The effects of multi-nutrient fortified dairy-based formulas on growth, anaemia, and micronutrient status in Nigerian late preterm infants and moderately malnourished toddlers

Milk and dairy-based drinks are nutrient-rich,[157] when fortified could be a cost-effective strategic nutritional intervention to increase the intake and status of essential nutrients such as iron, zinc, vitamins A and D, and polyunsaturated fatty acid thereby reducing the prevalence of anaemia and supporting both physical and cognitive development in children under 5 years old in anaemia endemic countries such as Nigeria. This thesis aims to determine the effects of multi-nutrient fortified dairy-based formula on growth, anaemia, micronutrient status, cognitive development and microbiota in Nigerian late preterm infants and moderately malnourished infants and toddlers. Specific objectives: I. To evaluate growth and nutritional status in Nigerian late preterm infants receiving a preterm formula or breastmilk milk II. To gain more insight into the healthcare perspective of the current nutritional management and practices of late preterm in Nigeria. III. To determine which dose of iron-fortified dairy-based drink would improve anaemia in anaemic Nigerian toddlers without stimulating gut potential pathogenic bacteria. IV. To study the effect of a multi-nutrient fortified dairy-based drink on micronutrient status, growth, and cognitive development in malnourished Nigerian toddlers Chapter 2 explores the effects of preterm infant formula on growth, iron, vitamin D and vitamin A status in apparently healthy Nigerian late preterm infants (gestational age 32-34 weeks) who could not breastfeed by medical indication, compared to a group of late preterm infants who were fed according to the ‘golden standard’ of feeding: breastmilk. Chapter 3 describes a formative research study conducted among Nigerian healthcare professionals who provide care for late preterm infants, with the aim of gaining more insight into their perspective on their current practices and the guidelines on which these are based. We also identified gaps between current practices, the Nigerian National Guideline for Comprehensive Newborn Care (released in November 2021), and international best practices used for managing late preterm in Nigeria. Chapters 4 and 5 describe the results of a 6-month dose-response open (partly blind: statistics, biochemical analyses), randomized intervention trial on the effect of a multi-nutrient fortified dairy-based formula on anaemia, haemoglobin concentration, and intestinal microbiota composition (chapter 3), and on anthropometrics, cognitive performance and micronutrient status (chapter 4) in moderately malnourished anaemic Nigerian toddlers, aged 12 – 36 months. In this study, the test product was provided daily in different amounts (200, 400 or 600 mL, supplying 2.24, 4.48 and 6.72 mg of elemental iron, respectively). Chapter 6 provides a general discussion based on the results reported in this thesis, its public health implications, and suggestions for future research.