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Title:   Author  item
                                            ANNA MARIA, SIEGA-RIZ - University Of North Carolinaitem
                                            DEL CAMPO, YANIRE - University Of North Carolinaitem
                                            KINLAW, ALAN - University Of North Carolinaitem
                                            REINHART, GREGORY - The Mathile Institute For The Advancement Of Human Nutritionitem
                                            Allen, Lindsay

                                                         - *A*item
                                            Shahab-Ferdows, Settiitem
                                            HECK, JEFF - University Of North Carolinaitem
                                            SUCHINDRAN, CHIRAYATH - University Of North Carolinaitem
                                            BENTLEY, MARGARET - University Of North Carolina
  Submitted to: Paediatric and Perinatal Epidemiology
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 12/30/2014
                                    Publication  Date: 3/3/2014
                                    Citation: Anna Maria, S., Del Campo, Y.E., Kinlaw, A., Reinhart, G., Allen, L.H., Shahab-Ferdows, S., Heck, J., Suchindran, C., Bentley, M. 2014. Effect of supplementation with a lipid-based nutrient supplement on the micronutrient status of children aged 6–18 months living in the rural region of Intibucá, Honduras. Paediatric and Perinatal Epidemiology. 28:245-254. DOI: 10.1111/ppe.12117.Interpretive Summary: Lipid-based nutrient supplements (LNS) have been effective for treating children who have acute malnutrition. In this study we evaluated whether LNS supplementation would improve micronutrient status of preschool children. The randomized, controlled supplementation trial was conducted with 6-18 month old children in Intibucá, Honduras. Eighteen communities were randomized into 9 intervention and 9 control communities, matched by poverty indicators. Children in the intervention communities (n=160) were fed 46.3 g LNS/d if their age was <12 mo and 70 g/d if age >12 mo, during the 12 mo intervention. Children in the control communities (n=140) did not receive LNS. All families were given food vouchers and nutrition education. At baseline, 6 and 12 months blood was collected to assess folate, iron, zinc, riboflavin and vitamin B12 status. Hemoglobin was measured every 3 mo, and diet and anthropometry every month. Data analysis was based on intent to treat and adherence to consuming the LNS. After 6 mo, 43.6% of children in the LNS intervention group were B12 deficient compared to 67.7% of controls (P=0.03). The LNS group also had higher serum folate after 6 mo (P=0.06). Significant improvements in serum folate and a reduction in the prevalence of vitamin A deficiency were seen after 12 mo of intervention. Adjusting for the amount of LNS consumed made these outcomes even more statistically significant. We conclude that LNS improved the status of selected micronutrients in young Honduran children.
                                Technical Abstract: Background: Lipid-based nutrient supplements (LNS) have been effective in the treatment of acute malnutrition among children. We evaluated the use of LNS supplementation for improving the micronutrient status of young children.
Methods: A 12-month randomised controlled trial was conducted among children aged 6–18 months living in Intibucá, Honduras. Communities (n'='18) were randomised into clusters matched by poverty indicators (9 intervention, n'='160 and 9 controls, n'='140). Intervention participants received LNS. All children received food vouchers and nutrition education. Primary outcomes included measures of micronutrient status: at baseline, 6 and 12 months' blood were collected for assessment of folate, iron, zinc, riboflavin, and vitamin B12 status; haemoglobin was measured every 3 months; and dietary and anthropometry collected monthly. Longitudinal analyses were based on intent to treat and LNS adherence. Generalised estimating equations were used in the estimation of generalised linear regression models specified for the data.
Results: At 6-month follow-up, children in the intervention group had a lower proportion classified as deficient for B12 (43.6%) compared with the control (67.7%; P'='0.03). The intervention group had a higher mean concentration for folate at 6 months (P'='0.06), and improvements continued through 12 months for folate (P'='0.002) and vitamin A deficiency (P'='0.03). This pattern of results, with improved significance, remained in subanalysis based on LNS adherence. 
Conclusion: These data demonstrate that LNS improved select micronutrient status in young non-malnourished Honduran children.


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