Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials.
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Wessells K Ryan, Arnold Charles D, Stewart Christine P, Prado Elizabeth L, Abbeddou Souheila, Adu-Afarwuah Seth, Arnold Benjamin F, Ashorn Per, Ashorn Ulla, Becquey Elodie, Brown Kenneth H, Byrd Kendra A, Campbell Rebecca K, Christian Parul, Fernald Lia C H, Fan Yue-Mei, Galasso Emanuela, Hess Sonja Y, Huybregts Lieven, Jorgensen Josh M, Kiprotich Marion, Kortekangas Emma, Lartey Anna, Le Port Agnes, Leroy Jef L, Lin Audrie, Maleta Kenneth, Matias Susana L, Mbuya Mduduzi N N, Mridha Malay K, Mutasa Kuda, Naser Abu M, Paul Rina R, Okronipa Harriet, Ouédraogo Jean-Bosco, Pickering Amy J, Rahman Mahbubur, Schulze Kerry, Smith Laura E, Weber Ann M, Zongrone Amanda, Dewey Kathryn G
Аннотация
OBJECTIVES: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes.
METHODS: We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers.
RESULTS: SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics.
CONCLUSIONS: SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.