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Balanced Energy and Protein Dietary Supplementation

BEPS is a promising intervention to enhance the nutritional status of mothers and babies, particularly in resource-poor settings where access to nutrition and antenatal care (ANC) services is limited.

Providing balanced protein and energy dietary supplementation (BEPS) to undernourished pregnant women has been shown to promote weight gain during pregnancy and improve birth outcomes [1, 2, 3].

The World Health Organization (WHO) recommends antenatal BEP dietary supplementation for pregnant women in undernourished populations with a prevalence of more than 20% underweight pregnant women (body mass index [BMI] <18.5 kg/m2) to reduce the risk of stillbirths and small for gestational age (SGA) newborns [4].



BEPS are a type of ready-to-use supplement that provide multiple micronutrients and, specifically, energy and protein in a balanced composition such that protein provides less than 25% of the total energy content.

Product specifications for BEPS are still under development. In 2017, an Expert Consultation Report [5] proposed the following macronutrient recommendations for BEP dietary supplements:


  • Energy: 250-500 kcals (or double in high-risk populations or lower in low-to-moderate-risk contexts)
  • Fat: 10-60% of energy
  • Protein: 14-16 g
  • Carbohydrates: No recommendations given the wide range of energy from fat
  • Trans Fats: No more than 1%, as a standard requirement.
  • Fatty Acid (optional): Minimum of 1.3 g of n-3 or 300 mg DHA+EPA (200 mg DHA) to achieve a healthy n-6:n ratio of 5:1.


BEP products should also be fortified with MMS and the report provides a comprehensive list of micronutrients in Table I.

Over 15 micronutrients are recommended, with ranges set at a minimum of EAR and a maximum of RDA. If the nutrient had (adequate intake) AI then this was considered as the maximum limit. Calcium to be included at 500 mg.

BEP food products may include high-energy biscuits, lipid-based spreads, extruded snacks (savory, puffy crispy product, with an option to have a paste inside), bars, encapsulated foods (e.g. a sweet or savory outer covering with a legume-base inside) and liquid drink or drink powder.




What does the evidence show?

Current evidence indicates that BEPS improves fetal growth, and may reduce the risk of stillbirth, low birthweight (LBW) infants and infants born small-for-gestational age (SGA), especially among undernourished pregnant women.

According to a systematic review by Ota et al., BEPS reduced SGA by 21% and stillbirth by 40% among undernourished pregnant women [2].



Another meta-analysis indicated that providing pregnant women with BEPS resulted in a significant reduction of 31 % in the risk of giving birth to small for gestational age infants and greater birth weight gain. The latter effect was more pronounced in malnourished women compared to adequately nourished women [6].


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