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, Elizabeth L;
Arnold, Charles D;
Wessells, K Ryan;
Stewart, Christine P;
Abbeddou, Souheila;
Adu-Afarwuah, Seth;
Arnold, Benjamin F;
Ashorn, Ulla;
Ashorn, Per;
Becquey, Elodie;
+33 more...Brown, Kenneth H;
Chandna, Jaya;
Christian, Parul;
Dentz, Holly N;
Dulience, Sherlie JL;
Fernald, Lia CH;
Galasso, Emanuela;
Hallamaa, Lotta;
Hess, Sonja Y;
Huybregts, Lieven;
Iannotti, Lora L;
Jimenez, Elizabeth Y;
Kohl, Patricia;
Lartey, Anna;
Le Port, Agnes;
Luby, Stephen P;
Maleta, Kenneth;
Matchado, Andrew;
Matias, Susana L;
Mridha, Malay K;
Ntozini, Robert;
Null, Clair;
Ocansey, Maku E;
Parvez, Sarker M;
Phuka, John;
Pickering, Amy J;
Prendergast, Andrew J;
Shamim, Abu A;
Siddiqui, Zakia;
Tofail, Fahmida;
Weber, Ann M;
Wu, Lee SF;
Dewey, Kathryn G;
(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: https://doi.org/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.
