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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

Wessells KR 1 , Arnold CD 1 , Stewart CP 1 , Prado EL 1 , Abbeddou S 2 , Adu-Afarwuah S 3 Show all authors , Arnold BF 4 , Ashorn P 5 , Ashorn U 5 , Becquey E 6 , Brown KH 1 , Byrd KA 7 , Campbell RK 8 , Christian P 9 , Fernald LCH 10 , Fan YM 5 , Galasso E 11 , Hess SY 1 , Huybregts L 6 , Jorgensen JM 12 , Kiprotich M 13 , Kortekangas E 5 , Lartey A 3 , Le Port A 14 , Leroy JL 6 , Lin A 10 , Maleta K 15 , Matias SL 16 , Mbuya MNN 17 , Mridha MK 18 , Mutasa K 17 , Naser AM 19 , Paul RR 18 , Okronipa H 20 , Ouédraogo JB 21 , Pickering AJ 22 , Rahman M 19 , Schulze K 9 , Smith LE 23 , Weber AM 24 , Zongrone A 25 , Dewey KG 1

Affiliations 

  • 1 Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
  • 2 Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
  • 3 Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
  • 4 Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
  • 5 Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  • 6 Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
  • 7 WorldFish, Bayan Lepas, Penang, Malaysia
  • 8 Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
  • 9 Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • 10 School of Public Health, University of California, Berkeley, Berkeley, CA, USA
  • 11 Development Research Group, World Bank, Washington, DC, USA
  • 12 Nutrition Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
  • 13 One Acre Fund, Nairobi, Kenya
  • 14 Independent consultant, Dakar, Senegal
  • 15 Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
  • 16 Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
  • 17 Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
  • 18 Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
  • 19 International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
  • 20 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
  • 21 Health Sciences Research Institute (IRSS), Bobo-Dioulasso, Burkina Faso
  • 22 School of Engineering, Tufts University, Medford, MA, USA
  • 23 Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA
  • 24 Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
  • 25 Independent consultant, Washington, DC, USA
Am J Clin Nutr, 2021 11 02;114(Suppl 1):68S-94S.
PMID: 34590114 DOI: 10.1093/ajcn/nqab276

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 modifiers.

RESULTS: SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/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 retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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