A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement. Prenatal lipid-based nutrient supplements increase cord leptin concentration in pregnant women from rural Burkina Faso. Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso Willingness to pay for small‐quantity lipid‐based nutrient supplements for women and children: Evidence from Ghana and Malawi Associations of maternal nutrition during pregnancy and post‐partum with maternal cognition and caregiving A mixed method study exploring adherence to and acceptability of small quantity lipid-based nutrient supplements (SQ-LNS) among pregnant and lactating women in Ghana and Malawi Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. Maternal supplementation with small-quantity lipid-based nutrient supplements during pregnancy and lactation does not reduce depressive symptoms at 6 months postpartum in Ghanaian women: a randomized controlled trial Ghanaian parents' perceptions of pre and postnatal nutrient supplements and their effects Adherence to recommendations on lipid‐based nutrient supplement and iron and folic acid tablet consumption among pregnant and lactating women participating in a community health programme in northwest Bangladesh The impact of maternal diet fortification with lipid‐based nutrient supplements on postpartum depression in rural Malawi: a randomised‐controlled trial Prenatal Lipid-Based Nutrient Supplements Affect Maternal Anthropometric Indicators Only in Certain Subgroups of Rural Bangladeshi Women. The impact of lipid-based nutrient supplementation on anti-malarial antibodies in pregnant women in a randomized controlled trial Late-Pregnancy Salivary Cortisol Concentrations of Ghanaian Women Participating in a Randomized Controlled Trial of Prenatal Lipid-Based Nutrient Supplements. The impact of lipid-based nutrient supplement provision to pregnant women on newborn size in rural Malawi: a randomized controlled trial. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial. Lipid-Based Nutrient Supplements During Pregnancy and Lactation Did Not Affect Human Milk Oligosaccharides and Bioactive Proteins in a Randomized Trial Use of lipid-based nutrient supplements by HIV-infected Malawian women during lactation has no effect on infant growth from 0 to 24 weeks. Effects of a lipid-based nutrient supplement during pregnancy and lactation on maternal plasma fatty acid status and lipid profile: Results of two randomized controlled trials☆ Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial12 A cluster-randomized, controlled trial of nutritional supplementation and promotion of responsive parenting in Madagascar: the MAHAY study design and rationale Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Acceptability of lipid-based nutrient supplements (LNS) among Ghanaian infants and pregnant or lactating women. A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6- to 18-month-old moderately underweight children in rural Malawi. Prenatal Lipid-Based Nutrient Supplements Do Not Affect Pregnancy or Childbirth Complications or Cesarean Delivery in Bangladesh: A Cluster-Randomized Controlled Effectiveness Trial. Association of prenatal lipid‐based nutritional supplementation with fetal growth in rural Gambia Effects of maternal and child lipid-based nutrient supplements on infant development: a randomized trial in Malawi. Plasma and breast-milk selenium in HIV-infected Malawian mothers are positively associated with infant selenium status but are not associated with maternal supplementation: results of the Breastfeeding, Antiretrovirals, and Nutrition study. A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding. Lipid-based nutrient supplementation in the first 1000 d improves child growth in Bangladesh: a cluster-randomized effectiveness trial. Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana. Supplementation of Maternal Diets during Pregnancy and for 6 Months Postpartum and Infant Diets Thereafter with Small-Quantity Lipid-Based Nutrient Supplements Does Not Promote Child Growth by 18 Months of Age in Rural Malawi: A Randomized Controlled Trial. Daily Consumption of Lipid-Based Nutrient Supplements Containing 250 μg Iodine Does Not Increase Urinary Iodine Concentrations in Pregnant and Postpartum Women in Bangladesh. Impact of small‐quantity lipid‐based nutrient supplement on hemoglobin, iron status and biomarkers of inflammation in pregnant Ghanaian women Maternal and Child Supplementation with Lipid-Based Nutrient Supplements, but Not Child Supplementation Alone, Decreases Self-Reported Household Food Insecurity in Some Settings Effects of pre- and post-natal lipid-based nutrient supplements on infant development in a randomized trial in Ghana. Maternal cortisol and stress are associated with birth outcomes, but are not affected by lipid-based nutrient supplements during pregnancy: an analysis of data from a randomized controlled trial in rural Malawi Seasonality modifies the effect of a lipid-based nutrient supplement for pregnant rural women on birth length. Lipid-Based Nutrient Supplements Providing Approximately the Recommended Daily Intake of Vitamin A Do Not Increase Breast Milk Retinol Concentrations among Ghanaian Women. Maternal Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Compared with Multiple Micronutrients, but Not with Iron and Folic Acid, Reduces the Prevalence of Low Gestational Weight Gain in Semi-Urban Ghana: A Randomized Controlled Trial123
Background : There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries . Objective : We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods ( RUSFs ) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau . Methods : A 3-month cluster-r and omized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants ( 6 - 23 months ) and children ( 24 - 59 months ) from 13 villages . The RUSFs contained either 478 ( mothers , children ) or 239 kcal/d ( infants ) with 15 % or 33 % of protein from dairy and were distributed at community health centers 5 d/wk . Controls were wait-listed to receive RUSF . Primary outcomes were mid-upper arm circumference ( MUAC ) in mothers , and weight-for-age and height-for-age z-scores ( WAZ and HAZ ) in infants and children . Results : There was a significant effect of the RUSF-33 % on MUAC in mothers ( P = .03 ) . The WAZ and HAZ increased substantially , by ≈1 z-score , in infants and children ( P < .01 ) independent of group r and omization . In children , but not infants , baseline WAZ and change in maternal MUAC were associated with change in WAZ ( β = .07 , P = .02 ) . Conclusion : Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers , supporting a comparable recent finding in preschool children . In addition , supplementation of children < 2 years result ed in improved growth independent of family nutritional status , whereas success in older children was associated with change in maternal nutrition , suggesting the need for community-level education about preventing malnutrition in older , as well as younger , children BACKGROUND Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas . Stunting affects 1 in 5 young children . OBJECTIVE We aim ed to test the efficacy of a daily lipid-based nutrient supplement ( LNS ) for increased linear growth in  young children . DESIGN Healthy , singleton infants aged 6 - 11 mo ( n = 589 ) were recruited from an urban slum of Cap Haitien and r and omly assigned to receive : 1 ) a control ; 2 ) a 3-mo LNS ; or 3 ) a 6-mo LNS . The LNS provided 108 kcal and other nutrients including vitamin A , vitamin B-12 , iron , and zinc at ≥80 % of the recommended amounts . Infants were followed monthly on growth , morbidity , and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects . The Bonferroni multiple comparisons test was applied , and generalized least-squares ( GLS ) regressions with mixed effects was used to examine impacts longitudinally . RESULTS Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group . GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score ( ±SE ) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age ( P < 0.001 ) . The effects were sustained 6 mo postintervention . Morbidity and developmental outcomes did not differ by trial arm . CONCLUSION A low-energy , fortified product improved the linear growth  of young children in this urban setting . The trial was registered at clinical trials.gov as NCT01552512 In developing countries , prenatal lipid-based nutrient supplements ( LNSs ) were shown to increase birth size ; however , the mechanism of this effect remains unknown . Cord blood hormone concentrations are strongly associated with birth size . Therefore , we hypothesize that LNSs increase birth size through a change in the endocrine regulation of fetal development . We compared the effect of daily prenatal