{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:11:37Z","timestamp":1783577497696,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T00:00:00Z","timestamp":1639526400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1159195"],"award-info":[{"award-number":["OPP1159195"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Some evidence suggests that balanced energy protein (BEP) supplements taken during pregnancy and lactation can have positive effects on birth outcomes such as small\u2010for\u2010gestational age and birthweight, but more evidence is needed on the long\u2010term use and acceptability of such supplements. We conducted a mixed\u2010methods formative research study to assess and compare compliance with and acceptability of two BEP supplements, a lipid\u2010based peanut paste and a biscuit, to identify BEP supplements for subsequent inclusion in an efficacy trial. We conducted an 8\u2010week feeding trial of daily supplementation among two groups of 40 pregnant women each in rural Nepal. Compliance data were collected and supplements distributed at the weekly visits. Sensory properties of the supplements were assessed using a 7\u2010point Likert scale. In addition, in\u2010depth interviews with women (<jats:italic>n<\/jats:italic>\u2009=\u200916), family members (<jats:italic>n<\/jats:italic>\u2009=\u20096) and health workers (<jats:italic>n<\/jats:italic>\u2009=\u20096) and focus group discussions (FGDs) (<jats:italic>n<\/jats:italic>\u2009=\u20094) were conducted to explore themes related to general use and intention of future use of the supplement. Overall self\u2010reported compliance was high: medians of 91.1% in the lipid\u2010based peanut paste group and 96.4% in the biscuit group. Both supplements were rated highly on overall likability (median score 6\/7) and sensory properties. Qualitative findings showed that sustained use of the supplements was attributed to expected health benefits, favourable sensory attributes, and family support. The FGDs suggested providing the option to choose between more than one type\/flavour of supplements to improve compliance. Sharing was mostly evident in the first week with higher sharing reported in the biscuit group.<\/jats:p>","DOI":"10.1111\/mcn.13306","type":"journal-article","created":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T11:17:33Z","timestamp":1639567053000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Compliance with and acceptability of two fortified balanced energy protein supplements among pregnant women in rural Nepal"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6054-4075","authenticated-orcid":false,"given":"Tsering P.","family":"Lama","sequence":"first","affiliation":[{"name":"Nepal Nutrition Intervention Project\u2014Sarlahi (NNIPS) Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0211-0452","authenticated-orcid":false,"given":"Katie","family":"Moore","sequence":"additional","affiliation":[{"name":"Anthrologica  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4503-2861","authenticated-orcid":false,"given":"Sheila","family":"Isanaka","sequence":"additional","affiliation":[{"name":"Departments of Nutrition and Global Health and Population Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5107-2413","authenticated-orcid":false,"given":"Leslie","family":"Jones","sequence":"additional","affiliation":[{"name":"Anthrologica  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet","family":"Bedford","sequence":"additional","affiliation":[{"name":"Anthrologica  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0138-7118","authenticated-orcid":false,"given":"Saskia","family":"de Pee","sequence":"additional","affiliation":[{"name":"Department of Global Health Milken Institute School of Public Health George Washington University  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5997-7823","authenticated-orcid":false,"given":"Joanne","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of International Health Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subarna K.","family":"Khatry","sequence":"additional","affiliation":[{"name":"Nepal Nutrition Intervention Project\u2014Sarlahi (NNIPS) Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C.","family":"LeClerq","sequence":"additional","affiliation":[{"name":"Nepal Nutrition Intervention Project\u2014Sarlahi (NNIPS) Kathmandu Nepal"},{"name":"Anthrologica  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Tielsch","sequence":"additional","affiliation":[{"name":"Department of Global Health Milken Institute School of Public Health George Washington University  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxq001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1740-8709.2010.00286.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12050"},{"key":"e_1_2_10_5_1","volume-title":"Framework and specifications for the nutritional composition of a food supplement for pregnant and lactating women (PLW) in undernourished and low\u2010income settings","author":"Bill & Melinda Gates Foundation","year":"2017"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30565-5"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30451-0"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/03670240600846336"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt109"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu10081073"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13134"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000389"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/15648265090304s408"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","unstructured":"Fisher R. 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