The Effects ofComplementary Feeding of Eggs on Infant Developmentand Growth in Guatemala: The Saqmolo Study

Background: Approximately 150 million children, or roughly one-quarter of children worldwide, experience stunting (low height-for-age), while 20% are underweight.1 World-wide, undernutrition is estimated to be responsible for 2.2 million deaths and 21% of Disability-Adjusted Life Years (DALYs) in children less than 5 years of age. 1 The recent United Nations Sustainable Development Goals call for reducing stunting and wasting in children <5 years by 40%, which would affect 90 million children worldwide 1.

The global attention to stunting is based on the premise that any intervention aimed at improving linear growth may subsequently lead to improvements in the correlates of stunting 2. In children, stunting is consistently associated with poor developmental outcomes3. However, optimal interventions to concurrently address stunting and child development still need to be identified3-9.

In Guatemala, stunting is a serious public health problem10,11. The overall prevalence of stunting in children under 5 years of age in Guatemala is close to 50% and is even higher (close to 70%) for indigenous children12. The majority of indigenous families in Guatemala live on less than $2 (USD) per day and have inadequate access to health and nutrition services.

Wuqu' Kawoq-Maya Health Alliance (MHA) (http://www.wuqukawoq.org) is a non-governmental organization, located in Tecpán, Guatemala, working with vulnerable indigenous communities to provide culturally and linguistically appropriate healthcare services. MHA is currently collaborating with the Academy of Nutrition and Dietetics/UNM on projects to address malnutrition in rural Guatemala.

This study will specifically focus on evaluating the impact of regular egg consumption from about 6-12 months of age, in addition to the local standard of nutrition care, as an intervention to improve development, growth and diet quality in Mayan children. Eggs are a rich source of nutrients important to child growth and development: essential fatty acids, choline, vitamins A, and B12, and bioavailable iron, zinc and iodine13. Individual components of eggs may be associated with improved cognitive development in healthy populations, as recently reviewed by Wallace14. Eggs are culturally acceptable as part of the typical Mayan diet, are generally more affordable than other animal-source foods and are relatively simple to store and prepare15. A recent study found that egg consumption (1 egg/d for 6 months) reduced stunting in mixed-indigenous rural Andean children in Ecuador by 47% (HR: 0.53; 95% CI: 0.38-0.88);16 however, child cognitive development was not assessed in this small intervention study. This study will address a gap in understanding the impact of egg consumption, combined with other common interventions to address undernutrition in low- and middle-income settings, on both child development and growth.