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

Abstract

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.

Milk–cereal mix supplementation during infancy and impact on neurodevelopmental outcomes at 12 and 24 months of age: a randomised controlled trial in India

“…Therefore, if the intent is to improve neurodevelopment outcome, investment is needed not only in nutrition but also in other aspects of nurturing care, especially responsive care and learning opportunities. Similar to the present study, a recent systematic review and individual participant data meta-analysis (including data from about 30 000 children from thirteen RCT) found a modest improvement in motor, language and socio-emotional scores in children, aged 6-24 months, receiving small quantity lipidbased supplement (42) . The nutritional composition of small quantity lipid-based supplement was similar to the milk-cereal mix provided to infants in the modest-protein group in our study.…”

Association between prenatal provision of lipid‐based nutrient supplements and caesarean delivery: Findings from a randomised controlled trial in Malawi

“…Provision of LNS to infants and young children during the complementary feeding period is an effective intervention to promote growth and development (Das et al, 2019 ; Dewey et al, 2021 ; Prado et al, 2021 ), improve micronutrient status (Wessells et al, 2021 ), and prevent malnutrition and mortality (Dewey et al, 2021 ; Stewart et al, 2020 ) in over 6‐month‐old children. This positive experience, the ease of use, and preliminary evidence of benefits from antenatal administration (Das et al, 2018 ) are likely to lead to increased use of LNS products also for maternal supplementation during pregnancy.…”

Study Protocol: The Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia (ZamCharts): A Cluster Randomized Controlled Trial

“…Recent meta-analytic evidence (25) based on randomized trials that included a total of more than 37,000 children shows that SQ-LNS can reduce the prevalence of stunting by 12 to 14 percent (26) and wasting by 14 to 30 percent (27). SQ-LNS can also lower the prevalence of micronutrient de ciencies (28), including iron de ciency anaemia, and reduce the risk of cognitive, socio-emotional, and motor development delay (29). The Lancet 2021 series on Maternal and Child Undernutrition included SQ-LNS as one of the recommended interventions for preventing/reducing malnutrition among children (30).…”