(P17-017-23) Lipid-Based Nutrient Supplements for Prevention of Child Undernutrition: When Less May Be More

Objectives: Lipid-based nutrient supplements (LNS) of various quantities have been used for prevention of child undernutrition. Evidence of efficacy of small-quantity (SQ)-LNS (~100-120 kcal/d) is strong, but less is known about the efficacy of medium quantity (MQ)-LNS (~250-499 kcal/d). We aimed to examine the effects of preventive MQ-LNS provided at ~6-24 mo of age on child growth outcomes compared to (1) no provision of LNS and (2) provision of SQ-LNS.

Methods: We conducted a systematic review of studies in which MQ-LNS was used for prevention, and categorized studies based on duration of supplementation ( < 6 mo vs. > 6 mo); for the latter category we conducted a meta-analysis of effects on mean z-scores for weight-for-length (WLZ) and length-for age (LAZ) and on the prevalence of wasting (WLZ < -2) and stunting (LAZ < -2).

Results: Four MQ-LNS studies that examined supplementation for 3-5 mo (mostly seasonal) targeted at children 6-24 or 6-36 mo of age had mixed effects on WLZ and wasting and no significant effects on LAZ or stunting, compared to no LNS. Seven longer-duration studies met inclusion criteria for our meta-analysis; they generally provided MQ-LNS starting at 6 mo of age for a duration of 6-18 mo. In those 7 studies (max total n=13,673), MQ-LNS increased WLZ (MD (95% CI)=+0.09 (0.05, 0.13)) and reduced wasting (prevalence ratio (95% CI)=0.89 (0.81, 0.97)), but had no effect on LAZ (+0.04 (-0.02, 0.11)) or stunting (0.97 (0.92, 1.02)) compared to no LNS. Previous meta-analyses of SQ-LNS vs no LNS (14 trials, max total n=36,795) showed similar effects on WLZ (+0.08 (0.06, 0.10)) and wasting (0.86 (0.80, 0.93)), but SQ-LNS also had an impact on LAZ (+0.14 (0.11, 0.16)) and stunting (0.88 (0.85, 0.91)). In two studies that directly compared SQ-LNS and MQ-LNS (both in Malawi), there were no significant differences in these growth outcomes.

Conclusions: The current evidence suggests that MQ-LNS offers no added benefits over SQ-LNS, although further studies directly comparing MQ-LNS vs SQ-LNS would be useful. One possible explanation is incomplete consumption of the MQ-LNS ration and thus lower than desirable intake of certain nutrients, especially at 6-12 mo of age.

Funding Sources: Bill & Melinda Gates Foundation