Title: Does dietary aflatoxin exposure reduce linear growth in young children? Results from a cluster-randomized trial
Abstract: Linear growth faltering continues to negatively affect children in low- and middle-income countries and is associated with poor cognitive, developmental, and educational outcomes. Observational and laboratory data suggest aflatoxin is a potential contributor to stunting.
Methods: The Mycotoxin Mitigation Trial was a cluster-randomized community-based two group trial conducted in the Kongwa District of Tanzania between 2018-2020. The trial assessed whether an intervention to reduce aflatoxin consumption, while maintaining usual feeding behaviors from 6 -18 mo, increased mean length-for-age Z score (LAZ) at 18 mo. An infant and young child feeding education intervention was delivered equally in both groups. In the intervention group, low-aflatoxin pre-blended porridge flour and separate groundnut flour were provided, 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. 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).
Discussion and 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. Forthcoming laboratory analyses will determine the frequency and exposure levels in these infants during the trial period and further clarify the effect of AF consumption on linear growth.