18 months.

Outcome Measures

Primary Outcome Measures :
  1. Linear growth velocity [ Time Frame: 6 to 18 months of age ]

Secondary Outcome Measures :
  1. Infant Zinc and Ferritin levels [ Time Frame: 18 months ]
  2. Bayleys II [ Time Frame: 18 months ]
  3. Incidence of diarrhea, lower respiratory infection, and malaria [ Time Frame: 6 to 18 months ]

Eligibility Criteria

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Ages Eligible for Study:   3 Months to 4 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Inclusion criteria for clusters: Each cluster will be a rural community characterized by inhabitants with low income and served by one community health center. A primary criterion is that national or other available statistics indicate a prevalence of stunting (mean length for age Z-scores in second year < -2) of at least 20% in young children.
  • Inclusion criteria for individual families:

    • Infant aged 3-4 months;
    • Primarily or exclusively breast feeding with intent to continue breast feeding through at least 1 year.

Exclusion Criteria:

  • Exclusion criteria for individual families: Exclusion criteria include any population/family that is receiving or likely to receive free or subsidized complementary foods (or infant formula) through the health system or NGOs; any individual families who are feeding or intend to feed fortified infant formula or micronutrient-fortified commercial complementary foods.
  • Exclusion criteria for infants: Infants meeting the following criteria will be excluded from participation:

    1. known congenital anomaly;
    2. infant of multiple births;
    3. known neurological deficit apparent at the time of enrollment (including seizures).
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01084109

Kinshasa School of Public Health
Karawa, Congo
Institute for Nutrition of Central America and Panama (INCAP)
Chiimaltenango, Guatemala
Agha Khan University
Karachi, Pakistan
University of Zambia
Lusaka, Zambia
Sponsors and Collaborators
NICHD Global Network for Women's and Children's Health
Kinshasa School of Public Health
University of Zambia
INCAP, Chiimaltenango, Guatemala
Aga Khan University
University of Colorado, Denver
University of North Carolina, Chapel Hill
University of Alabama at Birmingham
Drexel University
RTI International