Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial

Cornelius M Smuts, Tonderayi M Matsungo, Linda Malan, Herculina S Kruger, Marinel Rothman, Jane D Kvalsvig, Namukolo Covic, Karen Joosten, Saskia J M Osendarp, Maaike J Bruins, Leon G J Frenken, Carl J Lombard, Mieke Faber, Cornelius M Smuts, Tonderayi M Matsungo, Linda Malan, Herculina S Kruger, Marinel Rothman, Jane D Kvalsvig, Namukolo Covic, Karen Joosten, Saskia J M Osendarp, Maaike J Bruins, Leon G J Frenken, Carl J Lombard, Mieke Faber

Abstract

Background: Evidence on the effect of small-quantity lipid-based nutrient supplements (SQ-LNSs) on early child growth and development is mixed.

Objective: This study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth (primary outcome), psychomotor development, iron status (secondary outcomes), and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet.

Methods: Infants (n = 750) were randomly assigned to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNS products contained micronutrients and essential fatty acids. SQ-LNS-plus contained, in addition, docosahexaenoic acid, arachidonic acid (important for brain and eye development), lysine (limiting amino acid in maize), phytase (enhances iron absorption), and other nutrients. Infants' weight and length were measured bimonthly. At age 6 and 12 mo, psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin, plasma ferritin, C-reactive protein, and α1-acid glycoprotein were assessed. WHO Motor Milestone outcomes, adherence, and morbidity were monitored weekly through home visits. Primary analysis was by intention-to-treat, comparing each SQ-LNS group with the control.

Results: SQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo (mean difference: 0.11; 95% CI: 0.01, 0.22; P = 0.032) and 10 mo (0.16; 95% CI: 0.04, 0.27; P = 0.008) but not at 12 mo (0.09; 95% CI: -0.02, 0.21; P = 0.115), locomotor development score (2.05; 95% CI: 0.72, 3.38; P = 0.003), and Parent Rating Score (1.10; 95% CI: 0.14, 2.07; P = 0.025), but no effect for weight-for-age zscore. Both SQ-LNS (P = 0.027) and SQ-LNS-plus (P = 0.005) improved hemoglobin concentration and reduced the risk of anemia, iron deficiency, and iron-deficiency anemia. Both SQ-LNS products reduced longitudinal prevalence of fever, coughing, and wheezing but increased incidence and longitudinal prevalence of diarrhea, vomiting, and rash/sores.

Conclusions: Point-of-use fortification with SQ-LNS-plus showed an early transient effect on linear growth and improved locomotor development. Both SQ-LNS products had positive impacts on anemia and iron status. This trial was registered at clinicaltrials.gov as NCT01845610.

Figures

FIGURE 1
FIGURE 1
Flow diagram of participant progression through the intervention study. A total of 998 infants were recruited, and 750 were randomly assigned to 1 of the 3 groups: SQ-LNS, SQ-LNS-plus, and control. In total, 514 (68.5%) infants completed the trial. The infants were followed weekly by fieldworkers to monitor morbidity, adherence, and achievement of motor milestones. SQ-LNS, small-quantity lipid-based supplement; WLZ, weight-for-length z score.

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