Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial

Abstract

Background: Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life.

Objective: We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age.

Design: In this partially double-blind, individually randomized trial, 1320 women at ≤20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age.

Results: At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for-age z score (LAZ) were 79.3 cm and -0.83, respectively, and 12% of the children were stunted (LAZ <-2). In analysis based on the intended treatment, mean ± SD length and LAZ for the LNS group (79.7 ± 2.9 cm and -0.69 ± 1.01, respectively) were significantly greater than for the IFA (79.1 ± 2.9 cm and -0.87 ± 0.99) and MMN (79.1 ± 2.9 cm and -0.91 ± 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045).

Conclusion: Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child's attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.

Keywords: child growth; home fortification; lipid-based nutrient supplements; multiple micronutrients; supplementation.

FIGURE 1

Study profile of the randomized trial of daily IFA (pregnancy only), MMN (pregnancy and lactation), and LNS (pregnancy, lactation, and infancy) supplementation in a semi-urban setting in Ghana. IFA, iron and folic acid; LNS, small-quantity lipid-based nutrient supplement; MMN, multiple micronutrient.

FIGURE 2

Length-for-age z scores from birth to 18 mo of age of infants of women (n = 1320) who participated in a randomized trial of daily IFA (pregnancy only), MMN (pregnancy and lactation), and LNS (pregnancy, lactation, and infancy) supplementation in a semi-urban setting in Ghana. (A) Analysis of groups based on intended supplement. Mean ± SD (n) at birth: −0.58 ± 0.97 (379), −0.68 ± 1.01 (388), and −0.70 ± 1.05 (386); at 3 mo: −0.55 ± 0.97 (341), −0.72 ± 0.99 (349), and −0.71 ± 1.02 (351); at 6 mo: −0.62 ± 1.04 (351), −0.78 ± 0.96 (355), and −0.72 ± 1.03 (347); at 12 mo: −0.56 ± 1.05 (331), −0.84 ± 1.03 (330), and −0.71 ± 1.02 (347); and at 18 mo −0.69 ± 1.01 (347), −0.91 ± 1.01 (342), and −0.87 ± 0.99 (350) for LNS, MMN, and IFA groups, respectively. (B) Analysis of groups based on supplements received at enrollment. Mean ± SD (n) at birth: −0.58 ± 0.97 (379), −0.63 ± 1.02 (386), and −0.76 ± 1.04 (388); at 3 mo: −0.55 ± 0.97 (341), −0.63 ± 1.02 (357), and −0.80 ± 0.98 (343); at 6 mo: −0.62 ± 1.04 (351), −0.71 ± 1.01 (355), and −0.79 ± 0.98 (347); at 12 mo: −0.56 ± 1.05 (331), −0.71 ± 1.05 (345), and −0.84 ± 1.00 (332); at 18 mo: −0.69 ± 1.01 (347), −0.81 ± 1.01 (355), and −0.97 ± 0.97 (337) for LNS, MMN, and IFA groups, respectively. IFA, iron and folic acid; LNS, small-quantity lipid-based nutrient supplement; MMN, multiple micronutrient.