Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial

Abstract

BackgroundEvidence on the effect of small-quantity lipid-based nutrient supplements (SQ-LNSs) on early child growth and development is mixed.ObjectiveThis study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth (primary outcome), psychomotor development, iron status (secondary outcomes), and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet.MethodsInfants (n = 750) were randomly assigned to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNS products contained micronutrients and essential fatty acids. SQ-LNS-plus contained, in addition, docosahexaenoic acid, arachidonic acid (important for brain and eye development), lysine (limiting amino acid in maize), phytase (enhances iron absorption), and other nutrients. Infants’ weight and length were measured bimonthly. At age 6 and 12 mo, psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin, plasma ferritin, C-reactive protein, and α1-acid glycoprotein were assessed. WHO Motor Milestone outcomes, adherence, and morbidity were monitored weekly through home visits. Primary analysis was by intention-to-treat, comparing each SQ-LNS group with the control.ResultsSQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo (mean difference: 0.11; 95% CI: 0.01, 0.22; P = 0.032) and 10 mo (0.16; 95% CI: 0.04, 0.27; P = 0.008) but not at 12 mo (0.09; 95% CI: −0.02, 0.21; P = 0.115), locomotor development score (2.05; 95% CI: 0.72, 3.38; P = 0.003), and Parent Rating Score (1.10; 95% CI: 0.14, 2.07; P = 0.025), but no effect for weight-for-age zscore. Both SQ-LNS (P = 0.027) and SQ-LNS-plus (P = 0.005) improved hemoglobin concentration and reduced the risk of anemia, iron deficiency, and iron-deficiency anemia. Both SQ-LNS products reduced longitudinal prevalence of fever, coughing, and wheezing but increased incidence and longitudinal prevalence of diarrhea, vomiting, and rash/sores.ConclusionsPoint-of-use fortification with SQ-LNS-plus showed an early transient effect on linear growth and improved locomotor development. Both SQ-LNS products had positive impacts on anemia and iron status. This trial was registered at clinicaltrials.gov as NCT01845610.

Micronutrient-fortified infant cereal improves Hb status and reduces iron-deficiency anaemia in Indian infants: an effectiveness study

“…Longitudinal studies on long-term effects of IDA observed that children who had IDA in infancy did worse on tests of mental, motor and social-emotional functioning in later childhood and adolescence, despite Fe therapy and Fe status improvement (3) . A limited number of studies suggest a beneficial effect of Fe-fortified foods on short-term infant neurodevelopment (14,15) . Systematic reviews do not provide adequate evidence that Fe supplementation or fortification improves cognitive and motor development in the overall infant and young children population (16)(17)(18)(19) ; however, subgroup meta-analysis suggests a beneficial effect in Fe-deficient children (16) and provides limited evidence for benefits on motor development in non-anaemic infants (19) .…”

Dietary patterns of 6–24‐month‐old children are associated with nutrient content and quality of the diet

“…In Study 1 , additional data were collected 6 months after the completion of the RCT (at age 18–24 months). In Study 3 (Smuts et al ; Swanepoel et al, ), dietary intake data were collected for children who participated in an RCT that was done in a peri‐urban site in North West province. Study participants were recruited through primary health care facilities and house‐to‐house visits.…”

Associations of plasma total phospholipid fatty acid patterns with feeding practices, growth, and psychomotor development in 6‐month‐old South African infants

“…This cross‐sectional study was performed using baseline data of the Tswaka trial, which was a randomised, controlled trial designed to investigate the effects of two small‐quantity lipid‐based nutrient supplements on linear growth in infants aged six to 12 months (Smuts et al, ). The Tswaka trial was conducted during the period of September 2013 and January 2015 in the Jouberton area of the greater Matlosana Municipality in the North West Province, South Africa.…”