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 - Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the American Society for Nutrition.
PY - 2021/11/1
Y1 - 2021/11/1
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
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U2 - 10.1093/ajcn/nqab277
DO - 10.1093/ajcn/nqab277
M3 - Review article
C2 - 34590116
AN - SCOPUS:85119333601
SN - 0002-9165
VL - 114
SP - 43S-67S
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
ER -