Effect of lipid-based nutrient supplements on micronutrient status and hemoglobin among children with stunting: secondary analysis of a randomized, controlled trial in Uganda.

BACKGROUND:Micronutrient deficiencies and anemia are widespread among children with stunting. OBJECTIVE:We assessed the effects of lipid-based nutrient supplements (LNS) containing milk protein (MP) and/or whey permeate (WP) on micronutrient status and hemoglobin (Hb) among children with stunting. DESIGN:This was a secondary analysis of a randomized, controlled trial. Children 12-59-month-old with stunting were randomized to LNS (100g/d) with milk or soy protein and WP or maltodextrin for 12 weeks, or no supplement. Hb, serum ferritin (S-FE), serum soluble transferrin receptor (S-TfR), plasma cobalamin (P-Cob), plasma methylmalonic acid (P-MMA), plasma folate (P-Fol) and serum retinol binding protein (S-RBP) were measured at inclusion and at 12 weeks. Data was analyzed using linear and logistic mixed-effects models. RESULTS:Among 750 children, mean ±SD age was 32 ±11.7 months, 45% (n=338) were female and 98% (n=736) completed follow-up. LNS, compared to no supplementation, resulted in 43% (95% CI: 28, 60) greater increase in inflammation-corrected-S-FE (S-FEci), 2.4 (95% CI: 1.2, 3.5) mg/L greater decline in S-TfR, 138 (95% CI: 111, 164) pmol/L greater increase in P-Cob, 33% (95% CI: 27, 39) reduction in P-MMA, and 8.5 (95% CI: 6.6, 10.3) nmol/L greater increase in P-Fol. There was no effect of LNS on S-RBP. Lactation modified the effect of LNS on markers of cobalamin status, reflecting improved status among non-breastfed and no effects among breastfed children. LNS increased Hb by 3.8 (95% CI: 1.7, 6.0) g/L and reduced the odds of anemia by 55% (OR 0.45, 95% CI: 0.29, 0.70). MP compared to soy protein increased S-FEci by 14% (95% CI: 3, 26). CONCLUSIONS:LNS supplementation increased Hb and improved iron, cobalamin and folate status, but not vitamin A status among children with stunting. LNS should be considered for children with stunting. (www.isrctn.com: ISRCTN13093195) CLINICAL TRIAL REGISTRY: ISRCTN 13093195, website: https://www.isrctn.com/ISRCTN13093195.