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
Authors & affiliation
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, 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, Clair Null, 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
Abstract
Background: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. Objectives: We aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < -3) and severe stunting (length-for-age z score < -3). Methods: 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. 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. Results: SQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 95% CI: 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; 95% CI: 0.57, 0.96; n = 26,327 for severe wasting and PR: 0.88; 95% CI: 0.81, 0.95; n = 28,742 for severe stunting). Study-level characteristics generally did not significantly modify the effects of SQ-LNSs, but results suggested greater effects of SQ-LNSs in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation. Conclusions: Including SQ-LNSs in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting.
Publication date:
2022
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