Small-Quantity Lipid-Based Nutrient Supplements Do Not Affect Plasma or Milk Retinol Concentrations Among Malawian Mothers, or Plasma Retinol Concentrations among Young Malawian or Ghanaian Children in Two Randomized Trials

Abstract

Background Vitamin A (VA) deficiency is prevalent in preschool-aged children in sub-Saharan Africa. Objectives We assessed the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6 to 18 mo of age on women's plasma and milk retinol concentrations in Malawi, and children's plasma retinol concentration in Malawi and Ghana. Methods Pregnant women (≤20 wk of gestation) were randomized to receive daily: 1) iron and folic acid (IFA) during pregnancy only; 2) multiple micronutrients (MMN; 800 μg retinol equivalent (RE)/capsule), or 3) SQ-LNS (800 μg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 μg RE/20 g) from 6 to 18 mo of age; children of mothers in the IFA and MMN groups received no supplement. Plasma retinol was measured in mothers at ≤20 and 36 wk of gestation and 6 mo postpartum, and in children at 6 and 18 mo of age. Milk retinol was measured at 6 mo postpartum. VA status indicators were compared by group. Results Among Malawian mothers, geometric mean (95% CI) plasma retinol concentrations at 36 wk of gestation and 6 mo postpartum were 0.97 μmol/L (0.94, 1.01 μmol/L) and 1.35 μmol/L (1.31, 1.39 μmol/L), respectively; geometric mean (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 μmol/L (0.97, 1.13 μmol/L); results did not differ by intervention group. Geometric mean (95% CI) plasma retinol concentrations for Malawian children at 6 and 18 mo of age were 0.78 μmol/L (0.75, 0.81 μmol/L) and 0.81 μmol/L (0.78, 0.85 μmol/L), respectively, and for Ghanaian children they were 0.85 μmol/L (0.82, 0.88 μmol/L) and 0.88 μmol/L (0.85, 0.91 μmol/L), respectively; results did not differ by intervention group in either setting. Conclusions SQ-LNS had no effect on VA status of mothers or children, possibly because of low responsiveness of the VA status indicators.

Effectiveness of locally produced ready to use supplementary food on hemoglobin, anthropometrics, and plasma micronutrients concentrations of 6 to 23 months age children: a non-randomized community-based trial from Pakistan

“…In contrast to our findings, Haskell et al, studied the impact of SQ-LNS on serum vitamin A in children aged 6 to 18 months in Malawia and Ghana but did not find any change in serum vitamin A concentration. The authors attribute this lack of effect due to the low prevalence of VAD in the population and poor sensitivity to changes in the status of serum retinol concentration ( 28 ).…”

Associations of fish and meat intake with iron and anaemia in Malawian children

“…The study area was located along the southeastern shore of Lake Malawi, where fishing and farming are the predominant occupations and most children are breastfed through 23 months (National Statistical Office NSO Malawi, & ICF, 2017 ). This region is also known to have higher burdens of anaemia among pregnant women (43%–45%; Jorgensen et al, 2018 ), child stunting (33%–38% of 18‐month‐old children; Ashorn et al, 2015 ) and micronutrient deficiencies (11%–15% vitamin A deficiency in 6‐month‐old infants; Haskell et al, 2021 ) than the national average (National Statistical Office NSO Malawi, & ICF, 2017 ). From previous research in these communities, children aged 6–18 months had morbidity symptoms on 22%–24% of days per caregiver report and five nonscheduled visits to any health facility per child per year of follow‐up, predominantly with diagnoses of malaria and acute respiratory infections (Bendabenda et al, 2016 ).…”

Vitamin A-Mediated Birth Defects: A Narrative Review

“…Other studies attempting to ascertain the effects of vitamin A yielded contrasting results. Notably, in Ding et al, daily oral vitamin A supplementation helped improve vitamin A status in many pregnant women who are deficient [ 20 ], while in Haskell et al, small-quantity lipid-based nutrient supplements did not affect vitamin A levels [ 21 ]. Regardless, in these two studies, along with Nga et al, various versions of vitamin A supplementation did not affect maternal or infant outcomes as seen in Table 1 [ 22 ].…”

“…Currently, guidelines indicate a maximum of up to 10,000 IU daily before 60 days of gestation and no more than 25,000 IU weekly after 60 days. This difference is due to the higher risk of early pregnancy effects which can be seen in Table 1 [19][20][21][22][23][24]. Suppose a pregnant woman's intake of retinol exceeds 10,000 IU per day.…”