Effect of a 3-Month Modified, High-Quality Take-Home Ration on Linear Growth and Body Composition in Rural South Indian Infants Aged 6–9 Months: A Cluster-Randomized Controlled Trial

Background/Objectives: Linear growth faltering remains a major public health concern in low- and middle-income countries, wherein sub-optimal complementary feeding and hygiene practices are key modifiable factors. Inadequate complementary feeding is addressed through government-issued Take-Home Ration (THR) for <3-year-old children. This THR is not consumed regularly and does not bridge deficits in protein quality and fat intake among South Indian rural children. The addition of milk and legumes into a reformulated THR would address these gaps, but its efficacy remains unknown. Methods: In this 3-month cluster-randomized controlled trial among rural infants (6–9 months old), the intervention group (12 village clusters; n = 67) received a modified milk-and legume-based THR along with standard government THR, while the control group (12 village clusters; n = 67) received standard government THR alone. Caregivers of both groups were educated on nutrition and hygiene practices. Anthropometry, body composition (BC), morbidity, diet, and compliance data were collected. The primary outcome (length-for-age z-score (LAZ)) and secondary outcomes were analyzed using cluster-adjusted linear mixed models (LMM) in an intention-to-treat analysis. Results: While LAZ did not differ significantly between groups (β = 0.063 LAZ/month, 95%CI: −0.019, 0.145; p = 0.130), adjusted LMM showed significant differences in length (0.213 cm/month, 95%CI: 0.025, 0.400, p = 0.027), weight (0.040 kg/month, 95%CI: 0.001, 0.079, p = 0.044) and head circumference (0.067 cm/month, 95%CI: 0.005, 0.128, p = 0.033). LAZ decreased in both groups, with a significantly lower decline in the intervention group (slope difference: β = 0.05, 95% CI: 0.006, 0.095, p = 0.027). BC did not differ significantly. Conclusions: Improving protein quality and fat content of the government-issued THR showed a favourable LAZ trajectory among infants from rural South India. (Clinical Trial Registry-India: CTRI/2020/06/025825).