Small-quantity Lipid-based Nutrient Supplements Research Articles

Bifidobacterium longum and microbiome maturation modify a nutrient intervention for stunting in Zimbabwean infants

Small-quantity lipid-based nutrient supplements (SQ-LNS), which has been widely tested to reduce child stunting, has largely modest effects to date, but the mechanisms underlying these modest effects are unclear. Child stunting is a longstanding indicator of chronic undernutrition and it remains a prevalent public health problem. The infant gut microbiome may be a key contributor to stunting; and mother and infant fucosyltransferase (FUT) phenotypes are important determinants of infant microbiome composition. We investigated whether mother-infant FUT status (n=792) and infant gut microbiome composition (n=354 fecal specimens from 172 infants) modified the impact of an infant and young child feeding (IYCF) intervention, that included SQ-LNS, on stunting at age 18 months in secondary analysis of a randomized trial in rural Zimbabwe. We found that the impact of the IYCF intervention on stunting was modified by: (i) mother-infant FUT2+/FUT3- phenotype (difference-in-differences-32.6% [95% CI:-55.3%,-9.9%]); (ii) changes in species composition that reflected microbiome maturation (difference-in-differences-68.1% [95% CI:-99.0%,-28.5%); and (iii) greater relative abundance of B.longum (differences-in-differences 49.1% [95% CI: 26.6%, 73.6%]). The dominant strains of B.longum when the intervention started were most similar to the proficient milk oligosaccharide utilizer subspecies infantis, which decreased with infant age and differed by mother-infant FUT2+/FUT3- phenotypes. These findings indicate that a persistently "younger" microbiome at initiation of the intervention reduced its benefits on stunting in areas with a high prevalence of growth restriction. Bill and Melinda Gates Foundation, UK DFID/Aid, Wellcome Trust, Swiss Agency for Development and Cooperation, US National Institutes of Health, UNICEF, and Nutricia Research Foundation.

Impact of Small-Quantity Lipid-Based Nutrient Supplements on Pubertal Status of 9–13-Year Olds: A Follow-Up Study of the iLiNS-DYAD Ghana Trial

BackgroundEarly and delayed puberty are both associated with adverse health and psychosocial outcomes. ObjectivesWe assessed the impact of provision of small-quantity lipid-based nutrient supplement (SQ-LNS) to mothers during pregnancy and 6 mo postpartum and to their children aged 6–18 mo, on pubertal status. MethodsThis study was a follow-up to a partially double-blind randomized controlled trial. At ≤20 wk, 1320 females were randomly assigned to receive daily: iron and folic acid during pregnancy and placebo 0–6 mo postpartum; or multiple micronutrients during pregnancy and 0–6 mo postpartum; or SQ-LNS during pregnancy and 0–6 mo postpartum and to their children from 6 to 18 mo. We re-enrolled 966 and 919 children at 9–11 y and 11–13 y, respectively. We calculated a total pubertal status score based on the Petersen Pubertal Development Scale (PDS) to assess growth spurt, skin changes, body hair, facial hair, voice break, breast development, and menstruation. Pubertal status was regressed on child’s age to generate age-adjusted PDS z-scores (aPDSZ); we performed interaction and mediation analyses. ResultsMean ± standard deviation aPDSZ did not differ between the SQ-LNS and non-LNS groups at 9–11 y (0.01 ± 0.95 compared with –0.01 ± 0.98; P = 0.958) but was more advanced in the SQ-LNS group at 11–13 y (0.07 ± 1.04 compared with –0.04 ± 0.98; P = 0.049) in the adjusted model. The effect of SQ-LNS varied by sex (P-interaction = 0.003) and household asset index z-score (P-interaction = 0.002): Puberty was more advanced in the SQ-LNS compared with non-LNS group among females (P = 0.007) but not males (P = 0.877), and within lower (P = 0.002) than average (P = 0.436) and higher (P = 0.332) socioeconomic households. ConclusionProvision of SQ-LNS during the first 1000 d of life advanced pubertal status among females. Trial registration numberThis trial was registered at clinicaltrials.gov as NCT00970866 (https://clinicaltrials.gov/ct2/show/record/NCT00970866).

