Sustained Effects Of Small-Quantity Lipid-Based Nutrient Supplements Provided During The First 1000 Days On Child Growth At 9–11 Y In A Randomized Controlled Trial In Ghana

Abstract

Background: There is limited research on whether nutritional supplementation in the first 1000 days affects long-term child outcomes. We previously demonstrated that pre- and postnatal small-quantity lipid-based nutrient supplements (SQ-LNS) increased birth weight and child length at 18 months of age in Ghana. Objectives: We aimed to investigate the effect of pre- and postnatal SQ-LNS on child growth and blood pressure at 9–11 years. Methods: In the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, 1320 females ~20 weeks of gestation were randomly assigned to receive daily: iron and folic acid (IFA) during pregnancy and placebo during 6 months postpartum or multiple micronutrients (MMNs) during pregnancy and 6 months postpartum, or SQ-LNS during pregnancy and 6 months postpartum, and for their children aged from 6 to 18 months. We re-enrolled 966 children aged 9–11 years and assessed child blood pressure, height-for-age z-score (HAZ), body mass index (BMI)-for-age z-score, waist-to-height ratio, triceps skinfold, and midupper arm circumference. We compared SQ-LNS with control (IFA þ MMN) groups, adjusting for the child’s age. Results: The mean (standard deviation [SD]) of HAZ in the SQ-LNS and control groups was 0.04 (0.96) and 0.16 (0.99); P ¼ 0.060. There were no indications of group differences in the other outcomes (P > 0.10). Effects on HAZ varied by child sex (P-interaction ¼ 0.075) and maternal prepregnancy BMI (kg/ m2 ; P-interaction ¼ 0.007). Among females, HAZ was higher in the SQ-LNS [0.08 (1.04)] than in the control group [0.16 (1.01)] (P ¼ 0.010); among males, SQ-LNS [0.16 (0.85)] and control groups [0.16 (0.96)] did not differ (P ¼ 0.974). Among children of females with BMI of <25, HAZ was higher in the SQ-LNS [0.04 (1.00)] than in the control group [0.29 (0.94)] (P ¼ 0.004); among females with BMI of 25, SQ-LNS [0.04 (0.91)] and control groups [0.07 (1.00)] did not differ (P ¼ 0.281). Conclusions: There is a sustained impact of prenatal and postnatal SQ-LNS on linear growth among female children and children whose mothers were not overweight