Lipid-based nutrient supplementation in the first 1000 d improves child growth in Bangladesh: a cluster-randomized effectiveness trial

Abstract

Background: Stunting in linear growth occurs mainly during the first 1000 d, from conception through 24 mo of age. Despite the recognition of this critical period, there have been few evaluations of the growth impact of interventions that cover most of this window. Objective: We evaluated home fortification approaches for preventing maternal and child undernutrition within a community-based health program. We hypothesized that small-quantity lipid-based nutrient supplements (LNSs) provided to women during pregnancy and the first 6 mo postpartum, LNSs provided to their offspring from 6 to 24 mo of age, or both would result in greater child length-for-age z score (LAZ) at 24 mo than iron and folic acid (IFA) provided to women during pregnancy and postpartum plus micronutrient powder (MNP) or no supplementation for their offspring from 6 to 24 mo. Design: We conducted a cluster-randomized effectiveness trial with 4 arms: 1) women and children both received LNSs (LNS-LNS group), 2) women received IFA and children received LNSs (IFA-LNS group), 3) women received IFA and children received MNP (IFA-MNP group), and 4) women received IFA and children received no supplements (IFA-Control group). We enrolled 4011 women at #20 wk of gestation within 64 clusters, each comprising the supervision area of a community health worker. Analyses were primarily performed by using ANCOVA F tests and Tukey-Kramer-corrected pairwise comparisons. Results: At 24 mo, the LNS-LNS group had significantly higher LAZ (+0.13 compared with the IFA-MNP group) and head circumference (+0.15 z score compared with the IFA-Control group); these outcomes did not differ between the other groups. Stunting prevalence (LAZ ,22) was lower in the LNS-LNS group at 18 mo than in the IFA-MNP group (OR: 0.70; 95% CI: 0.53, 0.92), but the difference diminished by 24 mo (OR: 0.81; 95% CI: 0.63, 1.04). Conclusion: Home fortification with small-quantity LNSs, but not MNP, during the first 1000 d improved child linear growth and head size in rural Bangladesh. This trial was registered at clinicaltrials.gov as NCT01715038.Am J Clin Nutr

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

“…However, among girls, there was a significantly lower proportion in the lowest quartile for executive function in the group who received LNSs postnatally compared with the control group (no difference was seen among boys). This finding may be linked to the greater impact of the RDNS intervention on head size in girls than in boys observed at 24 mo of age (13).…”

“…This report describes the effects of the RDNS intervention on child development (secondary) outcomes during the first 24 mo. Findings on the primary outcome of the RDNS (i.e., growth) are reported separately (13).…”

A behaviour change intervention with lipid‐based nutrient supplements had little impact on young child feeding indicators in rural Kenya

“…Point‐of‐use home fortification methods, such as micronutrient powders and small‐quantity lipid‐based nutrient supplements (SQ‐LNS), have the potential to fill in the nutrient gaps (Adu‐Afarwuah & Dewey, ). SQ‐LNS is also under investigation as a potential intervention to prevent stunting (Adu‐Afarwuah et al, ; Dewey et al, ; Hess et al, ).…”

PROCOMIDA, a Food-Assisted Maternal and Child Health and Nutrition Program, Reduces Child Stunting in Guatemala: A Cluster-Randomized Controlled Intervention Trial

“…Some of the studies that compared LNS and MNP showed impacts of LNS, but not of MNP, on linear growth (12, 31). However, a key limitation of these studies is that the MNP supplements used have not included some macrominerals known to be important for growth (e.g., calcium, magnesium, phosphorus, and potassium) whereas they are typically included in LNS (32).…”