A cluster-randomized trial determining the efficacy of caterpillar cereal as a locally available and sustainable complementary food to prevent stunting and anaemia

This was a cluster-randomized trial in eight rural communities in Equateur Province, Democratic Republic of Congo. Exclusively breastfed infants were enrolled at about 6 months of age and followed to 18 months, with 1:1 allocation to caterpillar cereal supplementation or the usual diet.

Infants in the intervention arm received a daily caterpillar cereal supplement from 6 to 18 months of age in addition to the usual Congolese diet. The supplement was provided in 30 g sachets from 6 to 12 months and 45 g sachets from 12 to 18 months, delivered weekly; the 30 g dose provided about 552 kJ/132 kcal, 6.9 g protein, 3.8 mg Fe, and 3.8 mg Zn, and the 45 g dose provided about 828 kJ/198 kcal, 10.3 g protein, 5.7 mg Fe, and 5.6 mg Zn.

Caterpillar cereal did not reduce stunting or improve linear growth, but it did improve iron status. At 18 months, stunting was similar between groups (67% vs 71%, P=0.69), while haemoglobin was higher with caterpillar cereal (10.7 g/dl vs 10.1 g/dl, P=0.03) and anaemia was less common (26.0% vs 50.0%, P=0.006). Ferritin was lower in the cereal group than in control (145 ng/dl vs 187 ng/dl, P=0.03), and transferrin receptor, CRP, and body iron stores were not significantly different. The overall conclusion was that this locally produced complementary food may help prevent anaemia, but stunting in this setting likely reflects causes beyond micronutrient deficiency.

Attrition and incomplete outcome data were substantial: 111 infants were randomized per arm, but only 91 and 84 completed, and anthropometric data were available for 81 and 82. Several outcomes were missing or not significant, and there was no benefit for the primary growth outcome. Vitamin and mineral supplement use also differed between groups at some time points, which could complicate interpretation of the iron-status findings.