Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: An individual participant data meta-analysis of randomized controlled trials

K. Ryan Wessells, Charles D. Arnold, Christine P. Stewart, Elizabeth L. Prado, Souheila Abbeddou, Seth Adu-Afarwuah, Benjamin F. Arnold, Per Ashorn, Ulla Ashorn, Elodie Becquey, Kenneth H. Brown, Kendra A. Byrd, Rebecca K. Campbell, Parul Christian, Lia C.H. Fernald, Yue Mei Fan, Emanuela Galasso, Sonja Y. Hess, Lieven Huybregts, Josh M. JorgensenMarion Kiprotich, Emma Kortekangas, Anna Lartey, Agnes Le Port, Jef L. Leroy, Audrie Lin, Kenneth Maleta, Susana L. Matias, Mduduzi N.N. Mbuya, Malay K. Mridha, Kuda Mutasa, Abu M. Naser, Rina R. Paul, Harriet Okronipa, Jean Bosco Ouédraogo, Amy J. Pickering, Mahbubur Rahman, Kerry Schulze, Laura E. Smith, Ann M. Weber, Amanda Zongrone, Kathryn G. Dewey

    Research output: Contribution to journalArticleScientificpeer-review

    4 Citations (Scopus)
    7 Downloads (Pure)

    Abstract

    Background: Small-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design. Objectives: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes. Methods: We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers. Results: SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 μg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 μg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 μmol/L), with little evidence of effect modification by individual-level characteristics. Conclusions: SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.

    Original languageEnglish
    Pages (from-to)68S-94S
    JournalAmerican Journal of Clinical Nutrition
    Volume114
    Issue numberSupplement 1
    DOIs
    Publication statusPublished - Sept 2021
    Publication typeA1 Journal article-refereed

    Keywords

    • anemia
    • child undernutrition
    • complementary feeding
    • home fortification
    • iron deficiency
    • micronutrient status
    • nutrient supplements

    Publication forum classification

    • Publication forum level 3

    ASJC Scopus subject areas

    • Medicine (miscellaneous)
    • Nutrition and Dietetics

    Fingerprint

    Dive into the research topics of 'Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: An individual participant data meta-analysis of randomized controlled trials'. Together they form a unique fingerprint.

    Cite this