title: Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana.
abstract: BACKGROUND
  The International Lipid-Based Nutrient Supplements Project developed a small-quantity (20 g/d) lipid-based nutrient supplement (LNS) for pregnant and lactating women.
  
  
  OBJECTIVE
  We evaluated the effects of prenatal LNS supplementation on fetal growth.
  
  
  METHODS
  In a community-based, partially double-blind, individually randomized controlled trial, 1320 women ≤20 wk pregnant received 60 mg Fe/400 μg folic acid (IFA), or 1-2 Recommended Dietary Allowances of 18 micronutrients, including 20 mg Fe (MMN), or LNS with the same micronutrients as the MMN group, plus 4 minerals and macronutrients contributing 118 kcal (LNS) daily until delivery. Fetal growth was compared across groups by using intention-to-treat analysis. The primary outcome was birth length.
  
  
  RESULTS
  This analysis included 1057 women (IFA = 349, MMN = 354, LNS = 354). Groups did not differ significantly in mean birth length, length-for-age z score (LAZ), head circumference, or percentage low birth length but differed in mean birth weight (P = 0.044), weight-for-age z score (WAZ; P = 0.046), and BMI-for-age z score (BMIZ; P = 0.040), with a trend toward differences in low birth weight (P = 0.069). In pairwise comparisons, the LNS group had greater mean birth weight (+85 g; P = 0.040), WAZ (+0.19; P = 0.045), and BMIZ (+0.21; P = 0.035) and a lower risk of low birth weight (RR: 0.61, 95% CI: 0.39, 0.96; P = 0.032) than did the IFA group. The other group differences were not significant. The effect of intervention was modified by mother's parity, age, height, baseline hemoglobin, household food insecurity, and child sex, with parity being the most consistent modifier. Among primiparous women (IFA = 131; MMN = 110; LNS = 128), the LNS group had greater mean birth length (+0.91 cm; P = 0.001), LAZ (+0.47; P = 0.001), weight (+237 g; P < 0.001), WAZ (+0.56; P < 0.001), BMIZ (+0.52; P < 0.001), head circumference (0.50 cm; P = 0.017), and head circumference-for-age z score (+0.40; P = 0.022) than did the IFA group; similar differences were found when comparing the LNS and MMN groups among primiparous women, and no group differences were found among multiparous women.
  
  
  CONCLUSIONS
  Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana, particularly primiparous women. This trial was registered at clinicaltrials.gov as NCT00970866.
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Seth
authors.initials: S
authors.lastname: Adu-Afarwuah
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Anna
authors.initials: A
authors.lastname: Lartey
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Harriet
authors.initials: H
authors.lastname: Okronipa
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Mamane
authors.initials: M
authors.lastname: Zeilani
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Janet M
authors.initials: JM
authors.lastname: Peerson
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Mary
authors.initials: M
authors.lastname: Arimond
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Stephen
authors.initials: S
authors.lastname: Vosti
authors.affiliation: From the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (SA-A, AL, and HO); the Department for International Health, University of Tampere School of Medicine, Tampere, Finland (PA); Nutriset S.A.S., Malaunay, France (MZ); Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (SV); and the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (JMP, MA, and KGD).
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D001835:Body Weight; D019587:Dietary Supplements; D004311:Double-Blind Method; D002149:Energy Intake; D005260:Female; D047109:Fetal Development / Q000187:drug effects; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D005869:Ghana; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D016015:Logistic Models; D018977:Micronutrients / Q000008:administration & dosage*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D055815:Young Adult
chemical_list: D018977:Micronutrients; D005492:Folic Acid
keywords: child nutrition; fetal growth restriction; lipid-based nutrient supplements; maternal nutrition; multiple micronutrients; pregnancy outcome; prenatal supplementation