title: Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh.
abstract: BACKGROUND
  Maternal undernutrition and newborn stunting [birth length-for-age z score (LAZ) <-2] are common in Bangladesh.
  
  
  OBJECTIVE
  The objective was to evaluate the effect of lipid-based nutrient supplements for pregnant and lactating women (LNS-PLs) on birth outcomes.
  
  
  METHODS
  We conducted a cluster-randomized effectiveness trial (the Rang-Din Nutrition Study) within a community health program in rural Bangladesh. We enrolled 4011 pregnant women at ≤20 gestational weeks; 48 clusters received iron and folic acid (IFA; 60 mg Fe + 400 μg folic acid) and 16 clusters received LNS-PLs (20 g/d, 118 kcal) containing essential fatty acids and 22 vitamins and minerals. Both of the supplements were intended for daily consumption until delivery. Primary outcomes were birth weight and length.
  
  
  RESULTS
  Infants in the LNS-PL group had higher birth weights (2629 ± 408 compared with 2588 ± 413 g; P = 0.007), weight-for-age z scores (-1.48 ± 1.01 compared with -1.59 ± 1.02; P = 0.006), head-circumference-for-age z scores (HCZs; -1.26 ± 1.08 compared with -1.34 ± 1.12; P = 0.028), and body mass index z scores (-1.57 ± 1.05 compared with -1.66 ± 1.03; P = 0.005) than those in the IFA group; in adjusted models, the differences in length (47.6 ± 0.07 compared with 47.4 ± 0.04 cm; P = 0.043) and LAZ (-1.15 ± 0.04 compared with -1.24 ± 0.02; P = 0.035) were also significant. LNS-PLs reduced the risk of newborn stunting (18.7% compared with 22.6%; RR: 0.83; 95% CI: 0.71, 0.97) and small head size (HCZ <-2) (20.7% compared with 24.9%; RR: 0.85; 95% CI: 0.73, 0.98). The effects of LNS-PL on newborn stunting were greatest in infants born before a 10-wk interruption in LNS-PL distribution (n = 1301; 15.7% compared with 23.6%; adjusted RR: 0.69; 95% CI: 0.53, 0.89) and in infants born to women ≤24 y of age or with household food insecurity.
  
  
  CONCLUSIONS
  Prenatal lipid-based nutrient supplements can improve birth outcomes in Bangladeshi women, especially those at higher risk of fetal growth restriction. This trial was registered at clinicaltrials.gov as NCT01715038.
authors.affiliation: Departments of Nutrition and International Center for Diarrheal Disease Research, Dhaka, Bangladesh;
authors.forename: Malay K
authors.initials: MK
authors.lastname: Mridha
authors.affiliation: Departments of Nutrition and.
authors.forename: Susana L
authors.initials: SL
authors.lastname: Matias
authors.affiliation: Consultant, Milton, MA; and.
authors.forename: Camila M
authors.initials: CM
authors.lastname: Chaparro
authors.affiliation: International Center for Diarrheal Disease Research, Dhaka, Bangladesh;
authors.forename: Rina R
authors.initials: RR
authors.lastname: Paul
authors.affiliation: International Center for Diarrheal Disease Research, Dhaka, Bangladesh;
authors.forename: Sohrab
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Agricultural and Resource Economics, University of California, Davis, Davis, CA;
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Departments of Nutrition and.
authors.forename: Kassandra L
authors.initials: KL
authors.lastname: Harding
authors.affiliation: Department of Economics, University of California, Riverside, Riverside, CA;
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Cummins
authors.affiliation: LAMB, Dinajpur, Bangladesh.
authors.forename: Louise T
authors.initials: LT
authors.lastname: Day
authors.affiliation: LAMB, Dinajpur, Bangladesh.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Saha
authors.affiliation: Departments of Nutrition and.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Peerson
authors.affiliation: Departments of Nutrition and kgdewey@ucdavis.edu.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D001724:Birth Weight; D001827:Body Height; D004041:Dietary Fats / Q000494:pharmacology / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D005317:Fetal Growth Retardation / Q000209:etiology / Q000517:prevention & control*; D006130:Growth Disorders / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D044342:Malnutrition / Q000150:complications / Q000188:drug therapy; D018977:Micronutrients / Q000008:administration & dosage; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena; D055815:Young Adult
chemical_list: D004041:Dietary Fats; D018977:Micronutrients
keywords: head circumference; iron and folic acid; lipid-based nutrient supplements; low birth weight; newborn stunting