The impact of home-installed growth charts and small-quantity lipid-based nutrient supplements (SQ-LNS) on child growth in Zambia: a four-arm parallel open-label cluster randomised controlled trial

BackgroundChildhood stunting remains common in many low-income settings and is associated with increased morbidity and mortality, as well as impaired child development.MethodsThe main objective of the study was to assess...

Effects of prenatal small-quantity lipid-based nutrient supplements on pregnancy, birth, and infant outcomes: a systematic review and meta-analysis of individual participant data from randomized controlled trials in low- and middle-income countries

BackgroundUndernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNSs) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies. ObjectivesWe examined the effects of SQ-LNSs provided during pregnancy compared with 1) iron and folic acid or standard of care (IFA/SOC) or 2) multiple micronutrient supplements (MMSs) and identified characteristics that modified the estimates of effects of SQ-LNSs on birth outcomes. MethodsWe conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNSs provided during pregnancy (n = 5273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether the results differed depending on methods for gestational age dating, birth anthropometry, or study design. ResultsSQ-LNSs (compared with IFA/SOC) increased birth weight [mean difference: +49 g; 95% confidence interval (CI): 26, 71 g] and all birth anthropometric z-scores (+0.10–0.13 standard deviation); they reduced risk of low birth weight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 15%. Only 2 trials compared SQ-LNSs and MMSs; P values for birth outcomes were >0.10 except for head circumference (e.g., z-score for gestational age: +0.11; 95% CI: −0.01, 0.23). Effect estimates for SQ-LNSs compared with IFA/SOC were greater among female infants and, for certain outcomes, among mothers with body mass index <20 kg/m2, inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNSs compared with MMSs were greater for certain outcomes among female infants, first-born infants, and mothers <25 y. ConclusionsSQ-LNSs had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNSs and MMSs is needed. Targeting SQ-LNSs to vulnerable subgroups may be worth considering. Clinical Trial RegistryThis study was registered at PROSPERO as CRD42021283391.

Effects of Small-Quantity Lipid-Based Nutrient Supplements (SQ-LNSs) on Early Childhood Growth Trajectories Compared to Micronutrient Powders (MNPs)

Effects of Small-Quantity Lipid-Based Nutrient Supplements (SQ-LNSs) on Early Childhood Growth Trajectories Compared to Micronutrient Powders (MNPs)

Effect of Small-Quantity Lipid-Based Nutrient Supplements on Adolescent Physical Activity and Sedentary Behavior: A Follow-Up Study of iLiNS-DYAD Trial in Ghana

Effect of Small-Quantity Lipid-Based Nutrient Supplements on Adolescent Physical Activity and Sedentary Behavior: A Follow-Up Study of iLiNS-DYAD Trial in Ghana

Zinc Supplementation Initiated Prior to or During Pregnancy Modestly Impacted Maternal Status and High Prevalence of Hypozincemia in Pregnancy and Lactation: The Women First Preconception Maternal Nutrition Trial

BackgroundData regarding effects of small-quantity-lipid-based nutrient supplements (SQ-LNS) on maternal serum zinc concentrations (SZC) in pregnancy and lactation are limited. ObjectivesThe objectives of this study were to evaluate the effect of preconception compared with prenatal zinc supplementation (compared with control) on maternal SZC and hypozincemia during pregnancy and early lactation in women in low-resource settings, and assess associations with birth anthropometry. MethodsFrom ∼100 women/arm at each of 3 sites (Guatemala, India, and Pakistan) of the Women First Preconception Maternal Nutrition trial, we compared SZC at 12- and 34-wk gestation (n = 651 and 838, respectively) and 3-mo postpartum (n = 742) in women randomly assigned to daily SQ-LNS containing 15 mg zinc from ≥3 mo before conception (preconception, arm 1), from ∼12 wk gestation through delivery (early pregnancy, arm 2) or not at all (control, arm 3). Birth anthropometry was examined for newborns with ultrasound-determined gestational age. Statistical analyses were performed separately for each time point. ResultsAt 12-wk gestation and 3-mo postpartum, no statistical differences in mean SZC were observed among arms. At 34-wk, mean SZC for arms 1 and 2 were significantly higher than for arm 3 (50.3, 50.8, 47.8 μg/dL, respectively; P = 0.005). Results were not impacted by correction for inflammation or albumin concentrations. Prevalence of hypozincemia at 12-wk (<56 μg/dL) was 23% in Guatemala, 26% in India, and 65% in Pakistan; at 34 wk (<50 μg/dL), 36% in Guatemala, 48% in India, and 74% in Pakistan; and at 3-mo postpartum (<66 μg/dL) 79% in Guatemala, 91% in India, and 92% in Pakistan. Maternal hypozincemia at 34-wk was associated with lower birth length-for-age Z-scores (all sites P = 0.013, Pakistan P = 0.008) and weight-for-age Z-scores (all sites P = 0.017, Pakistan P = 0.022). ConclusionsDespite daily zinc supplementation for ≥7 mo, high rates of maternal hypozincemia were observed. The association of hypozincemia with impaired fetal growth suggests widespread zinc deficiency in these settings.This trial is registered at clinicaltrials.gov as #NCT01883193.

