Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial,

Abstract

Background: Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life.Objective: We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age.Design: In this partially double-blind, individually randomized trial, 1320 women at ≤20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age.Results: At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for-age z score (LAZ) were 79.3 cm and −0.83, respectively, and 12% of the children were stunted (LAZ <−2). In analysis based on the intended treatment, mean ± SD length and LAZ for the LNS group (79.7 ± 2.9 cm and −0.69 ± 1.01, respectively) were significantly greater than for the IFA (79.1 ± 2.9 cm and −0.87 ± 0.99) and MMN (79.1 ± 2.9 cm and −0.91 ± 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045).Conclusion: Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child’s attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.

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

“…Women were instructed to consume 1 IFA tablet/d during pregnancy and 1 IFA tablet every other day during the first 3 mo postpartum (15). LNS-C (two 10-g sachets/d) was similar to the LNS-C used in Ghana (8) and Malawi (9). Both LNS products were produced by Nutriset SA in France.…”

“…Home fortification entails adding specialized products [e.g., multiple micronutrient powder (MNP) 8 ] or food-based complementary food supplements [e.g., small-quantity lipidbased nutrient supplements (SQ-LNSs) or full-fat soy flour], containing a mix of vitamins and minerals, into home-prepared foods (3). MNPs are the most commonly used home fortification products, whereas SQ-LNSs represent a newer approach to address undernutrition during the first 1000 d, initially developed for young children and now extended to pregnant and lactating women (4).…”

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

“…3 Nutrient content was similar to the LNS-C used in recent trials in Africa (20), except that the iron content was 9 mg (instead of being reduced to 6 mg, as was done in the Africa trials to reduce the potential risk of malaria associated with iron supplementation) and amounts of folic acid, niacin, pantothenic acid, thiamin, riboflavin, vitamin B-6, and vitamin B-12 were slightly higher to cover the wider age range of 6-24 mo. 4 Nutrient content was the same as the MNP being distributed by BRAC and Renata Ltd. in Bangladesh. 10 Abbreviations used: CHDP, Community Health and Development Program; CHW, community health worker; HCZ, head circumference-for-age z score; IFA, iron and folic acid supplement; IFA-Control, women received iron and folic acid supplement during pregnancy and the first 3 mo postpartum and no supplement for the children; IFA-LNS, women received iron and folic acid during pregnancy and the first 3 mo postpartum and lipid-based nutrient supplements for the children from 6 to 24 mo of age; IFA-MNP, women received iron and folic acid during pregnancy and the first 3 mo postpartum and micronutrient powder for the offspring from 6 to 24 mo of age; LAZ, length-for-age z score; LNS, lipid-based nutrient supplement; LNS-C, lipid-based nutrient supplement for children; LNS-LNS, women received lipid-based nutrient supplements during pregnancy and the first 6 mo postpartum and offspring received lipid-based nutrient supplements from 6 to 24 mo of age; LNS-PL, lipid-based nutrient supplement for pregnant and lactating women; MNP, micronutrient powder; MUACZ, midupper arm circumference-for-age z score; RDNS, RangDin Nutrition Study; SES, socioeconomic status; SDU, safe delivery unit; UCD, University of California, Davis; VHV, village health volunteer; WAZ, weight-forage z score; WLZ, weight-for-length z score.…”

“…LNS-PL (one 20-g sachet/d) was modeled on the UNICEF/WHO/United Nations University international multiple micronutrient preparation for pregnant and lactating women and similar products used in Ghana and Malawi (20). LNS-C (two 10-g sachets/d) was similar to the LNS-C used in Ghana and Malawi (4,21,22). LNS-PL and LNS-C were produced by Nutriset S.A.S.…”

“…The process of stunting often begins in utero and continues to w2 y of age; thus, the key "window" for intervention is the first 1000 d (1). Despite the recognition of this critical period, there have been remarkably few attempts to evaluate the impact of interventions that cover the majority of this 1000-d window (3,4).…”