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

Rolland Mutumba, Hannah Pesu, Joseph Mbabazi, Eva Greibe, Ebba Nexo, Mette F. Olsen, André Briend, Christian Mølgaard, Kim F. Michaelsen, Christian Ritz, Suzanne Filteau, Ezekiel Mupere, Henrik Friis, Benedikte Grenov*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Background: Micronutrient deficiencies and anemia are widespread among children with stunting. Objectives: 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. Methods: This was a secondary analysis of a randomized controlled trial. Children aged 12–59 mo with stunting were randomly assigned to LNS (100 g/d) with milk or soy protein and WP or maltodextrin for 12 wk, 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 wk. Data were analyzed using linear and logistic mixed-effects models. Results: Among 750 children, with mean age ± SD of 32 ± 11.7 mo, 45% (n = 338) were female and 98% (n = 736) completed follow-up. LNS, compared with no supplementation, resulted in 43% [95% confidence interval (CI): 28, 60] greater increase in S-FE corrected for inflammation (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 nonbreastfed 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% (odds ratio: 0.45, 95% CI: 0.29, 0.70). MP compared with soy protein increased S-FEci by 14% (95% CI: 3, 26). Conclusions: : LNS supplementation increases Hb and improves iron, cobalamin, and folate status, but not vitamin A status among children with stunting. LNS should be considered for children with stunting. This trial was registered at ISRCTN as 13093195.

Original languageEnglish
JournalAmerican Journal of Clinical Nutrition
Volume119
Issue number3
Pages (from-to)829-837
ISSN0002-9165
DOIs
Publication statusPublished - Mar 2024

Keywords

  • anemia
  • hemoglobin
  • lipid-based nutrient supplement
  • micronutrient status
  • stunting
  • Micronutrients/pharmacology
  • Humans
  • Soybean Proteins
  • Infant
  • Male
  • Lipids
  • Trace Elements
  • Hemoglobins/metabolism
  • Vitamin B 12
  • Female
  • Uganda
  • Anemia/drug therapy
  • Folic Acid/pharmacology
  • Growth Disorders
  • Child
  • Dietary Supplements

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