Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status : an individual participant data meta-analysis of randomized controlled trials
Authors & affiliation
K Ryan Wessells, Charles D Arnold, Christine P Stewart, Elizabeth L Prado, Souheila Abbeddou, Seth Adu-Afarwuah, Benjamin F Arnold, Per Ashorn, Ulla Ashorn, Elodie Becquey, Kenneth H Brown, Kendra A Byrd, Rebecca K Campbell, Parul Christian, Lia C H Fernald, Yue-Mei Fan, Emanuela Galasso, Sonja Y Hess, Lieven Huybregts, Josh M Jorgensen, Marion Kiprotich, Emma Kortekangas, Anna Lartey, Agnes Le Port, Jef L Leroy, Audrie Lin, Kenneth Maleta, Susana L Matias, Mduduzi N N Mbuya, Malay K Mridha, Kuda Mutasa, Abu M Naser, Rina R Paul, Harriet Okronipa, Jean-Bosco Ouédraogo, Amy J Pickering, Mahbubur Rahman, Kerry Schulze, Laura E Smith, Ann M Weber, Amanda Zongrone, Kathryn G Dewey
Abstract
Background: Small-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design. Objectives: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes. Methods: We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect moditiers. Results: SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction). iron deficiency (plasma fenitin < 12 mu g/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma fenitin <12 mu g/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinal, but there was a 7% increase in plasma retinol-binding protein (RI3P) and a 56% reduction in vitamin A deficiency (RBP < 0.70 mu mol/L), with little evidence of effect modification by individual-level characteristics. Conclusions: SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.
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