Characteristics That Modify the Effect of Small-Quantity Lipid-Based Nutrient Supplementation on Child Growth

Characteristics That Modify the Effect of Small-Quantity Lipid-Based Nutrient Supplementation on Child Growth

An Individual Participant Data Meta-Analysis of Randomized Controlled Trials
Published: Nov 01, 2021
Publisher: The American Journal of Clinical Nutrition, vol. 114, supplement 1

Kathryn G. Dewey

K. Ryan Wessells

Charles D. Arnold

Elizabeth L. Prado

Souheila Abbeddou

Seth Adu-Afarwuah

Hasmot Ali

Benjamin F. Arnold

Per Ashorn

Ulla Ashorn

Sania Ashraf

Elodie Becquey

Jaden Bendabenda

Kenneth H. Brown

Parul Christian

John M. Colford, Jr.

Sherlie J. L. Dulience

Lia C. H. Fernald

Emanuela Galasso

Lotta Hallamaa

Sonja Y. Hess

Jean H. Humphrey

Lieven Huybregts

Lora L. Iannotti

Kaniz Jannat

Anna Lartey

Agnes Le Port

Jef L. Leroy

Stephen P. Luby

Kenneth Maleta

Susana L. Matias

Mduduzi N. N. Mbuya

Malay K. Mridha

Minyanga Nkhoma

Rina R. Paul

Harriet Okronipa

Jean-Bosco Ouédraogo

Amy J. Pickering

Andrew J. Prendergast

Marie Ruel

Saijuddin Shaikh

Ann M. Weber

Patricia Wolff

Amanda Zongrone

Christine P. Stewart


Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design.


We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes.


We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6–24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.


SQ-LNS provision decreased stunting (length-for-age z score < −2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < −2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < −2) by 18%, acute malnutrition (WLZ < −2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < −2) by 13%, and small head size (head circumference-for-age z score < −2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation.


The positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.

How do you apply evidence?

Take our quick four-question survey to help us curate evidence and insights that serve you.

Take our survey