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Using peanut butter, Manary helps pregnant moms

By Allison Floyd
University of Georgia, Peanut & Mycotoxin Innovation Lab

As a pediatrician, Mark Manary knows how important it is for young children to get enough vitamins and calories to grow. The St. Louis-based doctor has spent much of his career treating malnourished kids in Africa and helped create a supplement that more than doubled their chance of recovery.

But then he started to think: Why not intervene even earlier?

Supported by Feed the Future’s Peanut & Mycotoxin Innovation Lab, Manary is working in Malawi with hundreds of malnourished pregnant women, supplying them a food supplement and chronicling their outcomes.

“You need 1,000 extra calories a day near the end of pregnancy. What if an extra 1,000 calories isn’t so easy to come by in your house?” he said. “But that mother’s health is very important. Lots of people’s lives depend on her.”

While it’s fairly obvious that a malnourished mother can’t supply all the nutrients her baby needs, there is little research to show how much healthier a child will be if his mother had the right nutrition or how best to deliver that nutrition.

Over the past two years, Manary has enrolled 1,900 pregnant, malnourished women in a trial that gave them a food supplement to see if peanut- or soy-based products are best and how much impact they have on mother and child.

When Manary first arrived in Malawi in 1994, the common treatment for malnourished children involved hospitalizing them while they drank different milk-based products to recover.

“There is not problem with milk. It is very nutritious. But what we found was that only about 45 percent of kids would get better. Fifty-five percent just wouldn’t get better,” Manary said. No matter what the team tried, that statistic didn’t change.

At the same time, follow-up treatment at home also wasn’t practical. Milk requires refrigeration, and mothers were asked to prepare many more meals than they could make in a busy day.

“We thought: ‘What we need is something that doesn’t need to be cooked, that’s full of fat and protein, that doesn’t spoil at room temperature and that bacteria can’t grow in,’” Manary said.

He knew what might work.

Peanut butter seemed like a natural fit and within a few years, he started sending kids home with a peanut-based diet supplement. Not only did the kids gain weight, they were less likely to catch an illness than they would be if they were housed together in the hospital.

Recovery rates soared to 90-95 percent.

“That ceiling of 45 percent (recovery) was smashed,” he said.

In the years since, peanut butter supplements have become the standard treatment for malnutrition around the world.

One of the riskiest age ranges for malnutrition is 1 to 3 years old (as a child weans) but research also now shows that health effects of malnutrition – problems like stunting – begin before a child is born.

Manary’s PMIL-supported project enrolled nearly 2,000 moderately malnourished women across southern Malawi and provided them with a food supplement. Local nurses and research assistants at 15 clinics then took down the measurements of their babies within 48 hours of birth and continued to monitor them for the next three months.

Each of the three supplements was fortified with extra vitamins and nutrients. One was peanut based, while the other two were a corn-soy blend.

The babies whose mothers took the peanut-based supplement gained nearly 5 ounces more than the babies born to mothers who had the corn-soy supplements.

The project will now turn to breastfeeding mothers, who need even more nutrients than they did when they were pregnant.

Eight hundred moderately malnourished mothers will receive a peanut-based or corn-soy-based Supplement, and then be monitored to see how well the mom recovers and how quickly her baby grows.

As the data from the pregnant mothers intervention is compiled, it will help public health experts to draft programs to help mothers around the world.

“The way we see it is, we are helping people in the present – the people in the project – and we are getting knowledge to help other people in the future,” Manary said. “As a person, I am not content only to publish in an important scientific publication. I want to see how it will be used in practice."

“It’s not going to happen overnight, but it’s important. This has never been done.”

Manary also is on the faculty of Washington University in St. Louis.

Published April 29, 2016