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

Kathryn G. Dewey, K. Ryan Wessells, Charles D. Arnold, Elizabeth L. Prado, Souheila Abbeddou, Seth Adu-Afarwuah, Hasmot Ali, Benjamin F. Arnold, Per Ashorn, Ulla Ashorn, Sania Ashraf, Elodie Becquey, Jaden Bendabenda, Kenneth H. Brown, Parul Christian, John M. Colford, Sherlie J.L. Dulience, Lia C.H. Fernald, Emanuela Galasso, Lotta HallamaaSonja Y. Hess, Jean H. Humphrey, Lieven Huybregts, Lora L. Iannotti, Kaniz Jannat, Anna Lartey, Agnes Le Port, Jef L. Leroy, Stephen P. Luby, Kenneth Maleta, Susana L. Matias, Mduduzi N.N. Mbuya, Malay K. Mridha, Minyanga Nkhoma, Clair Null, Rina R. Paul, Harriet Okronipa, Jean Bosco Ouédraogo, Amy J. Pickering, Andrew J. Prendergast, Marie Ruel, Saijuddin Shaikh, Ann M. Weber, Patricia Wolff, Amanda Zongrone, Christine P. Stewart

Research output: Contribution to journalArticleScientificpeer-review

36 Citations (Scopus)
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Background: Meta-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. Objectives: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes. Methods: We 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. Results: SQ-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. Conclusions: The 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.

Original languageEnglish
Pages (from-to)15S-42S
JournalAmerican Journal of Clinical Nutrition
Issue numberSupplement 1
Publication statusPublished - Sept 2021
Publication typeA1 Journal article-refereed


  • child undernutrition
  • complementary feeding
  • home fortification
  • nutrient supplements
  • stunting
  • wasting

Publication forum classification

  • Publication forum level 3

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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