The Cost and Cost-Effectiveness of an Integrated Wasting Prevention and Screening Intervention Package in Burkina Faso and Mali

BackgroundLittle is known about costs and cost effectiveness of interventions that integrate wasting prevention into screening for child wasting. ObjectivesThis study’s objective was to estimate the cost and cost-effectiveness of an intervention that integrated behavior change communication (BCC) and small-quantity lipid-based nutrient supplements (SQ-LNS) into platforms for wasting screening in Burkina Faso (a facility-based platform, where BCC was enhanced compared with standard care) and Mali (a community-based platform, with standard BCC). MethodsActivity-based costing was used to estimate the cost per child-contact for the intervention and the comparison group, which did not receive the intervention. Costs were ascertained from accounting records, interviews, surveys, and observations. The number of child-contacts was calculated using population size estimates and average attendance rates for each service. Costs per disability-adjusted life year (DALY) averted were estimated using a Markov model populated with data from the parent trials on impact of wasting incidence and treatment coverage. ResultsIn the intervention group in Burkina Faso, the cost per child-contact of facility-based screening was $0.85 of enhanced BCC was $4.28, and of SQ-LNS was $8.86. In Mali, the cost per child-contact of community-based screening was $0.57, standard BCC was $0.72, and SQ-LNS was $4.14. Although no SQ-LNS costs were incurred in the comparison groups (hence lower total costs), costs per child-contact for screening and BCC were higher because coverage of these services was lower. The intervention package cost $1073 per DALY averted in Burkina Faso and $747 in Mali. ConclusionsIntegration of wasting prevention into screening for child wasting led to higher total costs but lower unit costs than standard screening due to increased coverage. Greater cost-effectiveness could be achieved if BCC were strengthened and led to improved caregiver health and nutrition practices and if screening triggered appropriate use of services and higher treatment coverage.

Sustained effects of small-quantity lipid-based nutrient supplements provided during the first 1000 days on child growth at 9–11 y in a randomized controlled trial in Ghana

BackgroundThere is limited research on whether nutritional supplementation in the first 1000 d affects long-term child outcomes. We previously demonstrated that pre- and postnatal small-quantity lipid-based nutrient supplements (SQ-LNS) increased birth weight and child length at 18 mo of age in Ghana. ObjectivesWe aimed to investigate the effect of pre- and postnatal SQ-LNS on child growth and blood pressure at 9–11 y. MethodsIn the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, 1320 females ≤20 weeks of gestation were randomly assigned to receive daily: iron and folic acid (IFA) during pregnancy and placebo during 6 mo postpartum or multiple micronutrients (MMNs) during pregnancy and 6 mo postpartum, or SQ-LNS during pregnancy and 6 mo postpartum and for their children aged from 6 to 18 mo. We re-enrolled 966 children aged 9–11 y and assessed child blood pressure, height-for-age z-score (HAZ), body mass index (BMI)-for-age z-score, waist-to-height ratio, triceps skinfold, and midupper arm circumference. We compared SQ-LNS with control (IFA + MMN) groups adjusting for child’s age. ResultsMean (standard deviation [SD]) HAZ in SQ-LNS and control group was −0.04 (0.96) and −0.16 (0.99); P = 0.060. There were no indications of group differences in the other outcomes (P > 0.10). Effects on HAZ varied by child sex (P-interaction = 0.075) and maternal prepregnancy BMI (kg/m2; P-interaction = 0.007). Among females, HAZ was higher in the SQ-LNS [0.08 (1.04)] than in the control group [−0.16 (1.01)] (P = 0.010); among males, SQ-LNS [−0.16 (0.85)] and control groups [−0.16 (0.96)] did not differ (P = 0.974). Among children of females with BMI of <25, HAZ was higher in the SQ-LNS [−0.04 (1.00)] than in the control group [−0.29 (0.94)] (P = 0.004); among females with BMI of ≥25, SQ-LNS [−0.04 (0.91)] and control groups [0.07 (1.00)] did not differ (P = 0.281). ConclusionsThere is a sustained impact of prenatal and postnatal SQ-LNS on linear growth among female children and children whose mothers were not overweight.This trial was registered at clinicaltrials.gov as NCT00970866 (https://clinicaltrials.gov/ct2/show/record/NCT00970866).

