(P17-002-23) Cognitive Outcomes at Age 9–11 Years of Children Who Received Pre- and Post-Natal Small-Quantity Lipid-Based Nutrient Supplements in a Randomized Controlled Trial in Ghana

Objectives: We aimed to determine the effects of pre- and post-natal small-quantity lipid-based nutrient supplements (SQ-LNS) on cognitive scores at age 9-11 y following a randomized controlled trial in Ghana and to assess the association of biomedical and socio-environmental risk factors measured from pregnancy through childhood on the children’s cognitive scores.

Methods: This was a follow-up study of children at 9-11 y of age from the iLiNS-DYAD Ghana randomized trial (2009-2014; NCT00970866), in which 1320 pregnant women (mean gestation age, 16.1 wk) were assigned to consume daily: 60 mg iron and 400 µg folic acid until childbirth and placebo until 6 mo postpartum (IFA group) or multiple micronutrients throughout (MMN) or 20 g/d SQ-LNS throughout (LNS); children born to women in the LNS group (but not the others) received SQ-LNS from 6 to 18 mo of age. Of 1217 children eligible, 966 (80%) were re-enrolled. We assessed the impact of SQ-LNS exposure versus no SQ-LNS exposure by unadjusted and adjusted ANCOVA and associations by multiple regression of 8 biomedical and 5 socio-environmental variables on general intellectual ability, literacy, arithmetic, declarative memory, procedural memory, and executive function scores.

Results: Pre- and post-natal SQ-LNS had no impact on any of the cognitive scores. Among the biomedical risk factors, baseline maternal anemia, child born small for gestational age, low post-natal linear growth, and child anemia were significantly associated with 1-3 outcomes, with mean differences between high- and low-risk groups ranging from -0.14 to -0.27 SD, analogous to 2-4 IQ points. Among the socio-environmental risk factors, low socio-economic status, low maternal education, and low home environment score were each significantly associated with 3 outcomes, with mean differences between high- and low-risk groups ranging from -0.12 to -0.42 SD, analogous to 2-6 IQ points.

Conclusions: SQ-LNS does not seem to be an effective strategy to improve pre-adolescent cognitive scores in this population. The strong association of socio-environmental factors with improved cognition suggests that programs addressing socio-environmental risks may be critical for child development in this setting.

Funding Sources: National Institutes of Health, Bill & Melinda Gates Foundation