Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth : an individual participant data meta-analysis of randomized controlled trials
Authors & affiliation
Kathryn G Dewey, K Ryan Wessells, Charles D Arnold, Elizabeth L Prado, Souheila Abbeddou, Seth Adu-Afarwuah, Hasmot Ali, Benjamin F Arnold, Per Ashorn, Ulla Ashorn, Sania Ashraf, Elodie Becquey, Jaden Bendabenda, Kenneth H Brown, Parul Christian, John M Colford, Sherlie J L Dulience, Lia C H Fernald, Emanuela Galasso, Lotta Hallamaa, Sonja Y Hess, Jean H Humphrey, Lieven Huybregts, Lora L Iannotti, Kaniz Jannat, Anna Lartey, Agnes Le Port, Jef L Leroy, Stephen P Luby, Kenneth Maleta, Susana L Matias, Mduduzi N N Mbuya, Malay K Mridha, Minyanga Nkhoma, Clair Null, Rina R Paul, Harriet Okronipa, Jean-Bosco Ouédraogo, Amy J Pickering, Andrew J Prendergast, Marie Ruel, Saijuddin Shaikh, Ann M Weber, Patricia Wolff, Amanda Zongrone, Christine P Stewart
Abstract
Background: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design. Objectives: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes. Methods: We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses. we examined whether results differed depending on study arm inclusion criteria and types of comparisons. Results: SQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < -2) by 18%, acute malnutrition (WLZ < -2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < -2) by 13%, and small head size (head circumference-for-age z score < -2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation. water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUM:, and small head size were greater among girls than among boys; effects on stunting. underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation. Conclusions: The positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.
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