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Title:   Author  item
                                            ARIMOND, MARY - University Of Californiaitem
                                            ZEILANI, MAMANE - Nutrisetitem
                                            JUNGJOHANN, SVENJA - University Of Californiaitem
                                            BROWN, KENNETH - University Of Californiaitem
                                            ASHORN, PER - University Of Tampere Medical Schoolitem
                                            Allen, Lindsay

                                                         - *A*item
                                            DEWEY, KATHRYN - University Of California
  Submitted to: Maternal and Child Nutrition
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 12/30/2014
                                    Publication  Date: 5/6/2013
                                    Citation: Arimond, M., Zeilani, M., Jungjohann, S., Brown, K., Ashorn, P., Allen, L.H., Dewey, K.G. 2013. Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the International Lipid-Based Nutrient Supplements (iLiNS). Maternal and Child Nutrition. DOI: 10.1111/mcn.12049.Interpretive Summary: This article describes the decisions that were made when designing lipid-based nutrient supplements (LNS) for use in the International Lipid-Based Nutrient Supplements (iLiNS) Project. The iLiNS trials were designed to investigate the potential of LNS to prevent undernutrition in vulnerable populations. The first objective was to develop acceptable LNS products for use in trials in Burkina Faso, Ghana and Malawi. Here we describe the rationale for decisions about supplement formulation and design including ration size, ingredients, nutrient content, safety and quality, and packaging. Most iLiNS supplements deliver 20 g/day and are intended for home fortification of local diets. This amount avoids displacement of breast milk for infants and allows for dietary diversity through the additional consumption of available and accessible nutrient-dense foods. Ingredient selection depends on the acceptability of the flavour, micronutrient, anti-nutrient and essential fatty acid contents. The nutrient content of the LNS for prevention of undernutrition reflects the likelihood that in many resource-poor settings, diets of the most nutritionally vulnerable individuals (infants, young children, and pregnant and lactating women) are likely to be deficient in multiple micronutrients and possibly essential fatty acids. During ingredient procurement and LNS production, safety and quality control procedures are needed to prevent contamination with toxins or pathogens and to ensure that the product stays stable and palatable over time. Packaging considerations include product protection, stability, convenience and portion control.
                                Technical Abstract: The International Lipid-Based Nutrient Supplements (iLiNS) Project began in 2009 with the goal of contributing to the evidence base regarding the potential of lipid-based nutrient supplements (LNS) to prevent undernutrition in vulnerable populations. The first project objective was the development of acceptable LNS products for infants 6–24 months and for pregnant and lactating women, for use in studies in three countries (Burkina Faso, Ghana and Malawi). This paper shares the rationale for a series of decisions in supplement formulation and design, including those related to ration size, ingredients, nutrient content, safety and quality, and packaging. Most iLiNS supplements have a daily ration size of 20 g and are intended for home fortification of local diets. For infants, this ration size is designed to avoid displacement of breast milk and to allow for dietary diversity including any locally available and accessible nutrient-dense foods. Selection of ingredients depends on acceptability of flavour, micronutrient, anti-nutrient and essential fatty acid contents. The nutrient content of LNS designed to prevent undernutrition reflects the likelihood that in many resource-poor settings, diets of the most nutritionally vulnerable individuals (infants, young children, and pregnant and lactating women) are likely to be deficient in multiple micronutrients and, possibly, in essential fatty acids. During ingredient procurement and LNS production, safety and quality control procedures are required to prevent contamination with toxins or pathogens and to ensure that the product remains stable and palatable over time. Packaging design decisions must include consideration of product protection, stability, convenience and portion control.


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