title: Lipid-based nutrient supplementation in the first 1000 d improves child growth in Bangladesh: a cluster-randomized effectiveness trial.
abstract: Background:Stunting in linear growth occurs mainly during the first 1000 d, from conception through 24 mo of age. Despite the recognition of this critical period, there have been few evaluations of the growth impact of interventions that cover most of this window.Objective:We evaluated home fortification approaches for preventing maternal and child undernutrition within a community-based health program. We hypothesized that small-quantity lipid-based nutrient supplements (LNSs) provided to women during pregnancy and the first 6 mo postpartum, LNSs provided to their offspring from 6 to 24 mo of age, or both would result in greater child length-for-agezscore (LAZ) at 24 mo than iron and folic acid (IFA) provided to women during pregnancy and postpartum plus micronutrient powder (MNP) or no supplementation for their offspring from 6 to 24 mo.Design:We conducted a cluster-randomized effectiveness trial with 4 arms:1) women and children both received LNSs (LNS-LNS group),2) women received IFA and children received LNSs (IFA-LNS group),3) women received IFA and children received MNP (IFA-MNP group), and4) women received IFA and children received no supplements (IFA-Control group). We enrolled 4011 women at ≤20 wk of gestation within 64 clusters, each comprising the supervision area of a community health worker. Analyses were primarily performed by using ANCOVAFtests and Tukey-Kramer-corrected pairwise comparisons.Results:At 24 mo, the LNS-LNS group had significantly higher LAZ (+0.13 compared with the IFA-MNP group) and head circumference (+0.15zscore compared with the IFA-Control group); these outcomes did not differ between the other groups. Stunting prevalence (LAZ <-2) was lower in the LNS-LNS group at 18 mo than in the IFA-MNP group (OR: 0.70; 95% CI: 0.53, 0.92), but the difference diminished by 24 mo (OR: 0.81; 95% CI: 0.63, 1.04).Conclusion:Home fortification with small-quantity LNSs, but not MNP, during the first 1000 d improved child linear growth and head size in rural Bangladesh. This trial was registered at clinicaltrials.gov as NCT01715038.
authors.affiliation: Departments of Nutrition and kgdewey@ucdavis.edu.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: Departments of Nutrition and.|Nutrition and Clinical Science Division and.
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: Departments of Nutrition and.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Arnold
authors.affiliation: Department of Economics, University of California, Riverside, CA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Cummins
authors.affiliation: Initiative of Noncommunicable Disease, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh; and.
authors.forename: Md Showkat Ali
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Food and Nutrition Technical Assistance III Project (FANTA)/FHI 360, Washington, DC.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Maalouf-Manasseh
authors.affiliation: Nutrition and Clinical Science Division and.
authors.forename: Zakia
authors.initials: Z
authors.lastname: Siddiqui
authors.affiliation: Departments of Nutrition and.
authors.forename: Md Barkat
authors.initials: MB
authors.lastname: Ullah
authors.affiliation: Agricultural and Resource Economics, University of California, Davis, CA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001827:Body Height; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D004041:Dietary Fats / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005526:Food, Formulated; D006130:Growth Disorders / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007501:Iron / Q000627:therapeutic use; D008055:Lipids / Q000627:therapeutic use; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000627:therapeutic use*; D011247:Pregnancy; D015995:Prevalence; D055815:Young Adult
chemical_list: D004041:Dietary Fats; D008055:Lipids; D018977:Micronutrients; D005492:Folic Acid; D007501:Iron
keywords: growth faltering; lipid-based nutrient supplements; malnutrition; micronutrient powder; stunting