Maternal and Child Supplementation with Lipid-Based Nutrient Supplements, but Not Child Supplementation Alone, Decreases Self-Reported Household Food Insecurity in Some Settings

Abstract

Background: It is unknown whether self-reported measures of household food insecurity change in response to food-based nutrient supplementation.Objective: We assessed the impacts of providing lipid-based nutrient supplements (LNSs) to women during pregnancy and postpartum and/or to their children on self-reported household food insecurity in Malawi [DOSE and DYAD trial in Malawi (DYAD-M)], Ghana [DYAD trial in Ghana (DYAD-G)], and Bangladesh [Rang-Din Nutrition Study (RDNS) trial].Methods: Longitudinal household food-insecurity data were collected during 3 individually randomized trials and 1 cluster-randomized trial testing the efficacy or effectiveness of LNSs (generally 118 kcal/d). Seasonally adjusted Household Food Insecurity Access Scale (HFIAS) scores were constructed for 1127 DOSE households, 732 DYAD-M households, 1109 DYAD-G households, and 3671 RDNS households. The impact of providing LNSs to women during pregnancy and the first 6 mo postpartum and/or to their children from 6 to 18-24 mo on seasonally adjusted HFIAS scores was assessed by using negative binomial models (DOSE, DYAD-M, and DYAD-G trials) and mixed-effect negative binomial models (RDNS trial).Results: In the DOSE and DYAD-G trials, seasonally adjusted HFIAS scores were not different between the LNS and non-LNS groups. In the DYAD-M trial, the average household food-insecurity scores were 14% lower (P = 0.01) in LNS households than in non-LNS households. In the RDNS trial, compared with non-LNS households, food-insecurity scores were 17% lower (P = 0.02) during pregnancy and the first 6 mo postpartum and 15% lower (P = 0.02) at 6-24 mo postpartum in LNS households.Conclusions: The daily provision of LNSs to mothers and their children throughout much of the "first 1000 d" may improve household food security in some settings, which could be viewed as an additional benefit that may accrue in households should policy makers choose to invest in LNSs to promote child growth and development. These trials were registered at clinicaltrials.gov as NCT00945698 (DOSE) NCT01239693 (DYAD-M), NCT00970866 (DYAD-G) and NCT01715038 (RDNS).

Keywords: Bangladesh; Ghana; Malawi; food insecurity; lipid-based nutrient supplements.

FIGURE 1

Estimated marginal mean seasonally adjusted HFIAS scores by combined intervention group and period of data collection among households of the children who participated in the DOSE randomized trial in Malawi (n = 1912). Estimates are from negative binomial models with household-level robust variance and group-by-period interactions. There was no difference in food insecurity between the group with LNSs and the group without LNSs in either period. HFIAS, Household Food Insecurity Access Scale; LNS, lipid-based nutrient supplement.

FIGURE 2

Estimated marginal mean seasonally adjusted HFIAS scores by combined intervention group and period of data collection among households of the women and their children who participated in the DYAD randomized trial in Malawi (n = 2674) (A) and the DYAD randomized trial in Ghana (n = 3140) (B). All estimates are from negative binomial models with household-level robust variance and group-by-period interactions. **,***PSR between the group with LNSs and the group with no LNSs at the indicated age: **P < 0.05, ***P < 0.01. HFIAS, Household Food Insecurity Access Scale; LNS, lipid-based nutrient supplement; PSR, predicted score ratio.

FIGURE 3

Baseline and periods 1 and 2 (n = 7204) (A) and periods 3–5 (n = 10,301) (B) estimated marginal mean seasonally adjusted HFIAS scores by combined intervention group and period of data collection among households of the women and their children who participated in the RDNS randomized trial in Bangladesh. Baseline estimates are from mixed-effect negative binomial models with random effects of work area and union. Postbaseline estimates are from mixed-effect negative binomial models adjusted for baseline seasonally adjusted HFIAS score and random effects of union, cluster, and household and group-by-period interactions. *,**,***PSR between the group with LNSs and the group with no LNSs at the indicated age: *P < 0.1, **P < 0.05, ***P < 0.01. HFIAS, Household Food Insecurity Access Scale; LNS, lipid-based nutrient supplement; PSR, predicted score ratio; RDNS, Rang-Din Nutrition Study.

FIGURE 4

Average predicted probability over all periods of food-security data collection of experiencing the food-insecurity access condition ≥1 time in the 4-wk recall period among households of the women and their children who participated in the DYAD randomized trial in Malawi (n = 2674). Predicted probabilities were estimated by using logistic models with household-level robust variance. *,**,***Difference in the predicted probability between the group with LNSs and the group with no LNSs: *P < 0.1, **P < 0.05, ***P < 0.01. LNS, lipid-based nutrient supplement.

FIGURE 5

Average predicted probability across periods 1 and 2 (n = 7210) (A) and periods 3–5 (n = 10,310) (B) of experiencing the food-insecurity access condition ≥1 time in the 4-wk recall period among households of the women and their children who participated in the Rang-Din Nutrition Study randomized trial in Bangladesh. Predicted probabilities were estimated by using logistic mixed models with random effects of household, work area, and union. **Difference in predicted probability between the maternal (child) group with LNSs and the maternal (child) group with no LNSs, **P < 0.05. LNS, lipid-based nutrient supplement.

FIGURE 6

Average predicted probability of relying on a food-insecurity coping strategy ≥1 time in the 4-wk recall period among households of the women and their children who participated in the DYAD randomized trial in Malawi (n = 2674). Predicted probabilities were estimated by using logistic models with household-level robust variance. There were no differences in predicted probabilities between groups with and without LNSs. LNS, lipid-based nutrient supplement.

FIGURE 7

Average predicted probability during periods 3–5 of relying on a food-insecurity coping strategy ≥1 time in the 4-wk recall period among households of women and their children who participated in the Rang-Din Nutrition Study randomized trial of LNS in Bangladesh (n = 6889). Predicted probabilities were estimated by using logistic mixed models with random effects of household, work area, and union. ***Difference in predicted probability between the child group with LNSs and the child group with no LNSs, P < 0.01. LNS, lipid-based nutrient supplement.