Small-quantity lipid-based nutrient supplements for children age 6-24 months: A systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers

Elizabeth L. Prado, Charles D. Arnold, K. Ryan Wessells, Christine P. Stewart, Souheila Abbeddou, Seth Adu-Afarwuah, Benjamin F. Arnold, Ulla Ashorn, Per Ashorn, Elodie Becquey, Kenneth H. Brown, Jaya Chandna, Parul Christian, Holly N. Dentz, Sherlie J.L. Dulience, Lia C.H. Fernald, Emanuela Galasso, Lotta Hallamaa, Sonja Y. Hess, Lieven HuybregtsLora L. Iannotti, Elizabeth Y. Jimenez, Patricia Kohl, Anna Lartey, Agnes Le Port, Stephen P. Luby, Kenneth Maleta, Andrew Matchado, Susana L. Matias, Malay K. Mridha, Robert Ntozini, Clair Null, Maku E. Ocansey, Sarker M. Parvez, John Phuka, Amy J. Pickering, Andrew J. Prendergast, Abu A. Shamim, Zakia Siddiqui, Fahmida Tofail, Ann M. Weber, Lee S.F. Wu, Kathryn G. Dewey

    Research output: Contribution to journalReview Articlepeer-review

    20 Citations (Scopus)
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    Background: Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. Objectives: We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. Methods: We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). Results: In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). Conclusions: Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.

    Original languageEnglish
    Pages (from-to)43S-67S
    JournalAmerican Journal of Clinical Nutrition
    Issue numberIssue Supplement_1
    Publication statusPublished - 2021
    Publication typeA2 Review article in a scientific journal


    • child undernutrition
    • complementary feeding
    • executive function
    • language development
    • motor development
    • nutrient supplements
    • social-emotional development

    Publication forum classification

    • Publication forum level 3

    ASJC Scopus subject areas

    • Medicine (miscellaneous)
    • Nutrition and Dietetics


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