Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials
Authors: Dewey Kathryn G. , Wessells K. Ryan , Arnold Charles D. , Prado Elizabeth L. , Abbeddou Souheila , Adu-Afarwuah Seth , Ali Hasmot , Arnold Benjamin F. , Ashorn Per , Ashorn Ulla , Ashraf Sania , Becquey Elodie , Bendabenda Jaden , Brown Kenneth H. , Christian Parul , Colford John M. , Dulience Sherlie J. L. , Fernald Lia C.H. , Galasso Emanuela , Hallamaa Lotta , Hess Sonja Y. , Humphrey Jean H. , Huybregts Lieven , Iannotti Lora L. , Jannat Kaniz , Lartey Anna , Port Agnes Le , Leroy Jef L. , Luby Stephen P. , Maleta Kenneth , Matias Susana L. , Mbuya Mduduzi NN , Mridha Malay K. , Nkhoma Minyanga , Null Clair , Paul Rina R. , Okronipa Harriet , Ouédraogo Jean-Bosco , Pickering Amy J. , Prendergast Andrew J. , Ruel Marie , Shaikh Saijuddin , Weber Ann M. , Wolff Patricia , Zongrone Amanda , Stewart Christine P. 
Published: February 2021

ABSTRACTBackgroundMeta-analyses have demonstrated that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce stunting and wasting prevalence among infants and young children. Identification of subgroups who benefit most from SQ-LNS may facilitate program design.ObjectiveOur objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child growth outcomes.MethodsWe conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n=37,066). We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models, with random-effects models as sensitivity analyses. We used random effects meta-regression to examine study-level effect modifiers. Heterogeneity was assessed using I2and Tau2statistics. Sensitivity analyses were conducted to examine whether results differed depending on inclusion criteria for arms within trials and types of comparisons.ResultsSQ-LNS provision decreased stunting (length-for-age z-score < −2) by 12% (relative reduction), wasting (weight-for-length (WLZ) z-score < −2) by 14%, low mid-upper arm circumference (MUAC < 125 mm or MUACZ < −2) by 18%, acute malnutrition (WLZ < −2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z-score < −2) by 13%, and small head size (head-circumference z-score < −2) by 9%. Effects of SQ-LNS on growth outcomes generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact or average reported compliance with SQ-LNS. Effects of SQ-LNS on stunting, wasting, low MUAC and small head size were greater among girls than among boys; effects on stunting, underweight and low MUAC were greater among later-born (vs. first-born) children; and effects on wasting and acute malnutrition were greater among children in households with improved (vs. unimproved) sanitation. Results were similar across sensitivity analyses.ConclusionsThe positive impact of SQ-LNS on growth is apparent across a wide variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNS in the mix of interventions to prevent both stunting and wasting. This study was registered atwww.crd.york.ac.uk/PROSPEROas CRD42019146592.