Egg supplementation for 24 weeks does not improve linear growth or reduce small intestinal permeability in Sierra Leonean children with moderate wasting: a randomized, blinded, controlled trial

Background: Environmental enteric dysfunction and linear growth faltering are common among children with moderate acute malnutrition (MAM) in low-income countries. Eggs contain high-quality protein and bioactive compounds that may improve gut integrity and growth. Objectives: This study aims to determine if daily supplementation with whole egg powder compared with corn flour for 24 wk reduces small intestinal permeability and improves linear growth in children with MAM. Methods: This individually randomized, outcomes-assessor and investigator-blinded, controlled trial enrolled participants aged 6–30 mo with MAM in Pujehun District, Sierra Leone. Participants received either 15 g/d whole egg powder or nearly isoenergetic corn flour for 24 wk. All children received Supercereal Plus for 6 wk, daily micronutrient supplementation, and malaria chemoprophylaxis every 6 wk. Primary outcomes were change in length-for-age z-score (ΔLAZ) at 12 and 24 wk and percent urinary lactulose excretion (%L) at 12 and 24 wk. Results: Of 461 enrolled children, 338 (73%) were eligible for ≥1 primary outcome analysis at 12 wk and 272 (59%) at 24 wk. No differences were observed in ΔLAZ at 12 wk [difference = 0.01; 95% confidence interval (CI): –0.09, 0.11; P = 0.79] or 24 wk (difference = 0.08; 95% CI: –0.05, 0.21; P = 0.22). Over 90% of participants had increased intestinal permeability, and there were no differences in %L excretion at 12 wk (median of differences: 0.02; 95% CI: –0.03, 0.07; P = 0.44) or 24 wk (median of differences = 0.0; 95% CI: –0.05, 0.06; P = 0.90). No significant differences were observed in the rates of weight, length, or mid-upper arm circumference gain. Conclusions: Supplementation with whole egg powder for 24 wk, while providing ample amounts of essential amino acids, did not improve linear growth or reduce small intestinal permeability when compared with corn flour in children with MAM. This trial was registered at clinicaltrials.gov as NCT06002438.