LNSs with multiple micronutrient tablets on cord blood hormone concentrations using a r and omized , controlled design including 197 pregnant women from rural Burkina Faso . Insulin-like growth factors ( IGF ) I and II , their binding proteins IGFBP-1 and IGFBP-3 , leptin , cortisol , and insulin were quantified in cord sera using immunoassays . LNS was associated with higher cord blood leptin mainly in primigravidae ( + 57 % ; P = 0.02 ) and women from the highest tertile of BMI at study inclusion ( + 41 % ; P = 0.02 ) . We did not find any significant LNS effects on other measured cord hormones . The observed increase in cord leptin was associated with a significantly higher birth weight . Cord sera from small-for-gestational age newborns had lower median IGF-I ( -9 μg/L ; P = 0.003 ) , IGF-II ( -79 μg/L ; P = 0.003 ) , IGFBP-3 ( -0.7 μg/L ; P = 0.007 ) , and leptin ( -1.0 μg/L ; P = 0.016 ) concentrations but higher median cortisol ( + 18 μg/L ; P = 0.037 ) concentrations compared with normally grown newborns . Prenatal LNS result ed in increased cord leptin concentrations in primigravidae and mothers with higher BMI at study inclusion . The elevated leptin concentrations could point toward a higher neonatal fat mass Background Previous review s have identified 44 risk factors for poor early child development ( ECD ) in low‐ and middle‐income countries . Further underst and ing of their relative influence and pathways is needed to inform the design of interventions targeting ECD . Methods We conducted path analyses of factors associated with 18‐month language and motor development in four prospect i ve cohorts of children who participated in trials conducted as part of the International Lipid‐Based Nutrient Supplements ( iLiNS ) Project in Ghana ( n = 1,023 ) , Malawi ( n = 675 and 1,385 ) , and Burkina Faso ( n = 1,122 ) . In two cohorts , women were enrolled during pregnancy . In two cohorts , infants were enrolled at 6 or 9 months . In multiple linear regression and structural equation models ( SEM ) , we examined 22 out of 44 factors identified in previous review s , plus 12 additional factors expected to be associated with ECD . Results Out of 42 indicators of the 34 factors examined , 6 were associated with 18‐month language and /or motor development in 3 or 4 cohorts : child linear and ponderal growth , variety of play material s , activities with caregivers , dietary diversity , and child hemoglobin/iron status . Factors that were not associated with child development were indicators of maternal Hb/iron status , maternal illness and inflammation during pregnancy , maternal perceived stress and depression , exclusive breastfeeding during 6 months postpartum , and child diarrhea , fever , malaria , and acute respiratory infections . Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practice s than by maternal or child biomedical conditions , while this pattern for motor development was not consistent across cohorts . Conclusions Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children , a variety of play material s , and a diverse diet , and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status Abstract Small‐quantity lipid‐based nutrient supplements ( SQ‐LNS ) are design ed to enrich maternal and child diets with the objective of preventing undernutrition during the first 1,000 days . Scaling up the delivery of supplements such as SQ‐LNS hinges on underst and ing private dem and and creatively leveraging policy‐relevant factors that might influence dem and . We used longitudinal stated willingness‐to‐pay ( WTP ) data from contingent valuation studies that were integrated into r and omized controlled nutrition trials in Ghana and Malawi to estimate private valuation of SQ‐LNS during pregnancy , postpartum , and early childhood . We found that average stated WTP for a day 's supply of SQ‐LNS was more than twice as high in Ghana than Malawi , indicating that dem and for SQ‐LNS ( and by extension , the options for effective delivery of SQ‐LNS ) may be very context specific . We also examined factors associated with WTP , including intervention group , household socioeconomic status , birth outcomes , child growth , and maternal and child morbidity . In both sites , WTP was consistently negatively associated with household food insecurity , indicating that subsidization might be needed to permit food insecure households to