title: Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial.
abstract: BACKGROUND
  Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life.
  
  
  OBJECTIVE
  We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age.
  
  
  METHODS
  In this partially double-blind, individually randomized trial, 1320 women at ≤20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age.
  
  
  RESULTS
  At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for-age z score (LAZ) were 79.3 cm and -0.83, respectively, and 12% of the children were stunted (LAZ <-2). In analysis based on the intended treatment, mean ± SD length and LAZ for the LNS group (79.7 ± 2.9 cm and -0.69 ± 1.01, respectively) were significantly greater than for the IFA (79.1 ± 2.9 cm and -0.87 ± 0.99) and MMN (79.1 ± 2.9 cm and -0.91 ± 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045).
  
  
  CONCLUSIONS
  Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child's attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana; ct3665@gmail.com.
authors.forename: Seth
authors.identifier: http://orcid.org/0000-0002-2720-5474
authors.initials: S
authors.lastname: Adu-Afarwuah
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana;
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0002-7870-2606
authors.initials: A
authors.lastname: Lartey
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana;
authors.forename: Harriet
authors.identifier: http://orcid.org/0000-0002-5373-6754
authors.initials: H
authors.lastname: Okronipa
authors.affiliation: Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland;
authors.forename: Per
authors.identifier: http://orcid.org/0000-0003-2311-2593
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and.
authors.forename: Janet M
authors.identifier: http://orcid.org/0000-0001-6816-1909
authors.initials: JM
authors.lastname: Peerson
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and.
authors.forename: Mary
authors.initials: M
authors.lastname: Arimond
authors.affiliation: Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland;
authors.forename: Ulla
authors.identifier: http://orcid.org/0000-0002-1720-868X
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: Nutriset S.A.S., Malaunay, France.
authors.forename: Mamane
authors.identifier: http://orcid.org/0000-0003-4566-6394
authors.initials: M
authors.lastname: Zeilani
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and.
authors.forename: Stephen
authors.initials: S
authors.lastname: Vosti
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D000328:Adult; D001827:Body Height / Q000208:ethnology; D002657:Child Development; D004041:Dietary Fats / Q000009:adverse effects / Q000627:therapeutic use; D019587:Dietary Supplements / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D005869:Ghana / Q000453:epidemiology; D006130:Growth Disorders / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007228:Infant Nutrition Disorders / Q000453:epidemiology / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D007227:Infant Nutritional Physiological Phenomena / Q000208:ethnology; D007231:Infant, Newborn; D007774:Lactation / Q000208:ethnology; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena / Q000208:ethnology; D018977:Micronutrients / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D015995:Prevalence; D012306:Risk; D018881:Suburban Health / Q000208:ethnology
chemical_list: D004041:Dietary Fats; D018977:Micronutrients
keywords: child growth; home fortification; lipid-based nutrient supplements; multiple micronutrients; supplementation