Abstract
ABSTRACTBackgroundMeta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design.ObjectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6–24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.ResultsSQ-LNS provision decreased stunting (length-for-age z score < −2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < −2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < −2) by 18%, acute malnutrition (WLZ < −2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < −2) by 13%, and small head size (head circumference-for-age z score < −2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation.ConclusionsThe positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
Highlights
Undernutrition, including stunting, wasting, and micronutrient deficiencies, is prevalent among infants and young children in low- and middle-income countries and is associated with increased morbidity and mortality and delayed psychomotor and neurocognitive development [1]
Seven trials provided minimal SBCC on IYCF other than reinforcing the normal IYCF messages already promoted in that setting [35, 37, 39,40,41, 44, 45], and 7 trials provided expanded SBCC on IYCF that went beyond the usual messaging, either in just the small-quantity lipid-based nutrient supplements (SQ-lipid-based nutrient supplements (LNSs)) intervention arms [36, 38, 42, 47, 48] or in all arms including the non-SQ-LNS control arm [34, 43, 46]
1IFA, iron–folic acid; IYCF, infant and young child feeding; LNS, lipid-based nutrient supplement; MMN, multiple micronutrients; micronutrient powders (MNPs), multiple micronutrient powder; MQ, medium-quantity; MUAC, midupper arm circumference; randomized controlled trials (RCTs), randomized controlled trial; RDNS, Rang-Din Nutrition Study; SQ, small-quantity; WASH, water, sanitation, and hygiene; WSB, wheat–soy blend. 2Minimal IYCF messages defined as providing minimal counseling on IYCF other than reinforcing the normal IYCF messages already promoted in that setting
Summary
Undernutrition, including stunting, wasting, and micronutrient deficiencies, is prevalent among infants and young children in low- and middle-income countries and is associated with increased morbidity and mortality and delayed psychomotor and neurocognitive development [1]. Even under the best of circumstances it is difficult to meet all nutrient needs during this age interval [10], and for lowincome populations the cost of certain nutrient-rich foods is often prohibitive [11, 12] For this reason, various types of fortified products designed to fill nutrient gaps have been evaluated, including fortified blended foods and products used for home fortification such as multiple micronutrient powders (MNPs) and small-quantity (SQ) lipid-based nutrient supplements (LNSs) [13]. Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS.
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