Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers.

BACKGROUND: Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. OBJECTIVES: We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. METHODS: We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). RESULTS: In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). CONCLUSIONS: Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.

Nutrition factors predict earlier acquisition of motor and language milestones among young children in Haiti.

AIM: To examine the nutrition-related factors associated with motor and language development among young children living in a poor urban area of Haiti. METHODS: Children aged 6-11 months (n = 583) were enrolled and followed monthly for one year. World Health Organization motor developmental milestones and vowel and consonant counts were assessed. Longitudinal regression models were applied to assess the association of anthropometric, dietary intake, infectious disease morbidity and socio-economic and demographic factors on developmental outcomes. RESULTS: At baseline, 9.4% were stunted or length-for-age Z score < -2, and 30.2% were mild-to-moderately stunted or length-for-age Z score < -1. Stunting status was significantly associated with motor and phonetic language acquisition at each time point during infancy. Several nutrition factors significantly predicted earlier achievement of motor and language development outcomes in longitudinal models: child anthropometry; breastfeeding and complementary feeding frequencies; dietary diversity; egg and oil intake; and reduced infectious disease morbidities. Increases in the length-for-age Z score significantly predicted all motor and language outcomes and yielded the best fit models compared to other anthropometric indicators (p < 0.001). CONCLUSION: Child development interventions may be enhanced by incorporating nutrition strategies such as improved diet quality, breastfeeding promotion and diarrhoeal disease mitigation.