Malnutrition is a major public health concern among children in developing countries, leading to impaired growth and increased risk of morbidity. This study evaluated the effectiveness of nutrient-dense composite flour cookies as a dietary intervention to improve the nutritional status of malnourished children. Composite cookies were developed using soy, chickpea, and peanut, and were subjected to nutritional and quality analysis including proximate composition and other physicochemical assessments prior to intervention. A randomized controlled trial was conducted among 60 malnourished children aged 3 to 10 years, divided into intervention and control groups. The intervention group received the composite cookies along with their regular diet, while the control group continued with their usual diet. Anthropometric indicators including weight, body mass index (BMI), and mid-upper arm circumference (MUAC), as well as biochemical parameters such as hemoglobin and serum albumin, were assessed at baseline and after a 3-month intervention period. The study aimed to determine whether supplementation with nutrient-rich composite cookies could significantly improve growth and nutritional outcomes in malnourished children.
This randomized controlled trial was conducted to evaluate the impact of composite flour-enriched cookies on the nutritional status of malnourished children. Malnutrition remains a critical public health issue, particularly in low-resource settings, necessitating the development of affordable and nutrient-rich food-based interventions. Prior to the intervention, composite cookies were formulated using soy, chickpea, and peanut to enhance protein and energy density. The developed product was evaluated through comprehensive analysis, including proximate composition, physicochemical properties, and sensory evaluation, to ensure nutritional adequacy and acceptability. The study included 60 children aged 3-10 years diagnosed with moderate to severe malnutrition. Participants were randomly assigned to either the intervention group or the control group. The intervention group received daily supplementation with the developed composite cookies, while the control group continued their usual diet without supplementation. The intervention period lasted for three months. Anthropometric measurements, including weight-for-age, BMI-for-age, and mid-upper arm circumference (MUAC), were recorded at baseline and at the end of the intervention. In addition, biochemical parameters such as hemoglobin and serum albumin levels were assessed to evaluate improvements in nutritional and physiological status. The primary objective was to assess improvement in anthropometric indicators, while secondary outcomes included changes in biochemical parameters and overall health status. The findings of this study support the potential use of locally produced, nutrient-dense functional foods as sustainable strategies to combat childhood malnutrition.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
One serving(5 cookies) constituting 50g supplemented cookies (T3) were provided as a daily dietary supplement to improve nutritional status in malnourished children over a period of three months.
Bilal Hospital Rawalpindi
Rawalpindi, Punjab Province, Pakistan
Change in Weight-for-Age Z-score (WAZ)
Change in weight-for-age Z-score calculated using WHO Child Growth Standards based on measured body weight (kg) from baseline to 3 months
Time frame: Baseline and monthly up to 3 months
Change in Height-for-Age Z-score (HAZ)
Change in height-for-age Z-score calculated using WHO Child Growth Standards based on measured height (cm) from baseline to 3 months.
Time frame: Baseline and monthly up to 3 months
Change in BMI-for-Age Z-score (BAZ)
Change in BMI-for-age Z-score calculated using WHO Child Growth Standards based on BMI (kg/m²) from baseline to 3 months
Time frame: Baseline and monthly up to 3 months
Change in Mid-Upper Arm Circumference (MUAC)
Change in MUAC measured in centimeters (cm) using a non-stretchable MUAC tape from baseline to 3 months and interpreted according to WHO MUAC classification criteria
Time frame: Baseline and monthly up to 3 months
Change in Serum Albumin Levels
Change in serum albumin concentration (g/dL) measured using standard biochemical laboratory methods at baseline and at 3 months
Time frame: Baseline and monthly over a 3-month period
Change in Hemoglobin
Change in hemoglobin levels (g/dL) measured using standard laboratory methods from baseline to 3 months to assess anemia status
Time frame: Baseline and monthly up to 3 months
Change in Physical Signs of Malnutrition
Assessment of clinical signs of malnutrition (e.g., muscle wasting, hair thinning, pale skin) using clinical examination based on PYMS criteria Unit of Measure: Presence/absence
Time frame: Baseline and monthly up to 3 months
Change in Daily Energy Intake
Daily energy intake (kcal/day) assessed using Food Frequency Questionnaire (FFQ) at baseline and caregiver-maintained food diary during follow-up, analyzed using NutriSurvey software
Time frame: Baseline and monthly up to 3 months
Change in Daily Protein Intake
Daily protein intake (g/day) assessed using FFQ and food diary, analyzed using NutriSurvey software
Time frame: Baseline and monthly up to 3 months
Change in Daily Carbohydrate Intake
Daily carbohydrate intake (g/day) assessed using FFQ and food diary, analyzed using NutriSurvey software
Time frame: Baseline and monthly up to 3 months
Change in Daily Fat Intake
Daily fat intake (g/day) assessed using FFQ and food diary, analyzed using NutriSurvey software
Time frame: Baseline and monthly up to 3 months
Change in Appetite Score
Appetite level assessed using caregiver-reported dietary intake patterns and food diary records, including frequency and quantity of meals consumed Unit of Measure: Score / qualitative assessment
Time frame: Baseline and monthly up to 3 months
Change in Energy and Fatigue Levels
Energy levels and fatigue assessed through caregiver-reported observations of child activity, alertness, and daily functioning Unit of Measure: Qualitative assessment (improved / no change / worsened)
Time frame: Baseline and monthly up to 3 months
Sensory Acceptability Score
Sensory evaluation of cookies including taste, texture, aroma, and overall acceptability assessed using a 9-point hedonic scale (1 = dislike extremely, 9 = like extremely). Evaluation conducted by a trained panel (n=12) under standard ethical guidelines
Time frame: Baseline
Physical Properties
Diameter (mm), thickness (mm), and spread ratio measured using standard AACC (2000) methods
Time frame: Baseline
Phytochemical Composition
Phytochemical constituents including total phenolic content (GAE/g), total flavonoid content (QE/g), saponins, isoflavones, and phytosterols (mg/100 g) determined using standard validated analytical methods
Time frame: Baseline
Mineral Content
Iron, calcium, zinc, magnesium, and phosphorus (mg/100 g) determined using AOAC (2012) methods and atomic absorption spectrophotometry
Time frame: Baseline
Proximate Composition
Moisture, protein, fat, ash, fiber, and carbohydrate content (%) determined using standard methods (AACC, 2000)
Time frame: Baseline
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