Abstract
Although different combinations of nutrition interventions are employed, most are insufficient to reduce stunting significantly. This study aimed to draw current evidence to reduce stunting among under 5 years children from randomized controlled trials. Eligible randomized controlled trials met inclusion criteria were included. The weighted mean effect sizes with 95% CIs were used as summary measures for changes in height-for-age z score (HAZ) using random-effect models; heterogeneity was analyzed using predefined characteristics. From the total of 116 articles, 47 randomized controlled trials with a sample size of 35,115 study participants were included for analysis. Except for educational intervention (0.14; 95%CI: 0.00, 0.27), the weighted mean effects of iron, zinc, water, sanitation and hygiene (WASH), multiple micronutrients (MMN) and dietary interventions were all insignificant. A fixed combination of nutrition interventions demonstrating similar benefit in all contexts is not found. Our results are insufficient to make a recommendation on the most appropriate interventions to reduce stunting in all settings. This result highlights the importance of further evidence before nutrition component formulation for large-scale interventions. The short duration of the interventions and lack of information about the infection status of participants in most of the included trials remain two of the possible limitations needing consideration.
Highlights
Stunting, wasting, and micronutrient deficiencies, remain one of the major challengesamong children younger than 5 years in developing countries [1]
The selected trials reported the effects of specific nutrition interventions on height-for-age z score (HAZ) in low and middle-income countries (LMICs) mostly in food-insecure settings
The individual interventions of iron, zinc, multiple micronutrients (MMN) containing iron and zinc, complimentary food, and WASH did not result in improved linear growth of children under five years of age, whereas interventions providing nutrition education had a significant positive effect (0.14; 95% CI: 0.00, 0.27) on linear growth
Summary
Stunting, wasting, and micronutrient deficiencies, remain one of the major challengesamong children younger than 5 years in developing countries [1]. For effective reduction of stunting, it is vital to have a deeper understanding of factors contributingto linear growth restrictions [2]. Growth restrictions may stem from deficiencies in single nutrients, micronutrients, macronutrients, or more commonly, a combination of many nutritional deficiencies [3]. There are ambitious targets to reduce the prevalence of stunting by 40% between 2010 and 2025 [4]. Undernutrition is commonly associated with food insecurity and hunger, it is unclear which nutrition intervention can be most effective in a specific context, in countries where undernutrition is a continuing problem [6]
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