Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials

Kathryn G Dewey; Charles D Arnold; K Ryan Wessells; Elizabeth L Prado; Souheila Abbeddou; Seth Adu-Afarwuah; Hasmot Ali; Benjamin F Arnold; Per Ashorn; Ulla Ashorn; Sania Ashraf; Elodie Becquey; Kenneth H Brown; Parul Christian; John M Colford; Sherlie J L Dulience; Lia C H Fernald; Emanuela Galasso; Lotta Hallamaa; Sonja Y Hess; Jean H Humphrey; Lieven Huybregts; Lora L Iannottie; 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

doi:10.1093/ajcn/nqac232

Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials

Kathryn G Dewey, Charles D Arnold, K Ryan Wessells, Elizabeth L Prado, Souheila Abbeddou, Seth Adu-Afarwuah, Hasmot Ali, Benjamin F Arnold, Per Ashorn, Ulla Ashorn, Sania Ashraf, Elodie Becquey, Kenneth H Brown, Parul Christian, John M Colford, Sherlie J L Dulience, Lia C H Fernald, Emanuela Galasso, Lotta Hallamaa, Sonja Y HessJean H Humphrey, Lieven Huybregts, Lora L Iannottie, 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

Health Sciences

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

BACKGROUND: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.

OBJECTIVE: We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3).

METHODS: We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. 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 led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.

CONCLUSIONS: Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

Original language	English
Pages (from-to)	1314–1333
Journal	American Journal of Clinical Nutrition
Volume	116
Issue number	5
DOIs	https://doi.org/10.1093/ajcn/nqac232
Publication status	Published - 31 Aug 2022
Publication type	A1 Journal article-refereed

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Publication forum level 3

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ajcn/nqac232

Preventive_SQ-LNS_reduce_severe_wasting_and_severe_stuntingAccepted author manuscript, 636 KBLicence: CC BY-NC-ND

https://urn.fi/URN:NBN:fi:tuni-202302142355Licence: CC BY-NC-ND

Cite this

Dewey, K. G., Arnold, C. D., Wessells, K. R., Prado, E. L., Abbeddou, S., Adu-Afarwuah, S., Ali, H., Arnold, B. F., Ashorn, P., Ashorn, U., Ashraf, S., Becquey, E., Brown, K. H., Christian, P., Colford, J. M., Dulience, S. J. L., Fernald, L. C. H., Galasso, E., Hallamaa, L., ... Stewart, C. P. (2022). Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 116(5), 1314–1333. https://doi.org/10.1093/ajcn/nqac232

@article{101c1ae59b8f4822ac59f515782df7de,

title = "Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials",

abstract = "BACKGROUND: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.OBJECTIVE: We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3).METHODS: We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. 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 led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.CONCLUSIONS: Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.",

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

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.",

year = "2022",

month = aug,

day = "31",

doi = "10.1093/ajcn/nqac232",

language = "English",

volume = "116",

pages = "1314–1333",

number = "5",

}

Dewey, KG, Arnold, CD, Wessells, KR, Prado, EL, Abbeddou, S, Adu-Afarwuah, S, Ali, H, Arnold, BF, Ashorn, P , Ashorn, U, Ashraf, S, Becquey, E, Brown, KH, Christian, P, Colford, JM, Dulience, SJL, Fernald, LCH, Galasso, E, Hallamaa, L, Hess, SY, Humphrey, JH, Huybregts, L, Iannottie, LL, Jannat, K, Lartey, A, Port, AL, Leroy, JL, Luby, SP, Maleta, K, Matias, SL, Mbuya, MNN, Mridha, MK, Nkhoma, M, Null, C, Paul, RR, Okronipa, H, Ouédraogo, J-B, Pickering, AJ, Prendergast, AJ, Ruel, M, Shaikh, S, Weber, AM, Wolff, P, Zongrone, A & Stewart, CP 2022, 'Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials', American Journal of Clinical Nutrition, vol. 116, no. 5, pp. 1314–1333. https://doi.org/10.1093/ajcn/nqac232

Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. / Dewey, Kathryn G; Arnold, Charles D; Wessells, K Ryan et al.
In: American Journal of Clinical Nutrition, Vol. 116, No. 5, 31.08.2022, p. 1314–1333.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children

T2 - an individual participant data meta-analysis of randomized controlled trials

AU - Dewey, Kathryn G

AU - Arnold, Charles D

AU - Wessells, K Ryan

AU - Prado, Elizabeth L

AU - Abbeddou, Souheila

AU - Adu-Afarwuah, Seth

AU - Ali, Hasmot

AU - Arnold, Benjamin F

AU - Ashorn, Per

AU - Ashorn, Ulla

AU - Ashraf, Sania

AU - Becquey, Elodie

AU - Brown, Kenneth H

AU - Christian, Parul

AU - Colford, John M

AU - Dulience, Sherlie J L

AU - Fernald, Lia C H

AU - Galasso, Emanuela

AU - Hallamaa, Lotta

AU - Hess, Sonja Y

AU - Humphrey, Jean H

AU - Huybregts, Lieven

AU - Iannottie, Lora L

AU - Jannat, Kaniz

AU - Lartey, Anna

AU - Port, Agnes Le

AU - Leroy, Jef L

AU - Luby, Stephen P

AU - Maleta, Kenneth

AU - Matias, Susana L

AU - Mbuya, Mduduzi N N

AU - Mridha, Malay K

AU - Nkhoma, Minyanga

AU - Null, Clair

AU - Paul, Rina R

AU - Okronipa, Harriet

AU - Ouédraogo, Jean-Bosco

AU - Pickering, Amy J

AU - Prendergast, Andrew J

AU - Ruel, Marie

AU - Shaikh, Saijuddin

AU - Weber, Ann M

AU - Wolff, Patricia

AU - Zongrone, Amanda

AU - Stewart, Christine P

PY - 2022/8/31

Y1 - 2022/8/31

N2 - BACKGROUND: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.OBJECTIVE: We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3).METHODS: We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. 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 led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.CONCLUSIONS: Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

AB - BACKGROUND: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.OBJECTIVE: We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3).METHODS: We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. 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 led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.CONCLUSIONS: Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

U2 - 10.1093/ajcn/nqac232

DO - 10.1093/ajcn/nqac232

M3 - Article

C2 - 36045000

SN - 1938-3207

VL - 116

SP - 1314

EP - 1333

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 5

ER -

Dewey KG, Arnold CD, Wessells KR, Prado EL, Abbeddou S, Adu-Afarwuah S et al. Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition. 2022 Aug 31;116(5):1314–1333. doi: 10.1093/ajcn/nqac232

Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials

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