Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials.

Abstract

BACKGROUND:

Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.

OBJECTIVES:

We aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < -3) and severe stunting (length-for-age z score < -3).

METHODS:

We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.

RESULTS:

SQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 95% CI: 0.55, 0.86; n = 34,373] and 17% in severe stunting (PR: 0.83; 95% CI: 0.78, 0.90; n = 36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded (PR: 0.74; 95% CI: 0.57, 0.96; n = 26,327 for severe wasting and PR: 0.88; 95% CI: 0.81, 0.95; n = 28,742 for severe stunting). Study-level characteristics generally did not significantly modify the effects of SQ-LNSs, but results suggested greater effects of SQ-LNSs in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.

CONCLUSIONS:

Including SQ-LNSs in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. This meta-analysis was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

• Authors: Kathryn G Dewey, Charles D Arnold, K Ryan Wessells, Elizabeth L Prado, Souheila Abbeddou, Seth Adu-Afarwuah, Hasmot Ali, Benjamin F Arnold, Per Ashorn, Ulla Ashorn, Sania Ashraf, Elodie Becquey, Kenneth H Brown, Parul Christian, John M Colford Jr, Sherlie Jl Dulience, Lia Ch Fernald, Emanuela Galasso, Lotta Hallamaa, Sonja Y Hess, Jean H Humphrey, Lieven Huybregts, Lora L Iannotti, Kaniz Jannat, Anna Lartey, Agnes Le Port, Jef L Leroy, Stephen P Luby, Kenneth Maleta, Susana L Matias, Mduduzi Nn Mbuya, Malay K Mridha, Minyanga Nkhoma, Clair Null, Rina R Paul, Harriet Okronipa, Jean-Bosco Ouédraogo, Amy J Pickering, Andrew J Prendergast, Marie Ruel, Saijuddin Shaikh, Ann M Weber, Patricia Wolff, Amanda Zongrone, Christine P Stewart
• Journal: The American journal of clinical nutrition (Am J Clin Nutr) Vol. 116 Issue 5 Pg. 1314-1333 (11 2022) ISSN: 1938-3207 [Electronic] United States
• PMID: 36045000 (Publication Type: Meta-Analysis, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 American Society for Nutrition.

Chemical References

• Lipids

Topics

• Humans
• Child
• Infant
• Child, Preschool
• Randomized Controlled Trials as Topic
• Dietary Supplements
• Growth Disorders (epidemiology, prevention & control)
• Nutrients
• Cachexia
• Lipids