Providing balanced energy and protein (BEP) dietary supplementation to undernourished pregnant women has been shown to improve birth outcomes compared to the standard of care for pregnant women, typically iron and folic acid (IFA) supplementation. [1, 2, 3].
BEP dietary supplementation is a promising intervention in enhancing the nutritional status of mothers and babies, particularly in resource-poor settings where access to nutrition and antenatal care (ANC) services is limited.
The World Health Organization (WHO) recommends antenatal BEP dietary supplementation for pregnant women in undernourished populations with a prevalence of more than 20% underweight women (body mass index [BMI] <18.5 kg/m2) to reduce the risk of stillbirths and small for gestational age (SGA) newborns [2].
BEP dietary supplements are a type of ready-to-use supplements, 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 BEP dietary supplementation are still under development. In 2017, an Expert Consultation Report [3] proposed the following macronutrient and micronutrient recommendations for BEP dietary supplements:
Macronutrients
Micronutrients
BEP dietary supplements should also be fortified with vitamins and minerals, and the Expert Consultation Report [3] provides a comprehensive list of micronutrients in Table I.
Over 15 micronutrients are recommended, with ranges set at a minimum of EAR (Estimated Average Requirement) and a maximum of RDA (Recommended Dietary Allowance). If a nutrient has an AI (Adequate Intake), then this is considered as the maximum limit. Calcium is to be included at 500 mg.
BEP dietary supplements 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.
Based on the evidence used by the WHO guidelines [2] (the Cochrane review conducted by Ota et al., 2016), BEP dietary supplementation, in comparison to the usual standard of care provided to pregnant women (typically IFA supplementation) has the potential to improve birth weight in infants.
BEP has also been shown to reduce the risk of stillbirth and infants born too small [1]. Also, this evidence points out that BEP dietary supplementation may have no potential impact on preterm births and little to no effect on newborn deaths [1].
