LATEBREAKER
Global Health
Effects of small-quantity lipid-based nutrient supplements (SQ-LNSs) on early childhood growth trajectories compared to micronutrient powders (MNPs) Solis Winters* Solis Winters Lia Fernald
Background: Small-quantity lipid-based nutrient supplements (SQ-LNSs) show great potential to prevent stunting and wasting for children under two years old; however, large variability in study results suggests the need for a more nuanced understanding of when supplementation may be most impactful during infancy and childhood. The primary goal of this study is to evaluate the impact of SQ-LNSs compared to MNPs on characteristics of length and weight growth trajectories.
Methods: In 76 communities in Baja Verapaz, Guatemala, 1720 households with pregnant women or children under 4.5 months old were randomly assigned to usual care (micronutrient powders (MNPs); n=760), treatment 1 (SQ-LNSs plus nutrition education; n=546), or treatment 2 (MNPs plus a nutrition education intervention; n=414). Using a subset of longitudinal anthropometric data collected for children 6-36 months old in treatment households, we constructed SuperImposition by Translation and Rotation (SITAR) length and weight trajectory models, which estimate a child’s deviation from the sample average growth curve across three dimensions – size, timing, and velocity. The intent-to-treat effects of SQ-LNSs vs MNPs on these trajectory characteristics were estimated for boys and girls separately.
Results: SITAR models, including 4737 measurements for 736 children (T1: n=420, T2: n=316), explained 90% and 88% of the variance in length of boys and girls, respectively, and 88% and 89% of the variance in weight. We found no evidence that there was a main effect of SQ-LNSs on any dimension of length or weight trajectories relative to MNPs. We are continuing to explore heterogeneity of effects by child age, sex, and baseline nutritional status, as well as by household size, income, and maternal education.
Conclusions: These findings suggest that supplementation with SQ-LNSs to children 6-24 months old in Guatemala provides no additional benefit on growth relative to MNPs, which is the current standard of care. While many existing studies compare SQ-LNSs to no supplementation, our study adds to the limited evidence comparing SQ-LNSs to MNPs. More research is needed to understand when and for which subpopulations SQ-LNSs are most cost-effective compared to MNPs.