TY - JOUR
T1 - Small-quantity lipid-based nutrient supplements for children age 6-24 months
T2 - A systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers
AU - Prado, Elizabeth L.
AU - Arnold, Charles D.
AU - Wessells, K. Ryan
AU - Stewart, Christine P.
AU - Abbeddou, Souheila
AU - Adu-Afarwuah, Seth
AU - Arnold, Benjamin F.
AU - Ashorn, Ulla
AU - Ashorn, Per
AU - Becquey, Elodie
AU - Brown, Kenneth H.
AU - Chandna, Jaya
AU - Christian, Parul
AU - Dentz, Holly N.
AU - Dulience, Sherlie J.L.
AU - Fernald, Lia C.H.
AU - Galasso, Emanuela
AU - Hallamaa, Lotta
AU - Hess, Sonja Y.
AU - Huybregts, Lieven
AU - Iannotti, Lora L.
AU - Jimenez, Elizabeth Y.
AU - Kohl, Patricia
AU - Lartey, Anna
AU - Le Port, Agnes
AU - Luby, Stephen P.
AU - Maleta, Kenneth
AU - Matchado, Andrew
AU - Matias, Susana L.
AU - Mridha, Malay K.
AU - Ntozini, Robert
AU - Null, Clair
AU - Ocansey, Maku E.
AU - Parvez, Sarker M.
AU - Phuka, John
AU - Pickering, Amy J.
AU - Prendergast, Andrew J.
AU - Shamim, Abu A.
AU - Siddiqui, Zakia
AU - Tofail, Fahmida
AU - Weber, Ann M.
AU - Wu, Lee S.F.
AU - Dewey, Kathryn G.
N1 - Funding Information:
Supported by Bill & Melinda Gates Foundation grant OPP49817 to the University of California, Davis (to KGD). The funder did not play a role in the design or implementation of the study or interpretation of the data. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.
Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the American Society for Nutrition.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - child undernutrition
KW - complementary feeding
KW - executive function
KW - language development
KW - motor development
KW - nutrient supplements
KW - social-emotional development
U2 - 10.1093/ajcn/nqab277
DO - 10.1093/ajcn/nqab277
M3 - Review Article
C2 - 34590116
AN - SCOPUS:85119333601
VL - 114
SP - 43S-67S
IS - Issue Supplement_1
ER -
