Effects of maternal and child lipid-based nutrient supplements on infant development: a randomized trial in Malawi

Abstract

Background: Maternal and infant undernutrition is associated with poor infant development; however, few studies have examined the impact of combined pre-and postnatal dietary supplementation on infant development. Objective: Our objective was to determine whether provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers during pregnancy and the first 6 mo postpartum, and to children aged 6-18 mo, improves infant development in Malawi. Design: We randomly assigned 869 pregnant women to receive one of the following daily: an iron and folic acid (IFA) capsule, a multiple micronutrient (MMN) capsule containing 18 micronutrients, or a 20-g sachet of SQ-LNSs containing 22 vitamins and minerals, protein, carbohydrates, essential fatty acids, and 118 kcal. Children in the lipid-based nutrient supplement (LNS) group only received SQ-LNSs from 6 to 18 mo of age. We monitored the acquisition of 11 developmental milestones monthly by maternal report; observed the attainment of 7 motor milestones at 6, 12, and 18 mo of age; and conducted a comprehensive assessment of motor, language, and socioemotional development and executive function at 18 mo of age. The primary analysis was by intention-to-treat. Results: By maternal report, children in the LNS group achieved walking alone (B = 0.53; 95% CI: 0.11, 0.94; P = 0.034) and waving goodbye (B = 0.60; 95% CI: 0.12, 1.08; P = 0.040) earlier than the IFA group and standing with assistance earlier than the MMN group (B = 0.51; 95% CI: 0.12, 0.89; P = 0.029). By researcher observation, there was a trend (P = 0.052) for a greater percentage of children in the LNS group (58%) to walk alone at age 12 mo than in the IFA (49%) and MMN (49%) groups. At age 18 mo, there were no significant differences between groups in any scores. Conclusion: Although provision of SQ-LNSs to pregnant women and infants in Malawi may affect the age of acquisition of certain developmental milestones, it did not affect our assessments of motor, language, socioemotional, or executive function skills at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT01239693.Am J Clin Nutr 2016;103:784-93.

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

“…In the efficacy trials conducted in Malawi (n = 869) (11) and Ghana (n = 1320) (10) in which both prenatal and postnatal LNSs were provided (the latter given from ages 6 to 18 mo), effects were observed at 12 mo but not at 18 mo of age. It should be noted that a different (direct-testing) assessment method was used at age 18 mo in those 2 trials.…”

“…We assessed executive function by direct testing with the use of the A-not-B task (25), which was previously used in 18-mo-old children in Ghana (10) and Malawi (11). At each of the 10 trials of this task, a small candy (or potato chip) was hidden underneath 1 of 2 identical (upside-down) cups positioned on a wooden board.…”

“…SQ-LNSs were provided both pre-and postnatally from 6 to 18 mo of age in 2 efficacy trials, 1 in Ghana (8) and 1 in Malawi (9). Although positive effects on motor development were observed at age 12 mo, there were no significant effects on motor, cognitive, or socio-emotional development at age 18 mo in these trials (10,11). The lack of sensitivity of development assessments in children younger than 2 y for detecting effects of improved nutrition was suggested as a potential explanation (among others) for these results (11).…”

Linear Growth and Child Development in Burkina Faso, Ghana, and Malawi

“…Inter-scorer agreement and test-retest reliability were evaluated for each team and have been reported elsewhere (E.L.P., S.A.A., A.L., et al, unpublished observations). 12,13,18,20 Further details are given in Supplemental Table 11.…”

“…8, 10 Effects on 18-month child development also differed across trials, with positive effects in Burkina Faso 11 but not in Ghana 12 or Malawi (E.L.P., S.A.A., A.L., et al, unpublished observations). 13 The focus of the present study was on the associations between linear growth and development in the 4 cohorts, regardless of intervention group (ie, controlling for intervention group as a covariate). We also investigated intervention group as a potential effect modifier (as detailed in the fourth objective).…”