Abstract
Background: Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life.Objective: We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age.Design: In this partially double-blind, individually randomized trial, 1320 women at ≤20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age.Results: At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for-age z score (LAZ) were 79.3 cm and −0.83, respectively, and 12% of the children were stunted (LAZ <−2). In analysis based on the intended treatment, mean ± SD length and LAZ for the LNS group (79.7 ± 2.9 cm and −0.69 ± 1.01, respectively) were significantly greater than for the IFA (79.1 ± 2.9 cm and −0.87 ± 0.99) and MMN (79.1 ± 2.9 cm and −0.91 ± 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045).Conclusion: Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child’s attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.
Highlights
Poor linear growth of children is a major problem in developing countries, where an estimated 28% of children,5 y of age are stunted (1)
For the Ghana study, we previously reported on the first of the 2 primary hypotheses (22) and showed that infants born to mothers who received prenatal supplementation with SQ-LNSs compared with iron and folic acid (IFA) had higher birth weight, and among those born to primiparous women, infants had higher birth length and head circumference than both control groups (IFA and multiple micronutrient (MMN))
The total follow-up days during which women in the IFA and MMN groups were exposed to the unintended supplements was estimated at 37,470 womandays, and for the 880 women assigned to those 2 groups, the total follow-up days during the study period was 293,059 woman-days
Summary
Poor linear growth of children is a major problem in developing countries, where an estimated 28% of children ,5 y of age are stunted (1). In a previous landmark study by the Institute of Nutrition of Central America and Panama conducted in the 1970s (14), a comprehensive approach involving supplementation during pregnancy, lactation, and early childhood was associated with greater length gain in children and long-term effects on cognitive development and adult stature. Conclusion: Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child’s attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.
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