Supplementation of Maternal Diets during Pregnancy and for 6 Months Postpartum and Infant Diets Thereafter with Small-Quantity Lipid-Based Nutrient Supplements Does Not Promote Child Growth by 18 Months of Age in Rural Malawi: A Randomized Controlled Trial.
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.
Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland; per.ashorn@uta.fi.
Per
http://orcid.org/0000-0003-2311-2593
P
Ashorn
Department for International Health, University of Tampere School of Medicine, Tampere, Finland;
Lotta
L
Alho
Department for International Health, University of Tampere School of Medicine, Tampere, Finland;
Ulla
http://orcid.org/0000-0002-1720-868X
U
Ashorn
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;
Yin Bun
YB
Cheung
Departments of Nutrition and.
Kathryn G
KG
Dewey
Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
Austrida
A
Gondwe
Department for International Health, University of Tampere School of Medicine, Tampere, Finland;
Ulla
http://orcid.org/0000-0003-1001-8864
U
Harjunmaa
Department of Nutrition & Food Science, University of Ghana, Accra, Ghana; and.
Anna
A
Lartey
Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
Nozgechi
N
Phiri
Department of Nutrition & Food Science, University of Ghana, Accra, Ghana; and.
Thokozani E
TE
Phiri
Agricultural and Resource Economics, University of California, Davis, Davis, CA;
Stephen A
SA
Vosti
Department for External Research and Nutrition Strategies Nutriset S.A.S., Malaunay, France.
Mamane
M
Zeilani
Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
Kenneth
K
Maleta
D001835:Body Weight; D002657:Child Development; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D005228:Fatty Acids, Essential / Q000008:administration & dosage; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D057238:Growth Charts; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D019266:Iron, Dietary / Q000008:administration & dosage; D008295:Malawi; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage; D009752:Nutritional Status; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D012424:Rural Population
D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D005228:Fatty Acids, Essential; D019266:Iron, Dietary; D018977:Micronutrients; D005492:Folic Acid
LNS; Sub-Saharan Africa; dietary supplementation; infant; linear growth failure; postnatal intervention; prenatal intervention; stunting