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
Auteurs & affiliatie
Elizabeth L Prado, Charles D Arnold, K Ryan Wessells, Christine P Stewart, Souheila Abbeddou, Seth Adu-Afarwuah, Benjamin F Arnold, Ulla Ashorn, Per Ashorn, Elodie Becquey, Kenneth H Brown, Jaya Chandna, Parul Christian, Holly N Dentz, Sherlie J L Dulience, Lia C H Fernald, Emanuela Galasso, Lotta Hallamaa, Sonja Y Hess, Lieven Huybregts, Lora L Iannotti, Elizabeth Y Jimenez, Patricia Kohl, Anna Lartey, Agnes Le Port, Stephen P Luby, Kenneth Maleta, Andrew Matchado, Susana L Matias, Malay K Mridha, Robert Ntozini, Clair Null, Maku E Ocansey, Sarker M Parvez, John Phuka, Amy J Pickering, Andrew J Prendergast, Abu A Shamim, Zakia Siddiqui, Fahmida Tofail, Ann M Weber, Lee S F Wu, Kathryn G Dewey
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.
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