Mineral- and vitamin-enhanced micronutrient powder reduces stunting in full-term low-birth-weight infants receiving nutrition, health, and hygiene education: a 2 × 2 factorial, cluster-randomized trial in Bangladesh

Shafique, Sohana; Sellen, Daniel; Lou, Wendy; Jalal, Chowdhury; Jolly, Saira Parveen; Zlotkin, Stanley

doi:10.3945/ajcn.115.117770

Cited by 38 publications

(50 citation statements)

References 37 publications

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“…This has important policy implications because MNP distribution is being scaled-up nationally in Bangladesh and in other countries (5), mainly to reduce anemia. Although enhanced formulations of MNPs with 22 micronutrients may promote growth in low-birth-weight infants (37), their efficacy and effectiveness for the general population of infants have not been tested. It should be noted that postnatal growth faltering in the RDNS and other studies (34,36) was still evident (although reduced) despite the provision of fortified supplements, pointing to the need for more comprehensive interventions that target the multiple causes of poor growth, including both prenatal and postnatal infections (2).…”

Section: Postnatal Growth Ratementioning

confidence: 99%

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

Dewey¹,

Mridha²,

Matias³

et al. 2017

The American Journal of Clinical Nutrition

111

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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

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Section: Postnatal Growth Ratementioning

confidence: 99%

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

Dewey¹,

Mridha²,

Matias³

et al. 2017

The American Journal of Clinical Nutrition

111

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“…With these formulations, we found a positive impact on stunting apparent at 1 mo and a larger impact at 24 mo of age in the group that received MNP and no effect in the group that received LNS. A recent study from Bangladesh that provided MNP to full-term, low birth weight children 6–12 mo of age in conjunction with general nutrition, health, and hygiene education (but not family ration) also demonstrated a significant impact on reducing stunting (OR = 0.35 at 12 mo) (11). The MNP formulation for the Bangladesh study included 22 micronutrients, many with identical or nearly identical concentrations as in our study.…”

Section: Discussionmentioning

confidence: 99%

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

Olney

Leroy

Bliznashka

et al. 2018

The Journal of Nutrition

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BackgroundFood-assisted maternal and child health and nutrition (FA-MCHN) programs may foster child growth during the first 1000 d (pregnancy and the first 2 y of a child's life), but evidence is scant.ObjectiveWe evaluated the impact of an FA-MCHN program, PROCOMIDA, on linear growth (stunting [length-for-age z score (LAZ) < –2] and length-for-age difference [LAD]) among children aged 1–24 mo. PROCOMIDA was implemented in Guatemala by Mercy Corps and was available to beneficiaries throughout the first 1000 d.MethodsWe used a longitudinal, cluster-randomized controlled trial with groups varying in family ration sizes [full (FFR), reduced (RFR), and none (NFR)] and individual ration types provided to mothers (pregnancy to 6 mo postpartum) and children (6–24 mo of age) [corn-soy blend (CSB), lipid-based nutrient supplement (LNS), micronutrient powder (MNP)]: 1) FFR + CSB (n = 576); 2) RFR + CSB (n = 575); 3) NFR + CSB (n = 542); 4) FFR + LNS (n = 550); 5) FFR + MNP (n = 587); 6) control (n = 574). Program impacts compared with control, and differential impacts between groups varying family ration size or individual ration type, were assessed through the use of linear mixed-effects models and post hoc simple effect tests (significant if P < 0.05).Results PROCOMIDA significantly reduced stunting at age 1 mo in FFR + CSB, RFR + CSB, and FFR + MNP groups compared with control [5.05, 4.06, and 3.82 percentage points (pp), respectively]. Stunting impact increased by age 24 mo in FFR + CSB and FFR + MNP relative to control (impact = 11.1 and 6.5 pp at age 24 mo, respectively). For CSB recipients, the FFR compared with RFR or NFR significantly reduced stunting (6.47–9.68 pp). CSB reduced stunting significantly more than LNS at age 24 mo (8.12 pp).ConclusionsFA-MCHN programs can reduce stunting during the first 1000 d, even in relatively energy/food-secure populations. Large family rations with individual rations of CSB or MNP were most effective. The widening of impact as children age highlights the importance of intervening throughout the full first 1000 d.This trial was registered at clinicaltrials.gov as NCT01072279.

