title: Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial.
abstract: Background:Nutrition during the first 1000 d is critical for brain development.Objective:We evaluated the effects on child development of home fortification with lipid-based nutrient supplements (LNSs) for mothers and/or children or micronutrient powder (MNP) for children.Design:We conducted a cluster-randomized effectiveness trial with 4 arms:1) LNSs during pregnancy and the first 6 mo postpartum and LNSs for the offspring from 6 to 24 mo (LNS-LNS),2) iron and folic acid (IFA) during pregnancy and the first 3 mo postpartum and LNSs for the children from 6 to 24 mo (IFA-LNS),3) IFA (as above) and MNP for the offspring from 6 to 24 mo (IFA-MNP), and4) IFA (as above) and no child supplement (IFA-Control). Women were enrolled at ≤20 wk of gestation; children were assessed at 12 (n= 3331), 18 (n= 3364), and 24 (n= 3379) mo.Results:Compared with the IFA-Control group, motor development scores were higher in the LNS-LNS (P= 0.016) and IFA-LNS groups (P= 0.006) at 18 mo and in the IFA-MNP group (P= 0.048) at 24 mo. Receptive language scores were higher for the LNS-LNS group (P= 0.028) at 18 mo and for all 3 groups at 24 mo (P= 0.008 for LNS-LNS,P= 0.022 for IFA-LNS, andP= 0.009 for IFA-MNP compared with IFA-Control). Expressive language scores did not differ at 18 mo (P= 0.236) but were higher in the LNS-LNS (P= 0.035) and IFA-MNP (P= 0.002) groups than in the IFA-Control group at 24 mo. Groups did not differ in personal-social scores at 18 (P= 0.233) or 24 (P= 0.146) mo or in executive function score at 24 mo (P= 0.467).Conclusion:Prenatal LNSs, postnatal LNSs, or both, or postnatal MNP had a positive effect on motor and language development in Bangladeshi children. This trial was registered at clinicaltrials.gov as NCT01715038.
authors.affiliation: Department of Nutrition, University of California, Davis, Davis, CA; slmatias@ucdavis.edu.
authors.forename: Susana L
authors.initials: SL
authors.lastname: Matias
authors.affiliation: Department of Nutrition, University of California, Davis, Davis, CA.|Nutrition and Clinical Services Division.
authors.forename: Malay K
authors.initials: MK
authors.lastname: Mridha
authors.affiliation: Nutrition and Clinical Services Division.|Child Development Unit, and.
authors.forename: Fahmida
authors.initials: F
authors.lastname: Tofail
authors.affiliation: Department of Nutrition, University of California, Davis, Davis, CA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Arnold
authors.affiliation: Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
authors.forename: Md Showkat A
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Nutrition and Clinical Services Division.
authors.forename: Zakia
authors.initials: Z
authors.lastname: Siddiqui
authors.affiliation: Department of Nutrition, University of California, Davis, Davis, CA.
authors.forename: Md Barkat
authors.initials: MB
authors.lastname: Ullah
authors.affiliation: Department of Nutrition, University of California, Davis, Davis, CA.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D002657:Child Development / Q000187:drug effects*; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D004041:Dietary Fats / Q000494:pharmacology*; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007223:Infant; D007804:Language Development; D008055:Lipids / Q000494:pharmacology; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000494:pharmacology*; D009048:Motor Skills; D011247:Pregnancy; D055815:Young Adult
chemical_list: D004041:Dietary Fats; D008055:Lipids; D018977:Micronutrients
keywords: Bangladesh; executive function; language development; lipid-based nutrient supplements; micronutrient powder; motor development; young children