1. 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.
- Author
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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, 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, and Dewey, Kathryn G
- Subjects
Humans ,Lipids ,Child Development ,Language Development ,Motor Skills ,Socioeconomic Factors ,Dietary Supplements ,Child ,Preschool ,Infant ,Africa South of the Sahara ,Haiti ,Bangladesh ,Female ,Male ,Randomized Controlled Trials as Topic ,Infant Nutritional Physiological Phenomena ,Effect Modifier ,Epidemiologic ,child undernutrition ,complementary feeding ,executive function ,language development ,motor development ,nutrient supplements ,social-emotional development ,Pediatric ,Clinical Research ,Clinical Trials and Supportive Activities ,Zero Hunger ,Engineering ,Medical and Health Sciences ,Nutrition & Dietetics - Abstract
BackgroundSmall-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development.ObjectivesWe 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.MethodsWe 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).ResultsIn 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).ConclusionsChild 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.
- Published
- 2021