Research Article: Multiple micronutrient supplementation using spirulina platensis and infant growth, morbidity, and motor development: Evidence from a randomized trial in Zambia

Date Published: February 13, 2019

Publisher: Public Library of Science

Author(s): Kazuya Masuda, Maureen Chitundu, Jacobus P. van Wouwe.


In developing countries, micronutrient deficiency in infants is associated with growth faltering, morbidity, and delayed motor development. One of the potentially low-cost and sustainable solutions is to use locally producible food for the home fortification of complementary foods. This study aimed to test the hypothesis that locally producible spirulina platensis supplementation would achieve the following: 1) increase infant physical growth, 2) reduce morbidity, and 3) improve motor development. We randomly assigned 501 Zambian infants into the control group or the spirulina group. Children in the control group (n = 250) received a soya-maize-based porridge for 12 months; those in the spirulina group (n = 251) received the same food with the addition of spirulina. We assessed the change in infants’ anthropometric status, morbidity (probable pneumonia, cough, probable malaria, and fever), and motor development over 12 months. The baseline characteristics were not different between the two groups. The attrition rate (47/501) was low. The physical growth of infants in the two groups was similar at 12 months of intervention, as measured by height-for-age z-scores and weight-for-age z-scores. Infants in the spirulina group were 11 percentage points less likely to develop a cough (CI: -0.23, -0.00; P < 0.05) and were more likely to be able to walk alone at 15 months (0.96 ± 0.19) than infants in the control group (0.92 ± 0.28). Home-fortification of complementary foods using spirulina had positive effects on upper respiratory infection morbidity prevention and motor milestone acquisition among Zambian infants.

Partial Text

Micronutrient deficiency in infancy is associated with growth faltering [1], morbidity [2], and delayed motor development [3], and is common in developing countries where the food available for infants has low micronutrient density [4]. A low-cost and sustainable way to address this problem is to utilize locally producible foods rich in multi-micronutrients as home supplements to complementary food. Arthrospira platensis, also known as spirulina, is a blue-green micro-algae, from the Oscillatoriaceae family, indigenous to Africa [5, 6]. It contains a high percentage of protein, and is rich in multiple micronutrients (MMN) known to support infant growth, such as beta carotene, B vitamins, and minerals including calcium, iron, magnesium, manganese, potassium, and zinc [6–9]. Other than breast milk, spirulina is the only dietary source of gamma linolenic acid, and contains various other essential fatty acids and amino acids [10, 11]. The cost of producing spirulina is much lower than that of producing other comparably protein-rich foods, such as soya beans or beef [12], and therefore may potentially be a sustainable method for meeting the nutritional demands of African infants.

Our study showed similar increase in linear growth between infants that received spirulina-fortified porridge supplementation and those that received control porridge supplementation. These results are contrary to a similar study in Zambia [19], which reported that the daily intake of fortified porridge using spirulina was associated with greater height gain compared to a control group that received no porridge supplement. However, the control group in the present study also received a porridge made with a soybean-based powder; only the addition of spirulina was excluded, and the amount of protein and energy supplied to the SP group and the CON group was almost equivalent. Hence, infants in the CON group in the present study may have shown a better increase in linear growth than children in the previous study. Although spirulina supplementation provides MMN to infants and micronutrient, e.g., zinc, deficiency is known to negatively affect growth of children [36, 37], several randomized trials have shown that MMN supplementation has little effect on growth. Our results are consistent with the IRIS clinical studies [38–41], and other studies in Africa [42–43] and in Cambodia [44] which have shown that MMN supplementation was not associated with infant growth. These findings suggest that supplementation with MMN alone may not improve the growth of infants in some populations in resource-poor settings.




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