Maternal and Infant Lipid-Based Nutritional Supplementation Increases Height of Ghanaian Children at 4-6 Years Only if the Mother Was Not Overweight Before Conception

Sika M Kumordzie, Seth Adu-Afarwuah, Mary Arimond, Rebecca R Young, Theodosia Adom, Rose Boatin, Maku E Ocansey, Harriet Okronipa, Elizabeth L Prado, Brietta M Oaks, Kathryn G Dewey, Sika M Kumordzie, Seth Adu-Afarwuah, Mary Arimond, Rebecca R Young, Theodosia Adom, Rose Boatin, Maku E Ocansey, Harriet Okronipa, Elizabeth L Prado, Brietta M Oaks, Kathryn G Dewey

Abstract

Background: Few studies have evaluated the long-term effects of nutritional supplementation during the first 1000 d of life. We previously reported that maternal and child lipid-based nutrient supplements (LNS) increased child length by 18 mo.

Objective: The aim of this study was to examine the effects of LNS on later growth and body composition at 4-6 y of age.

Design: This was a follow-up of children in the International Lipid-based Nutrient Supplements (iLiNS)-DYAD trial in Ghana. Women (n = 1320) at ≤20 weeks of gestation were randomly assigned to: 1) iron and folic acid during pregnancy and 200 mg calcium/d for 6 mo postpartum, 2) multiple micronutrients (1-2 RDA of 18 vitamins and minerals) during both periods, or 3) maternal LNS during both periods plus child LNS from 6 to 18 mo. At 4-6 y, we compared height, height-for-age z score (HAZ), and % body fat (deuterium dilution method) between the LNS group and the 2 non-LNS groups combined.

Results: Data were available for 961 children (76.5% of live births). There were no significant differences between LNS compared with non-LNS groups in height [106.7 compared with 106.3 cm (mean difference, MD, 0.36; P = 0.226)], HAZ [-0.49 compared with -0.57 (MD = 0.08; P = 0.226)], stunting (< -2 SD) [6.5 compared with 6.3% (OR = 1.00; P = 0.993)], or % body fat [15.5 compared with 15.3% (MD = 0.16; P = 0.630)]. However, there was an interaction with maternal prepregnancy BMI (kg/m2) (P-interaction = 0.046 before correction for multiple testing): among children of women with BMI < 25 , LNS children were taller than non-LNS children (+1.1 cm, P = 0.017), whereas there was no difference among children of women with BMI ≥ 25 (+0.1 cm; P = 0.874).

Conclusions: There was no overall effect of LNS on height at 4-6 y in this cohort, which had a low stunting rate, but height was greater in the LNS group among children of nonoverweight/obese women. There was no adverse impact of LNS on body composition. This trial was registered at clinicaltrials.gov as NCT00970866.

Keywords: body composition; follow-up; growth; lipid-based nutrient supplements; prenatal supplementation.

Copyright © American Society for Nutrition 2019.

Figures

FIGURE 1
FIGURE 1
Study profile of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD Ghana trial. IFA, iron folic acid; LNS, lipid-based nutrient supplement; MMN, multiple micronutrients.
FIGURE 2
FIGURE 2
Child height at 4–6 y by intervention group (LNS compared with non-LNS), stratified by maternal BMI at enrollment into the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD Ghana trial. Values represent mean (95% CI) from an ANCOVA model (SAS PROC GLIMMIX). P-interaction between estimated maternal prepregnancy BMI as a continuous variable and intervention group = 0.046, before Benjamini/Hochberg correction, adjusting for maternal height, years of education, nulliparity, asset score, and child sex. LNS, lipid-based nutrient supplements group; non-LNS, iron-folic acid group + multiple micronutrients group.
FIGURE 3
FIGURE 3
Child % fat mass at 4–6 y by intervention group (LNS compared with non-LNS), stratified by maternal BMI at enrollment into the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD Ghana trial. Values represent mean (95% CI) from an ANCOVA model (SAS PROC GLIMMIX). P-interaction between estimated maternal prepregnancy BMI as a continuous variable and intervention group = 0.037, before Benjamini/Hochberg correction, adjusting for nulliparity and child sex. LNS, lipid-based nutrient supplements group; non-LNS, iron-folic acid group + multiple micronutrients group.

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