Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers

Authors

• Elizabeth L. Prado, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
• Charles D. Arnold, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
• K Ryan Wessells, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
• Christine P. Stewart, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
• Souheila Abbeddou, Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
• Seth Adu-Afarwuah, Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
• Benjamin F. Arnold, Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
• Ulla Ashorn, Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
• Per Ashorn, Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
• Elodie Becquey, Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
• Kenneth H. Brown, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA; Helen Keller International, New York, NY, USA
• Jaya Chandna, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
• Parul Christian, Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
• Holly N. Dentz, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
• Sherlie J L Dulience, Brown School, Washington University in St. Louis, St Louis, MO, USA
• Lia C H Fernald, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
• Emanuela Galasso, Development Research Group, World Bank, Washington, DC, USA
• Lotta Hallamaa, Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
• Sonja Y. Hess, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
• Lieven Huybregts, Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
• Lora L Iannotti, Brown School, Washington University in St. Louis, St Louis, MO, USA
• Elizabeth Yakes Jimenez, Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
• Patricia Kohl, Brown School, Washington University in St. Louis, St Louis, MO, USA
• Anna Lartey, Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
• Agnes Le Port, Independent consultant, Dakar, Senegal
• Stephen P. Luby, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
• Kenneth Maleta, Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
• Andrew Matchado, Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
• Susana L. Matias, Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
• Malay K. Mridha, Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
• Robert Ntozini, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
• Clair Null, Mathematica, Washington, DC, USA
• Maku E. Ocansey, CDC Foundation, Atlanta, GA, USA
• Sarker M. Parvez, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
• John Phuka, Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
• Amy J. Pickering, School of Engineering, Tufts University, Medford, MA, USA
• Andrew J. Prendergast, Blizard Institute, Queen Mary University of London, London, United Kingdom
• Abu A. Shamim, Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
• Zakia Siddiqui, Healthy Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
• Fahmida Tofail, Nutrition and Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
• Ann M. Weber, Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
• Lee S F Wu, Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
• Kathryn G. Dewey, Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA

Document Type

Article

Publication Date

11-2-2021

Abstract

BACKGROUND: Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development.

OBJECTIVES: We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects.

METHODS: We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024).

RESULTS: In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11).

CONCLUSIONS: Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.

Publisher

American Society of Clinical Nutrition

Publication Title

The American journal of clinical nutrition

ISSN

1938-3207

Volume

114

Issue

Suppl 1

First Page

43

Last Page

43

DOI

10.1093/ajcn/nqab277

Recommended Citation

Prado EL, Arnold CD, Wessells KR, Stewart CP, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn U, Ashorn P, Becquey E, Brown KH, Chandna J, Christian P, Dentz HN, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Huybregts L, Iannotti LL, Jimenez EY, Kohl P, Lartey A, Le Port A, Luby SP, Maleta K, Matchado A, Matias SL, Mridha MK, Ntozini R, Null C, Ocansey ME, Parvez SM, Phuka J, Pickering AJ, Prendergast AJ, Shamim AA, Siddiqui Z, Tofail F, Weber AM, Wu LSF, Dewey KG. Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. Am J Clin Nutr. 2021 Nov 2;114(Suppl 1):43S-67S. doi: 10.1093/ajcn/nqab277. PMID: 34590116; PMCID: PMC8560311.