Lipid-based nutrient supplements for prevention of child undernutrition: when less may be more

BackgroundBoth small-quantity and medium-quantity lipid-based nutrient supplements (LNS) have been used for the prevention of child undernutrition. A meta-analysis of 14 trials of small-quantity lipid-based nutrient supplements (SQ-LNS) – no LNS showed effects on length-for-age z-score {LAZ, +0.14 [95% confidence interval (CI): 0.11, 0.16]} and weight-for-length z-score [WLZ, +0.08 (0.06, 0.10)] z-scores, as well as prevalence ratios (95% CI) for stunting [LAZ < −2, 0.88 (0.85, 0.91)] and wasting [WLZ < −2, 0.86 (0.80, 0.93)]. However, little is known about the effects of medium-quantity lipid-based nutrient supplements (MQ-LNS) on growth. ObjectivesWe aimed to examine the effects of preventive MQ-LNS (∼250–499 kcal/d) provided at ∼6–23 mo of age on growth outcomes – no LNS or provision of SQ-LNS. MethodsWe conducted a systematic review of studies of MQ-LNS for prevention, and categorized them as providing <6 mo – ≥6 mo of supplementation; for the latter category, we conducted a meta-analysis, with the main outcomes being change in WLZ and LAZ, and prevalence of wasting and stunting. ResultsThree studies provided MQ-LNS for 3–5 mo (seasonal) for children 6–36 mo of age, and did not show consistent effects on growth outcomes. Eight studies provided MQ-LNS for 6–18 mo, generally starting at 6 mo of age; in the meta-analysis (max total n = 13,954), MQ-LNS increased WLZ [+0.09 (95% CI: 0.05, 0.13)] and reduced wasting [0.89 (0.81, 0.97)], but had no effect on LAZ [+0.04 (−0.02, 0.11)] or stunting [0.97 (0.92, 1.02)] – no LNS. Two studies directly compared SQ-LNS and MQ-LNS and showed no significant differences in growth outcomes. ConclusionsThe current evidence suggests that MQ-LNS offer no added benefits over SQ-LNS, although further studies directly comparing MQ-LNS with SQ-LNS would be useful. One possible explanation is incomplete consumption of the MQ-LNS ration and thus lower than desirable intake of certain nutrients. Trial registration numberRegistry and registry number for systematic reviews or meta-analyses: Registered with PROSPERO as CRD42022382448 on December 18, 2022: =https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022382448.

The cost-effectiveness of small-quantity lipid-based nutrient supplements for prevention of child death and malnutrition and promotion of healthy development: modelling results for Uganda.

Recent meta-analyses demonstrate that small-quantity lipid-based nutrient supplements (SQ-LNS) for young children significantly reduce child mortality, stunting, wasting, anaemia and adverse developmental outcomes. Cost considerations should inform policy decisions. We developed a modelling framework to estimate the cost and cost-effectiveness of SQ-LNS and applied the framework in the context of rural Uganda. We adapted costs from a costing study of micronutrient powder (MNP) in Uganda, and based effectiveness estimates on recent meta-analyses and Uganda-specific estimates of baseline mortality and the prevalence of stunting, wasting, anaemia and developmental disability. Rural Uganda. Not applicable. Providing SQ-LNS daily to all children in rural Uganda (> 1 million) for 12 months (from 6 to 18 months of age) via the existing Village Health Team system would cost ∼$52 per child (2020 US dollars) or ∼$58·7 million annually. SQ-LNS could avert an average of > 242 000 disability-adjusted life years (DALYs) annually as a result of preventing 3689 deaths, > 160 000 cases of moderate or severe anaemia and ∼6000 cases of developmental disability. The estimated cost per DALY averted is $242. In this context, SQ-LNS may be more cost-effective than other options such as MNP or the provision of complementary food, although the total cost for a programme including all age-eligible children would be high. Strategies to reduce costs, such as targeting to the most vulnerable populations and the elimination of taxes on SQ-LNS, may enhance financial feasibility.

