Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial

Abstract

Background: Nutrition during the first 1000 d is critical for brain development. Objective: We evaluated the effects on child development of home fortification with lipid-based nutrient supplements (LNSs) for mothers and/or children or micronutrient powder (MNP) for children. Design: We conducted a cluster-randomized effectiveness trial with 4 arms: 1) LNSs during pregnancy and the first 6 mo postpartum and LNSs for the offspring from 6 to 24 mo (LNS-LNS), 2) iron and folic acid (IFA) during pregnancy and the first 3 mo postpartum and LNSs for the children from 6 to 24 mo (IFA-LNS), 3) IFA (as above) and MNP for the offspring from 6 to 24 mo (IFA-MNP), and 4) IFA (as above) and no child supplement (IFA-Control). Women were enrolled at #20 wk of gestation; children were assessed at 12 (n = 3331), 18 (n = 3364), and 24 (n = 3379) mo. Results: Compared with the IFA-Control group, motor development scores were higher in the LNS-LNS (P = 0.016) and IFA-LNS groups (P = 0.006) at 18 mo and in the IFA-MNP group (P = 0.048) at 24 mo. Receptive language scores were higher for the LNS-LNS group (P = 0.028) at 18 mo and for all 3 groups at 24 mo (P = 0.008 for LNS-LNS, P = 0.022 for IFA-LNS, and P = 0.009 for IFA-MNP compared with IFA-Control). Expressive language scores did not differ at 18 mo (P = 0.236) but were higher in the LNS-LNS (P = 0.035) and IFA-MNP (P = 0.002) groups than in the IFA-Control group at 24 mo. Groups did not differ in personal-social scores at 18 (P = 0.233) or 24 (P = 0.146) mo or in executive function score at 24 mo (P = 0.467). Conclusion: Prenatal LNSs, postnatal LNSs, or both, or postnatal MNP had a positive effect on motor and language development in Bangladeshi children. This trial was registered at clinicaltrials.gov as NCT01715038.Am J Clin Nutr

A Path Analysis of Nutrition, Stimulation, and Child Development Among Young Children in Bihar, India

“…The only significant association with executive function was motor development. Other nutrition trials, published after the completion of our study, have shown a similar lack of relation with nutrition as measured using the A‐not‐B task in this same age group (Matias et al., ; Prado et al., ). The A‐not‐B task has been shown to be sensitive to poverty (Lipina, Martelli, Vuelta, & Colombo, ) and other health exposures, such as phenylketonuria (Diamond, Prevor, Callender, & Druin, ) and maternal drug abuse during pregnancy (Noland, Singer, Mehta, & Super, ).…”

Factors associated with nutritional status and dietary practices of Bangladeshi adolescents in early pregnancy

“…We used baseline data from the Rang‐Din Nutrition Study (RDNS) to address the objectives of our study. The RDNS was a longitudinal cluster‐randomized effectiveness trial conducted in rural Bangladesh, designed to evaluate the impact of nutrition interventions during the “1000 days” window on nutritional status of pregnant and lactating women and on growth, nutritional status, and development of their children . Of the 4011 pregnant women enrolled in the study, 1552 (39%) were adolescents (13–20 years of age).…”

Meeting nutritional needs in the first 1000 days: a place for small‐quantity lipid‐based nutrient supplements

“…SQ‐LNS supplementation had no impact on motor development at 18 months of age in the iLiNS‐DYAD trials in Ghana or Malawi, but, in the iLiNS‐ZINC trial in Burkina Faso, children who received SQ‐LNS supplementation along with morbidity surveillance and treatment for diarrhea and malaria had significantly greater mean motor development scores (indicating higher performance) than children who received no intervention. A positive impact of maternal plus child SQ‐LNS supplementation or child‐only SQ‐LNS supplementation on motor development at 18 months of age was also observed in Bangladesh …”

“…Six of the trials carried out on SQ‐LNS reported on infant development . SQ‐LNS supplementation of infant diet did not have any impact on motor milestone acquisition in Haiti or mean locomotor score in the Lungwena study in Malawi .…”

“…The impact of SQ‐LNS supplementation on other child developmental outcomes has been reported in five studies . In the Lungwena study in Malawi, no significant differences were observed in personal and social, hearing and language, eye–hand coordination, or performance development between children who received SQ‐LNS versus a corn–soy blend.…”