title: Maternal Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Compared with Multiple Micronutrients, but Not with Iron and Folic Acid, Reduces the Prevalence of Low Gestational Weight Gain in Semi-Urban Ghana: A Randomized Controlled Trial.
abstract: Background:It is unclear whether maternal supplementation with small-quantity lipid-based nutrient supplements (SQ-LNSs; 118 kcal/d) affects maternal weight.Objective:We compared several secondary anthropometric measures between 3 groups of women in the iLiNS (International Lipid-based Nutrient Supplements)-DYAD trial in Ghana.Methods:Women (n= 1320; <20 wk of gestation) were randomly assigned to receive 60 mg Fe + 400 μg folic acid/d (IFA), 18 vitamins and minerals/d [multiple micronutrients (MMNs)], or 20 g SQ-LNSs with 22 micronutrients/d (LNS) during pregnancy and a placebo (200 mg Ca/d), MMNs, or SQ-LNSs, respectively, for 6 mo postpartum. Weight, midupper arm circumference (MUAC), and triceps skinfold (TSF) thickness at 36 wk of gestation and 6 mo postpartum were analyzed, as were changes from estimated prepregnancy values. We assessed the adequacy of estimated gestational weight gain (GWG) by using Institute of Medicine (IOM) and International Fetal and Newborn Growth Standards for the 21st Century (INTERGROWTH-21st) guidelines.Results:The estimated prepregnancy prevalence of overweight or obesity was 38.5%. By 36 wk of gestation, women (n= 1015) had a mean ± SD weight gain of 7.4 ± 3.7 kg and changes of -1.0 ± 1.7 cm in MUAC and -2.8 ± 4.1 mm in TSF thickness. The LNS group had a lower prevalence of inadequate GWG on the basis of IOM guidelines (57.4%) than the MMN (67.2%) but not the IFA (63.1%) groups (P= 0.030), whereas the prevalence of adequate (26.9% overall) and excessive (10.4% overall) GWG did not differ by group. The percentages of normal-weight women (in kg/m2: 18.5 < body mass index < 25.0;n= 754) whose GWG was less than the third centile of the INTERGROWTH-21st standards were 23.0%, 28.7%, and 28.5% for the LNS, MMN, and IFA groups, respectively (P= 0.36). At 6 mo postpartum, the prevalence of overweight or obesity was 45.3%, and the risk of becoming overweight or obese did not differ by group.Conclusion:SQ-LNS supplementation is one potential strategy to address the high prevalence of inadequate GWG in women in settings similar to Ghana, without increasing the risk of excessive GWG. 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: 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: 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: 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: 0000-0003-2311-2593
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland.
authors.forename: Ulla
authors.identifier: 0000-0002-1720-868X
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: Nutriset S.A.S., Malaunay, France.
authors.forename: Mamane
authors.identifier: 0000-0003-4566-6394
authors.initials: M
authors.lastname: Zeilani
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, and.
authors.forename: Mary
authors.identifier: 0000-0003-1357-9077
authors.initials: M
authors.lastname: Arimond
authors.affiliation: Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, and.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D001835:Body Weight / Q000187:drug effects*; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000494:pharmacology*; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000494:pharmacology*; D008055:Lipids / Q000737:chemistry*; D018977:Micronutrients / Q000008:administration & dosage / Q000494:pharmacology*; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena; D015995:Prevalence; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D008055:Lipids; D018977:Micronutrients; D014815:Vitamins; D005492:Folic Acid; D007501:Iron
keywords: gestational weight gain; iron and folic acid supplementation; lipid-based nutrient supplements; maternal supplementation; multiple micronutrient supplementation