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 Jr; Sherlie Jl Dulience; Lia Ch Fernald; Emanuela Galasso; Lotta Hallamaa; Sonja 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 Nn 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

Am J Clin Nutr. 2022 Nov;116(5):1314-1333. doi: 10.1093/ajcn/nqac232. Epub 2023 Feb 10.

Authors

Kathryn G Dewey¹, Charles D Arnold², K Ryan Wessells², Elizabeth L Prado², Souheila Abbeddou³, Seth Adu-Afarwuah⁴, Hasmot Ali⁵, Benjamin F Arnold⁶, Per Ashorn⁷, Ulla Ashorn⁸, Sania Ashraf⁹, Elodie Becquey¹⁰, Kenneth H Brown¹¹, Parul Christian¹², John M Colford Jr¹³, Sherlie Jl Dulience¹⁴, Lia Ch Fernald¹³, Emanuela Galasso¹⁵, Lotta Hallamaa⁸, Sonja Y Hess², Jean H Humphrey¹⁶, Lieven Huybregts¹⁰, Lora L Iannotti¹⁴, Kaniz Jannat¹⁷, Anna Lartey⁴, Agnes Le Port¹⁸, Jef L Leroy¹⁰, Stephen P Luby¹⁹, Kenneth Maleta²⁰, Susana L Matias²¹, Mduduzi Nn Mbuya²², Malay K Mridha²³, Minyanga Nkhoma²⁰, Clair Null²⁴, Rina R Paul²³, Harriet Okronipa²⁵, Jean-Bosco Ouédraogo²⁶, Amy J Pickering²⁷, Andrew J Prendergast²⁸, Marie Ruel¹⁰, Saijuddin Shaikh⁵, Ann M Weber²⁹, Patricia Wolff³⁰, Amanda Zongrone³¹, Christine P Stewart²

Affiliations

¹ Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA. Electronic address: kgdewey@ucdavis.edu.
² Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.
³ Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium.
⁴ Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.
⁵ The JiVitA Maternal and Child Health and Nutrition Research Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh.
⁶ Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.
⁷ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
⁸ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁹ Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
¹¹ Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA; Helen Keller International, New York, NY, USA.
¹² Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹³ School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
¹⁴ Brown School, Washington University in St Louis, St Louis, MO, USA.
¹⁵ Development Research Group, World Bank, Washington, DC, USA.
¹⁶ Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
¹⁷ School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia.
¹⁸ Montpellier Interdisciplinary Center on Sustainable Agri-Food Systems (MoISA), French National Research Institute for Sustainable Development (IRD), Montpellier, France.
¹⁹ Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
²⁰ Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
²¹ Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA.
²² Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Global Alliance for Improved Nutrition, Washington, DC, USA.
²³ Center for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh.
²⁴ Mathematica, Washington, DC, USA.
²⁵ Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA.
²⁶ Malaria and Neglected Tropical Diseases Unit, Health Sciences Research Institute (IRSS), Bobo-Dioulasso, Burkino Faso.
²⁷ Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, USA.
²⁸ Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, United Kingdom.
²⁹ Division of Epidemiology, School of Public Health, University of Nevada, Reno, Reno, NV, USA.
³⁰ Med and Foods for Kids, Cap Haitien, St Louis, MO, USA.
³¹ Independent Consultant, Washington, DC, USA.

PMID: 36045000
DOI: 10.1093/ajcn/nqac232

Abstract

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

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

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. 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 led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 95% CI: 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; 95% CI: 0.57, 0.96; n = 26,327 for severe wasting and PR: 0.88; 95% CI: 0.81, 0.95; n = 28,742 for severe stunting). Study-level characteristics generally did not significantly modify the effects of SQ-LNSs, but results suggested greater effects of SQ-LNSs in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.

Conclusions: Including SQ-LNSs in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. This meta-analysis was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

Keywords: child undernutrition; complementary feeding; home fortification; severe malnutrition; stunting; wasting.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Cachexia
Child
Child, Preschool
Dietary Supplements*
Growth Disorders* / epidemiology
Growth Disorders* / prevention & control
Humans
Infant
Lipids
Nutrients
Randomized Controlled Trials as Topic

Substances

Lipids