Dietary Strategies for Complementary Feeding between 6 and 24 Months of Age: The Evidence.

Suboptimal complementary feeding practices remain highly prevent. This review aims to comprehensively synthesize new emerging evidence on a set of topics related to the selection and consumption of complementary foods. We synthesized evidence related to five key topics focused on nutritional interventions that target the complementary feeding period, based on four systematic reviews that include updated evidence to February 2022. While there have been many studies examining interventions during the complementary feeding period, there is an overall lack of relevant information through which to draw conclusions on the ideal feeding schedule by food type. Similarly, few studies have examined the effects of animal milk versus infant formula for non-breastfed infants (6-11 months), though those that did found a greater risk of anemia among infants who were provided cow's milk. This review highlights a number of interventions that are successful at improving micronutrient status and anthropometry during the complementary feeding period, including fortified blended foods, locally and commercially produced supplementary foods, and small-quantity lipid-based nutrient supplements. Complementary feeding education for caregivers can also be used to improve nutrition outcomes among infants in both food secure and insecure populations.

PTFS05-05-23 Effect of Small Quantity Lipid-Based Nutrient Supplements Provided During the First 1000 Days on Linear Growth From Birth to 9–11 Years in a Randomized Controlled Trial in Ghana

PTFS05-05-23 Effect of Small Quantity Lipid-Based Nutrient Supplements Provided During the First 1000 Days on Linear Growth From Birth to 9–11 Years in a Randomized Controlled Trial in Ghana

P17-002-23 Cognitive Outcomes at Age 9–11 Years of Children Who Received Pre- and Post-Natal Small-Quantity Lipid-Based Nutrient Supplements in a Randomized Controlled Trial in Ghana

P17-002-23 Cognitive Outcomes at Age 9–11 Years of Children Who Received Pre- and Post-Natal Small-Quantity Lipid-Based Nutrient Supplements in a Randomized Controlled Trial in Ghana

P26-025-23 An Alternative Growth Metric To Assess the Effect of Small-Quantity Lipid-Based Nutrient Supplements on Child Linear Growth in Low- and Middle-Income Countries (LMICs)

P26-025-23 An Alternative Growth Metric To Assess the Effect of Small-Quantity Lipid-Based Nutrient Supplements on Child Linear Growth in Low- and Middle-Income Countries (LMICs)

Why small-quantity lipid-based nutrient supplements should be integrated into comprehensive strategies to prevent child undernutrition in nutritionally vulnerable populations: response to Gupta et al.’s commentary

Why small-quantity lipid-based nutrient supplements should be integrated into comprehensive strategies to prevent child undernutrition in nutritionally vulnerable populations: response to Gupta et al.’s commentary

Prenatal and postnatal small-quantity lipid-based nutrient supplements and children’s social–emotional difficulties at ages 9–11 y in Ghana: follow-up of a randomized controlled trial

BackgroundProvision of small-quantity lipid-based nutrient supplements (SQ-LNSs) during early life improves growth and development. In the International Lipid-Based Nutrient Supplements DYAD–Ghana trial, prenatal and postnatal SQ-LNS reduced social–emotional difficulties at age 5 y, with greater effects among children in less-enriched home environments. ObjectivesWe aimed to investigate the effect of prenatal and postnatal SQ-LNS on children's social–emotional problems at age 9–11 y. MethodsIn 2009–2011, 1320 pregnant women ≤20 wk gestation were randomly assigned to receive the following daily until 6 mo postpartum: 1) iron and folic acid until delivery, then placebo, 2) multiple micronutrients (MMNs), or 3) SQ-LNS (20 g/d). Children in group 3 received SQ-LNS from 6 to 18 mo. In 2021, we evaluated children's social–emotional outcomes with 6 assessment tools that used caregiver, teacher, and/or self-report to measure socioemotional difficulties, conduct problems, temperament, mood, anxiety, and emotion management. ResultsWe assessed outcomes in 966 children, comprising 79.4% of 1217 participants eligible for re-enrolment. No significant differences were found between the SQ-LNS and control (non-LNS groups combined) groups. Few children (<2%) experienced high parent-reported social–emotional difficulties at 9–11 y, in contrast to the high prevalence at age 5 in this cohort (25%). Among children in less-enriched early childhood home environments, the SQ-LNS group had 0.37 SD (−0.04 to 0.82) lower self-reported conduct problems than the control group (P-interaction = 0.047). ConclusionsOverall positive effects of SQ-LNS on social–emotional development previously found at age 5 y are not sustained to age 9–11 y; however, there is some evidence of positive effects among children in less-enriched environments. The lack of effects may be owing to low prevalence of social–emotional problems at preadolescence, resulting in little potential to benefit from early nutritional intervention at this age in this outcome domain. Follow-up during adolescence, when social-emotional problems more typically onset, may yield further insights.This trial was registered at clinicaltrials.gov as NCT00970866. https://clinicaltrials.gov/ct2/show/record/NCT00970866

