Effects of prenatal small-quantity lipid-based nutrient supplements on pregnancy, birth, and infant outcomes: a systematic review and meta-analysis of individual participant data from randomized controlled trials in low- and middle-income countries.

Autor:	Dewey KG; Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States. Electronic address: kgdewey@ucdavis.edu., Wessells KR; Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States., Arnold CD; Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States., Adu-Afarwuah S; Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana., Arnold BF; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States., Ashorn P; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland., Ashorn U; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland., Garcés A; Proyecto Salud y Nutrición, Jhpiego, Guatemala City, Guatemala., Huybregts L; Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States., Krebs NF; Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States., Lartey A; Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana., Leroy JL; Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States., Maleta K; Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi., Matias SL; Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, United States., Moore SE; Department of Women & Children's Health, King's College London, London, UK and MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia., Mridha MK; Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh., Okronipa H; Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States., Stewart CP; Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States.
Jazyk:	angličtina
Zdroj:	The American journal of clinical nutrition [Am J Clin Nutr] 2024 Oct; Vol. 120 (4), pp. 814-835. Date of Electronic Publication: 2024 Aug 16.
DOI:	10.1016/j.ajcnut.2024.08.008
Abstrakt:	Background: Undernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNSs) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies. Objectives: We examined the effects of SQ-LNSs provided during pregnancy compared with 1) iron and folic acid or standard of care (IFA/SOC) or 2) multiple micronutrient supplements (MMSs) and identified characteristics that modified the estimates of effects of SQ-LNSs on birth outcomes. Methods: We conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNSs provided during pregnancy (n = 5273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether the results differed depending on methods for gestational age dating, birth anthropometry, or study design. Results: SQ-LNSs (compared with IFA/SOC) increased birth weight [mean difference: +49 g; 95% confidence interval (CI): 26, 71 g] and all birth anthropometric z-scores (+0.10-0.13 standard deviation); they reduced risk of low birth weight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 15%. Only 2 trials compared SQ-LNSs and MMSs; P values for birth outcomes were >0.10 except for head circumference (e.g., z-score for gestational age: +0.11; 95% CI: -0.01, 0.23). Effect estimates for SQ-LNSs compared with IFA/SOC were greater among female infants and, for certain outcomes, among mothers with body mass index <20 kg/m 2 , inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNSs compared with MMSs were greater for certain outcomes among female infants, first-born infants, and mothers <25 y. Conclusions: SQ-LNSs had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNSs and MMSs is needed. Targeting SQ-LNSs to vulnerable subgroups may be worth considering. Clinical Trial Registry: This study was registered at PROSPERO as CRD42021283391. Competing Interests: Conflict of interest N.F.K. is on the Editorial Board of the American Journal of Clinical Nutrition and played no role in the Journal’s evaluation of the manuscript. (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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