Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers.

Prado, ELORCID logo; Arnold, CDORCID logo; Wessells, KRORCID logo; Stewart, CPORCID logo; Abbeddou, SORCID logo; Adu-Afarwuah, SORCID logo; Arnold, BFORCID logo; Ashorn, UORCID logo; Ashorn, PORCID logo; Becquey, EORCID logo; +33 more...Brown, KHORCID logo; Chandna, JORCID logo; Christian, PORCID logo; Dentz, HN; Dulience, SJ; Fernald, LCORCID logo; Galasso, EORCID logo; Hallamaa, LORCID logo; Hess, SYORCID logo; Huybregts, LORCID logo; Iannotti, LLORCID logo; Jimenez, EY; Kohl, P; Lartey, AORCID logo; Le Port, AORCID logo; Luby, SP; Maleta, KORCID logo; Matchado, AORCID logo; Matias, SLORCID logo; Mridha, MKORCID logo; Ntozini, RORCID logo; Null, CORCID logo; Ocansey, MEORCID logo; Parvez, SMORCID logo; Phuka, JORCID logo; Pickering, AJORCID logo; Prendergast, AJORCID logo; Shamim, AA; Siddiqui, Z; Tofail, FORCID logo; Weber, AMORCID logo; Wu, LS; Dewey, KGORCID logo and (2021) Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. The American journal of clinical nutrition, 114 (Suppl). 43S-67S. ISSN 0002-9165 DOI: 10.1093/ajcn/nqab277
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BACKGROUND: Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. OBJECTIVES: We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. METHODS: We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). RESULTS: In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). CONCLUSIONS: Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.


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