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-Reference-Cited by-同舟云学术

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

Published:2021-09-29 Issue:Supplement_1 Volume:114 Page:43S-67S
ISSN:0002-9165
Container-title:The American Journal of Clinical Nutrition
language:en
Short-container-title:

Author:

Prado Elizabeth L¹^ORCID,Arnold Charles D¹^ORCID,Wessells K Ryan¹^ORCID,Stewart Christine P¹^ORCID,Abbeddou Souheila²^ORCID,Adu-Afarwuah Seth³^ORCID,Arnold Benjamin F⁴^ORCID,Ashorn Ulla⁵^ORCID,Ashorn Per⁵⁶^ORCID,Becquey Elodie⁷^ORCID,Brown Kenneth H¹⁸^ORCID,Chandna Jaya⁹^ORCID,Christian Parul¹⁰^ORCID,Dentz Holly N¹,Dulience Sherlie J L¹¹,Fernald Lia C H¹²^ORCID,Galasso Emanuela¹³^ORCID,Hallamaa Lotta⁵^ORCID,Hess Sonja Y¹^ORCID,Huybregts Lieven⁷^ORCID,Iannotti Lora L¹¹^ORCID,Jimenez Elizabeth Y¹⁴,Kohl Patricia¹¹,Lartey Anna³^ORCID,Le Port Agnes¹⁵^ORCID,Luby Stephen P¹⁶,Maleta Kenneth¹⁷^ORCID,Matchado Andrew¹⁸^ORCID,Matias Susana L¹⁹^ORCID,Mridha Malay K²⁰^ORCID,Ntozini Robert²¹^ORCID,Null Clair²²^ORCID,Ocansey Maku E²³^ORCID,Parvez Sarker M²⁴^ORCID,Phuka John¹⁷^ORCID,Pickering Amy J²⁵^ORCID,Prendergast Andrew J²⁶^ORCID,Shamim Abu A²⁰,Siddiqui Zakia²⁷,Tofail Fahmida²⁸^ORCID,Weber Ann M²⁹^ORCID,Wu Lee S F¹⁰,Dewey Kathryn G¹^ORCID

Affiliation:

1. Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA

2. Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium

3. Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana

4. Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA

5. Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland

6. Department of Paediatrics, Tampere University Hospital, Tampere, Finland

7. Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA

8. Helen Keller International, New York, NY, USA

9. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom

10. Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

11. Brown School, Washington University in St. Louis, St Louis, MO, USA

12. School of Public Health, University of California, Berkeley, Berkeley, CA, USA

13. Development Research Group, World Bank, Washington, DC, USA

14. Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

15. Independent consultant, Dakar, Senegal

16. Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA

17. Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

18. Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi

19. Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA

20. Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh

21. Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe

22. Mathematica, Washington, DC, USA

23. CDC Foundation, Atlanta, GA, USA

24. Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

25. School of Engineering, Tufts University, Medford, MA, USA

26. Blizard Institute, Queen Mary University of London, London, United Kingdom

27. Healthy Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

28. Nutrition and Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

29. Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA

Abstract

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.

Funder

Bill and Melinda Gates Foundation

University of California

Publisher

Oxford University Press (OUP)

Subject

Nutrition and Dietetics,Medicine (miscellaneous)

Link

http://academic.oup.com/ajcn/article-pdf/114/Supplement_1/43S/41034995/nqab277.pdf

Reference76 articles.

1. Early brain development and plasticity;Couperus,2006

2. Nutrition and brain development in early life;Prado;Nutr Rev,2014