Prevalence of morbidity symptoms among pregnant and postpartum women receiving different nutrient supplements in Ghana and Malawi: A secondary outcome analysis of two randomised controlled trials.

Little is known about the impact of small-quantity lipid-based nutrient supplements (SQ-LNSs) on maternal morbidity. This secondary outcome analysis aimed to compare morbidity symptoms among women in two trials evaluating the efficacy of SQ-LNSs. From enrolment (≤20-week gestation) to 6 months postpartum, Ghanaian (n = 1320) and Malawian (n = 1391) women were assigned to consume daily: 60 mg iron and 400 µg folic acid until childbirth and placebo thereafter (iron and folic acid [IFA] group); or multiple micronutrients (MMN); or 20 g/day SQ-LNSs. Within country, we used repeated measures logistic regression and analysis of variance models to compare group differences in the period prevalence and percentage of days of monitoring when women had fever, gastrointestinal, reproductive, and respiratory symptoms during the second and third trimesters of pregnancy (n ~ 1243 in Ghana, 1200 in Malawi) and 0-3 and 3-6 months postpartum (n ~ 1212 in Ghana, 730 in Malawi). Most outcomes did not differ significantly among groups, with the following exceptions: in Ghana, overall, the prevalence of vomiting was lower in the LNS (21.5%) than MMN (25.6%) group, with the IFA group (23.2%) in-between (p = 0.046); mean ± SD percentage of days with nausea was greater in the LNS (3.5 ± 10.3) and MMN (3.3 ± 10.4) groups than the IFA (2.7 ± 8.3) group (p = 0.002). In Malawi, during 3-6 month postpartum, the prevalence of severe diarrhoea was greater in the LNS (8.1%) than the MMN (2.9%) group, with IFA (4.6%) in-between, p = 0.041). We conclude that the type of nutrient supplement received during pregnancy and lactation generally does not influence morbidity symptoms in these settings. Clinicaltrials.gov identifiers: NCT00970866; NCT01239693.

Investing in Nutrition: A Global Best Investment Case

AbstractUndernutrition and micronutrient deficiencies are key drivers of infant and child mortality and are causes of impaired human potential for hundreds of millions of children every year. Investing in nutrition in the first 1,000 days from conception not only supports individual lifetime health, education, and productivity, but is also key to breaking the intergenerational cycle of malnutrition and enhance equitable development pathways for low- and middle-income countries. This paper provides a cost–benefit analysis of three nutrition interventions: 1) provision of preventive small-quantity lipid-based nutrient supplements (SQ-LNS) to children 6−23 months of age; 2) Complementary Feeding Promotion (CFP) for children 6−23 months of age; 3) provision of multiple micronutrient (MMN) and calcium (Ca) supplements to pregnant women. The benefit–cost ratios (BCRs) for MMN supplementation for pregnant women replacing iron and folic acid (37.5), as well as MMN and Ca combined (19-24), are the highest. The BCRs for CFP for children in the two highest socio-economic status (SES) quintiles and SQ-LNS for children in the three lowest SES quintiles are fairly similar at 16 and 14, respectively. The lowest BCR is for CFP for children in the three lowest SES quintiles due to the high cost of accomplishing behavioral change for improved complementary feeding in resource-poor households.

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data

Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy<70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P<0.01] and higher GWG at delivery (WMD: 209g; 95% CI: 139, 280g; P<0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P<0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P=0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.