Small-Quantity Lipid-Based Nutrient Supplements Increase Infants’ Plasma Essential Fatty Acid Levels in Ghana and Malawi: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Trials

Abstract

Introduction Small-quantity lipid-based nutrient supplements (SQ-LNSs) may influence infants’ plasma fatty acid (FA) profiles, which could be associated with short- and long-term outcomes. Objectives We aimed to determine the impact of SQ-LNS consumption on infants’ plasma FA profiles in Ghana and Malawi. Methods Ghanaian (n = 1320) and Malawian (n = 1391) women ≤ 20 wk pregnant were assigned to consume daily: 60 mg iron and 400 µg folic acid until delivery (IFA group); or multiple micronutrients until 6 mo postpartum (MMN); or SQ-LNSs (∼7.8 Linoleic acid: α-Linolenic acid ratio) until 6 mo postpartum (LNS). LNS group infants received SQ-LNS from 6 to 18 mo of age. We compared infant plasma FAs by intervention group in sub-samples (n = 379, Ghana; n = 442, Malawi) at 6 and 18 mo using ANOVA and Poisson regression models. Main outcomes were mean % composition (%C, % FAs by weight) of α-linolenic (ALA), linoleic (LA), eicosapentaenoic (EPA), docosahexaenoic (DHA), and arachidonic (AA) acids. Results At 6 mo, LNS infants had greater mean ± SD ALA %C in Ghana (0.23 ± 0.08 vs IFA, 0.21 ± 0.06; MMN, 0.21 ± 0.07; P = 0.034) and Malawi (0.42 ± 0.16 vs IFA, 0.38 ± 0.15; MMN, 0.38 ± 0.14; P = 0.034) and greater AA (6.25 ± 1.24 vs IFA, 6.12 ± 1.13; MMN, 5.89 ± 1.24; P = 0.049) in Ghana. At 18 mo, LNS infants had a tendency towards greater ALA (0.32 ± 0.16 vs IFA, 0.24 ± 0.08; MMN, 0.24 ± 0.10; P = 0.06) and LA (27.8 ± 3.6 vs IFA, 26.9 ± 2.9; MMN, 27.0 ± 3.1; P = 0.06) in Ghana, and greater ALA (0.45 ± 0.18 vs IFA, 0.39 ± 0.18; MMN, 0.39 ± 0.18; P < 0.001) and LA (29.7 ± 3.5 vs IFA, 28.7 ± 3.3; MMN, 28.6 ± 3.4; P = 0.011) in Malawi. The prevalence of ALA below the population-specific 10th percentile was lower in the LNS group compared to the MMN group, but not the IFA group. Groups did not differ significantly in plasma EPA or DHA levels. Conclusion SQ-LNS increases infants’ plasma essential FA levels in Ghana and Malawi, which may have implications for health and developmental outcomes. Clinicaltrials.gov identifiers: NCT00970866; NCT01239693. Clinical Trial Registry Number; website: NCT00970866, NCT01239693; ClinicalTrials.gov