Preventive Small-Quantity Lipid-Based Nutrient Supplements Reduce Severe Wasting and Severe Stunting Among Young Children: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials

Preventive Small-Quantity Lipid-Based Nutrient Supplements Reduce Severe Wasting and Severe Stunting Among Young Children: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials

Published: Aug 31, 2022
Publisher: The American Journal of Clinical Nutrition (online ahead of print)
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Authors

Kathryn G. Dewey

Charles D. Arnold

K. Ryan Wessells

Elizabeth L. Prado

Souheila Abbeddou

Seth Adu-Afarwuah

Hasmot Ali

Benjamin F. Arnold

Per Ashorn

Ulla Ashorn

Sania Ashraf

Elodie Becquey

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. Iannottie

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

Background

Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.

Objective

We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3).

Methods

We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age. We generated study-specific and subgroup estimates of SQ-LNS vs. 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.

Results

SQ-LNS provision led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.

Conclusions

Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting.

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