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“…Several studies with randomized controlled design, which combined using only MNP as intervention are mixed. A positive effect on linear growth was found in some trials (Adu-Afarwuah et al, 2007;Shafique et al, 2016;Soofi et al, 2013), whereas no difference between intervention and control children was observed in other studies (Bilukha, Howard, Wilkinson, Bamrah, & Husain, 2011;Giovannini et al, 2006;Lemaire et al, 2011;Macharia-Mutie et al, 2012;Osei et al, 2010). Moreover, two systematics reviews conducted in 2013 concluded no significant effects on growth assessed by mean z scores (De-Regil et al, 2013;Salam et al, 2013) and prevalence of stunting and wasting (Salam et al, 2013).…”

Section: Anthropometrymentioning

confidence: 97%

“…Therefore, improved feeding practises were not be translated into linear growth outcomes as suggested by findings of several other studies that provided nutrition education on complementary feeding (Negash et al, 2014;Owais et al, 2016;Schroeder et al, 2002;Zhang et al, 2016). On the other hand, a positive effect on growth has been reported in two randomized controlled trials with prospective follow-up of young children in Pakistan (Soofi et al, 2013) and Bangladesh (Shafique et al, 2016).…”

Section: Anthropometrymentioning

confidence: 99%

Micronutrient powder supplements combined with nutrition education marginally improve growth amongst children aged 6–23 months in rural Burkina Faso: A cluster randomized controlled trial

Lanou

Osendarp

Argaw

et al. 2019

Maternal & Child Nutrition

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Micronutrients powder (MNP) can prevent anaemia amongst children 6–23 months old. However, evidence of an effect on growth is limited and concerns about the safety of iron‐containing MNP interventions limits their applicability. In a cluster randomized controlled intervention, we evaluated the effectiveness of a nutritional package including counselling and provision of MNP to improve the nutritional status of children aged 6–23 months and the effect of sustained use of MNP on morbidity in a malaria‐endemic area. Child feeding practises and nutritional status were assessed through cross‐sectional surveys. Biweekly morbidity surveillance and anthropometry measurements were carried out in a nested cohort study. No significant differences in the prevalence of wasting (−0.7% [−6.8, 5.3] points; p = .805), stunting (+4.6% [−2.9, 12.0] points; p = .201), or mean length‐for‐age z‐score and weight‐for‐length z‐score scores were found between study groups. The proportion of children with a minimum dietary diversity score and those with a minimum acceptable diet significantly increased in the intervention group compared with the control by 6.5% points (p = .043) and 5.8% points (p = .037), respectively. There were no significant differences in the risk of diarrhoea (RR: 1.68, 95% CI [0.94, 3.08]), fever (RR: 1.20 [0.82, 1.77]), and malaria (RR: 0.68 [0.37, 1.26]) between study groups. In the nested study, the rate of linear growth was higher in the intervention than in the control group by 0.013 SD/month (p = .027). In a programmatic intervention, MNP and nutrition education marginally improved child feeding practises and growth, without increasing morbidity from malaria or fever.

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Mineral- and vitamin-enhanced micronutrient powder reduces stunting in full-term low-birth-weight infants receiving nutrition, health, and hygiene education: a 2 × 2 factorial, cluster-randomized trial in Bangladesh

Abstract: The use of a mineral- and vitamin-enhanced MNP significantly reduced stunting in FT-LBW infants in this high-risk setting. The use of a water-based HS did not have an additive effect. This trial was registered at clinicaltrials.gov as NCT01455636.

Cited by 38 publications

References 37 publications

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

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

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

Micronutrient powder supplements combined with nutrition education marginally improve growth amongst children aged 6–23 months in rural Burkina Faso: A cluster randomized controlled trial

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