Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials

Author:

Wessells K. RyanORCID,Arnold Charles D.ORCID,Stewart Christine P.ORCID,Prado Elizabeth L.ORCID,Abbeddou SouheilaORCID,Adu-Afarwuah SethORCID,Arnold Benjamin F.ORCID,Ashorn PerORCID,Ashorn UllaORCID,Becquey ElodieORCID,Brown Kenneth H.ORCID,Byrd Kendra A.ORCID,Campbell Rebecca K.,Christian ParulORCID,Fernald Lia C.H.,Fan Yue-Mei,Galasso Emanuela,Hess Sonja Y.ORCID,Huybregts LievenORCID,Jorgensen Josh M.ORCID,Kiprotich MarionORCID,Kortekangas EmmaORCID,Lartey AnnaORCID,Le Port AgnesORCID,Leroy Jef L.ORCID,Lin AudrieORCID,Maleta Kenneth,Matias Susana L.,Mbuya Mduduzi NNORCID,Mridha Malay K.ORCID,Mutasa KudaORCID,Naser Abu Mohd.ORCID,Paul Rina R.ORCID,Okronipa HarrietORCID,Ouédraogo Jean-BoscoORCID,Pickering Amy J.,Rahman Mahbubur,Schulze KerryORCID,Smith Laura E.,Weber Ann M.ORCID,Zongrone AmandaORCID,Dewey Kathryn G.ORCID

Abstract

ABSTRACTBackgroundSmall-quantity lipid-based nutrient supplements (SQ-LNS) have been shown to reduce the prevalence of anemia and iron deficiency among infants and young children, but effects on other micronutrients are less well known. Identifying subgroups who may experience greater benefits from SQ-LNS, or who are more likely to respond to the intervention, may facilitate the development of public health policies and programs.ObjectiveOur objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child hematological and micronutrient status outcomes.MethodsWe conducted a two-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n = 15,946). Outcomes were hemoglobin (Hb), inflammation-adjusted plasma ferritin, soluble transferrin receptor, zinc, retinol and retinol binding protein (RBP), and erythrocyte zinc protoporphyrin, and respective dichotomous outcomes indicative of anemia and micronutrient deficiency. We generated study-specific estimates of SQ-LNS vs. control, including main effects and subgroup estimates for individual-level effect modifiers, and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine potential study-level effect modifiers.ResultsProvision of SQ-LNS decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56% and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin < 12 µg/L) by 64%. We observed positive effects of SQ-LNS on hematological and iron status outcomes within all subgroups of the study-level and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNS on anemia and iron status were greater in trials that provided SQ-LNS for > 12 months and provided 9 mg/d vs. < 9 mg iron/d, and among later-born (vs. first-born) children. There was no effect of SQ-LNS on plasma zinc or retinol, but there was a 7% increase in plasma RBP and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics.ConclusionsSQ-LNS provided to infants and young children 6-24 months of age can substantially reduce the prevalence of anemia, iron deficiency, and IDA across a range of individual, population and study design characteristics. Policy-makers and program planners should consider SQ-LNS within intervention packages to prevent anemia and iron deficiency. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.

Publisher

Cold Spring Harbor Laboratory

Reference91 articles.

1. Maternal and child undernutrition and overweight in low-income and middle-income countries

2. Muthayya S , Rah JH , Sugimoto JD , Roos FF , Kraemer K , Black RE . The global hidden hunger indices and maps: an advocacy tool for action. PLoS One 2013;8:e67860.

3. A systematic analysis of global anemia burden from 1990 to 2010

4. The Epidemiology of Global Micronutrient Deficiencies

5. United Nations Children’s Fund (UNICEF). Improving Child Nutrition: The Achievable Imperative for Global Progress. New York, UNICEF, 2013. Available at: https://www.unicef.org/publications/index_68661.html. Accessed on: 25 September 2020.

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3