Per Ashorn1, Lotta Alho2, Ulla Ashorn2, Yin Bun Cheung3, Kathryn G Dewey4, Austrida Gondwe5, Ulla Harjunmaa2, Anna Lartey6, Nozgechi Phiri5, Thokozani E Phiri6, Stephen A Vosti7, Mamane Zeilani8, Kenneth Maleta5. 1. Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland; per.ashorn@uta.fi. 2. Department for International Health, University of Tampere School of Medicine, Tampere, Finland; 3. Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore; 4. Departments of Nutrition and. 5. Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi; 6. Department of Nutrition & Food Science, University of Ghana, Accra, Ghana; and. 7. Agricultural and Resource Economics, University of California, Davis, Davis, CA; 8. Department for External Research and Nutrition Strategies Nutriset S.A.S., Malaunay, France.
Abstract
BACKGROUND: Intrauterine growth restriction may be reduced by supplementing maternal diets during pregnancy, but few studies have assessed the impact of combined prenatal and postnatal interventions on child growth. OBJECTIVE: We tested a hypothesis that provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers in pregnancy and 6 mo postpartum and to their infants from 6 to 18 mo of age would promote infant and child growth in the study area in rural Malawi. METHODS: We enrolled 869 pregnant women in a randomized trial in Malawi. During pregnancy and 6 mo thereafter, the women received daily 1 capsule of iron-folic acid (IFA), 1 capsule containing 18 micronutrients (MMN), or one 20-g sachet of SQ-LNS [lipid-based nutrient supplements (LNS), containing 21 MMN, protein, carbohydrates, essential fatty acids, and 118 kcal]. Children in the IFA and MMN groups received no supplementation; children in the LNS group received SQ-LNSs from 6 to 18 mo. Primary outcome was child length at 18 mo. RESULTS: At 18 mo, the mean length in the IFA, MMN, and LNS groups was 77.0, 76.9, and 76.8 cm (P = 0.90), respectively, and the prevalence of stunting was 32.7%, 35.6%, and 37.9% (P = 0.54), respectively. No intergroup differences were found in the mean weight, head circumference, or midupper arm circumference or the proportions with low z scores for these variables (P > 0.05). Covariate adjustment did not change the analysis results, and the associations between the intervention and child length were not modified by maternal parity, age, or nutritional status (P > 0.10). CONCLUSIONS: The findings do not support a hypothesis that provision of SQ-LNSs to women in pregnancy and postpartum and to children from 6 to 18 mo of age would promote child growth in this Malawian study area. This trial was registered at clinicaltrials.gov as NCT01239693.
RCT Entities:
BACKGROUND: Intrauterine growth restriction may be reduced by supplementing maternal diets during pregnancy, but few studies have assessed the impact of combined prenatal and postnatal interventions on child growth. OBJECTIVE: We tested a hypothesis that provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers in pregnancy and 6 mo postpartum and to their infants from 6 to 18 mo of age would promote infant and child growth in the study area in rural Malawi. METHODS: We enrolled 869 pregnant women in a randomized trial in Malawi. During pregnancy and 6 mo thereafter, the women received daily 1 capsule of iron-folic acid (IFA), 1 capsule containing 18 micronutrients (MMN), or one 20-g sachet of SQ-LNS [lipid-based nutrient supplements (LNS), containing 21 MMN, protein, carbohydrates, essential fatty acids, and 118 kcal]. Children in the IFA and MMN groups received no supplementation; children in the LNS group received SQ-LNSs from 6 to 18 mo. Primary outcome was child length at 18 mo. RESULTS: At 18 mo, the mean length in the IFA, MMN, and LNS groups was 77.0, 76.9, and 76.8 cm (P = 0.90), respectively, and the prevalence of stunting was 32.7%, 35.6%, and 37.9% (P = 0.54), respectively. No intergroup differences were found in the mean weight, head circumference, or midupper arm circumference or the proportions with low z scores for these variables (P > 0.05). Covariate adjustment did not change the analysis results, and the associations between the intervention and child length were not modified by maternal parity, age, or nutritional status (P > 0.10). CONCLUSIONS: The findings do not support a hypothesis that provision of SQ-LNSs to women in pregnancy and postpartum and to children from 6 to 18 mo of age would promote child growth in this Malawian study area. This trial was registered at clinicaltrials.gov as NCT01239693.
Authors: Richard D Semba; Indi Trehan; Marta Gonzalez-Freire; Klaus Kraemer; Ruin Moaddel; M Isabel Ordiz; Luigi Ferrucci; Mark J Manary Journal: Adv Nutr Date: 2016-09-15 Impact factor: 8.701
Authors: Jai K Das; Rehana A Salam; Yousaf Bashir Hadi; Sana Sadiq Sheikh; Afsah Z Bhutta; Zita Weise Prinzo; Zulfiqar A Bhutta Journal: Cochrane Database Syst Rev Date: 2019-05-02
Authors: Robert C Stewart; Per Ashorn; Eric Umar; Kathryn G Dewey; Ulla Ashorn; Francis Creed; Atif Rahman; Barbara Tomenson; Elizabeth L Prado; Ken Maleta Journal: Matern Child Nutr Date: 2016-04-05 Impact factor: 3.092