Small-Quantity Lipid-Based Nutrient Supplements for Children Age 6–24 Months

Small-Quantity Lipid-Based Nutrient Supplements for Children Age 6–24 Months

A Systematic Review and Individual Participant Data Meta-Analysis of Effects on Developmental Outcomes and Effect Modifiers
Published: Nov 01, 2021
Publisher: The American Journal of Clinical Nutrition, vol. 114, issue supplement 1

Elizabeth L. Prado

Charles D. Arnold

K. Ryan Wessells

Christine P. Stewart

Souheila Abbeddou

Seth Adu-Afarwuah

Benjamin F. Arnold

Ulla Ashorn

Per Ashorn

Elodie Becquey

Kenneth H. Brown

Jaya Chandna

Parul Christian

Holly N. Dentz

Sherlie J. L. Dulience

Lia C. H. Fernald

Emanuela Galasso

Lotta Hallamaa

Sonja Y. Hess

Lieven Huybregts

Lora L. Iannotti

Elizabeth Y. Jimenez

Patricia Kohl

Anna Lartey

Agnes Le Port

Stephen P. Luby

Kenneth Maleta

Andrew Matchado

Susana L. Matias

Malay K. Mridha

Robert Ntozini

Maku E. Ocansey

Sarker M. Parvez

John Phuka

Amy J. Pickering

Andrew J. Prendergast

Abu A. Shamim

Zakia Siddiqui

Fahmida Tofail

Ann M. Weber

Lee S. F. Wu

Kathryn G. Dewey


Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development.


We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects.


We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6–24 months (total n = 30,024).


In 11–13 intervention against control group comparisons (n = 23,588–24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 months by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11–0.13 SD; 8–9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11).


Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1–1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.

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