acquire SQ‐LNS if it is made available for purchase . In Ghana , WTP was higher among heads of household than among mothers , which may be related to control over household re sources . Personal experience using SQ‐LNS was not associated with WTP in either site Abstract Pregnant and post‐partum women require increased nutrient intake and optimal cognition , which depends on adequate nutrition , to enable reasoning and learning for caregiving . We aim ed to assess ( a ) differences in maternal cognition and caregiving between women in Malawi who received different nutritional supplements , ( b ) 14 effect modifiers , and ( c ) associations of cognition and caregiving with biomarkers of iron , Vitamin A , B‐vitamin , and fatty acid status . In a r and omized controlled trial ( n = 869 ) , pregnant women daily received either multiple micronutrients ( MMN ) , 20 g/day lipid‐based nutrient supplements ( LNS ) , or a control iron/folic acid ( IFA ) tablet . After delivery , supplementation continued in the MMN and LNS arms , and the IFA control group received placebo until 6 months post‐partum , when cognition ( n = 712 ) , caregiving behaviour ( n = 669 ) , and biomarkers of nutritional status ( n = 283 ) were assessed . In the full group , only one difference was significant : the IFA arm scored 0.22 SD ( 95 % CI [ 0.01 , 0.39 ] , p = .03 ) higher than the LNS arm in mental rotation . Among subgroups of women with baseline low hemoglobin , poor iron status , or malaria , those who received LNS scored 0.4 to 0.7 SD higher than the IFA arm in verbal fluency . Breastmilk docosahexaenoic acid and Vitamin B12 concentrations were positively associated with verbal fluency and digit span forward ( adjusting for covariates ps < .05 ) . In this population in Malawi , maternal supplementation with MMN or LNS did not positively affect maternal cognition or caregiving . Maternal docosahexaenoic acid and B12 status may be important for post‐partum attention and executive function Background Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements ( SQ-LNS ) has result ed in improvements in birth outcomes in some low-income setting s. In order to be effective , SQ-LNS must be consumed regularly over sustained periods . Methods The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation . We enrolled women before 20 gestation weeks into r and omized trials in Ghana ( n = 1320 ) and Malawi ( n = 869 ) . In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation . In the control groups participants received multiple micronutrients ( MMN ) during pregnancy and lactation or iron and folic acid ( IFA ) during pregnancy and calcium during lactation . We used question naires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability . Results The mean self-reported adherence during the supplementation period was lower in Ghana ( 79.9 % ) than in Malawi ( 91.7 % ) for all supplements ( difference 11.8 % , P < 0.001 ) . Over time , adherence increased in Malawi but decreased in Ghana . In both countries , adherence in the SQ-LNS group was non-inferior to that in the control groups . Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences , most of the women described incidents of non-adherence . A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy . Especially in Malawi , women reported sharing SQ-LNS with families and friends . Sustained use of  SQ-LNS  was attributed to expected health benefits and favorable sensory attributes . Often women compared their pregnancy to previous ones , and were of the view that SQ-LNS made a positive difference . ConclusionS elf-reported sustained adherence to consume  SQ-LNS  daily was high in both sites but lower in Ghana than in Malawi . In Ghana , adherence decreased over time whereas in Malawi adherence increased . Acceptability and adherence appeared interlinked , complex and context -related . Sustained consumption of SQ-LNS may require tailoring interventions by context .Trial registration The Ghana trial was registered at clinical trials.gov as NCT00970866 , and the Malawi trial as NCT01239693 BACKGROUND The World Health Organization recommends a liquid , milk-based diet ( F100 ) during the rehabilitation phase of the treatment of severe malnutrition . A dry , solid , ready-to-use food ( RTUF ) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water . The efficacies of RTUF and F100 have not been compared . OBJECTIVE The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children . DESIGN In an open-labeled , r and omized trial , 70 severely malnourished Senegalese children aged 6 - 36 mo were r and omly allocated to receive 3 meals containing either F100 ( n = 35 ) or RTUF ( n = 35 ) in addition to the local diet . The data from 30 children in each group were analyzed . RESULTS The mean ( + /- SD ) daily energy intake in the RTUF group was 808 + /- 280 ( 95 % CI : 703.8 , 912.9 ) kJ x kg body wt(-1 ) x d(-1 ) , and that in the F100 group was 573 + /- 201 ( 95 % CI : 497.9 , 648.7 ) kJ. kg body wt(-1 ) x d(-1 ) ( P < 0.001 ) . The average weight gains in the RTUF and F100 groups were 15.6 ( 95 % CI : 13.4 , 17.8 ) and 10.1 ( 95 % CI : 8.7 , 11.4 ) g x kg body wt(-1 ) x d(-1 ) , respectively ( P < 0.001 ) . The difference in weight gain was greater in the most wasted children ( P < 0.05 ) . The average duration of rehabilitation was 17.3 ( 95 % CI : 15.6 , 19.0 ) d in the F100 group and was 13.4 ( 95 % CI : 12.1 , 14.7 ) d in the RTUF group ( P < 0.001 ) . CONCLUSIONS This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children We examined the impact on depression at 6 months postpartum of maternal supplementation with small-quantity lipid-based nutrient supplement ( SQ-LNS ) compared to supplementation with iron and folic acid ( IFA ) or multiple micronutrients ( MMN ) . In this partially double-blinded r and omized controlled trial , pregnant women ≤20 weeks gestation ( n = 1320 ) were recruited from antenatal clinics and r and omly assigned to receive either ( 1 ) SQ-LNS during pregnancy and for 6 months postpartum , or ( 2 ) IFA during pregnancy only , or ( 3 ) MMN during pregnancy and for 6 months postpartum . Maternal depressive symptoms were measured at 6 months postpartum using the Edinburgh Postnatal Depression Scale ( EPDS ) . Women who scored 12 or more on the EPDS were considered to show symptoms of depression . One thous and one hundred fifty-one women were included in this analysis ( LNS = 382 , IFA = 387 and MMN = 382 ) . Characteristics of the three groups were similar at baseline , and there were no significant differences between women who were included in the analysis ( n = 1151 ) and those who were not ( n = 169 ) . At 6 months postpartum , 13 % of the women overall showed symptoms of depression , and this did not differ by group ( LNS = 13.1 % , IFA = 11.2 % and MMN = 14.7 % . P = 0.36 ) . The median ( 25 , 75 percentile ) EPDS score did not differ by group ( LNS 4.0 ( 1.0 , 8.0 ) , IFA 4.0 ( 1.0 , 8.0 ) , MMN 5.0 ( 2.0 , 9.0 ) , Ptransformed = 0.13 ) . Adjustment for covariates did not alter these findings . Maternal supplementation with SQ-LNS compared to MMN or IFA did not affect postnatal depressive symptoms in this sample of Ghanaian women Abstract Small‐quantity lipid‐based nutrient supplements ( SQ‐LNS ) have been studied in efficacy and effectiveness trials , but little is known about how parents perceive the products and their effects . In a r and omised trial in Ghana , efficacy of SQ‐LNS provided to women during pregnancy and the first 6 months postpartum and to their children from 6 to 18 months of age was assessed by comparison with iron‐folic acid ( IFA ) capsules and multiple micronutrient ( MMN ) capsules provided to women . In a follow‐up study conducted when the index children from the original trial were between 4 and 6 years of age , we used survey‐based methods to assess retrospective and current parental perceptions of nutrient supplements generally and of SQ‐LNS and their effects compared with perceptions IFA and MMN capsules . Most parents perceived that the assigned supplements ( SQ‐LNS , IFA , or MMN ) positively impacted the mother during pregnancy ( approximately 89 % of both mothers and fathers ) and during lactation ( 84 % of mothers and 86 % of fathers ) . Almost all ( ≥90 % ) of mothers and fathers perceived that the assigned supplement positively impacted the index child and expected continued positive impacts on the child 's health and human capital into the future . A smaller percentage of parents perceived negative impacts of the supplements ( 7%–17 % of mothers and 4%–12 % of fathers ) . Perceptions of positive impacts and of negative impacts did not differ by intervention group . The results suggest that similar population s would likely be receptive to programs to deliver SQ‐LNS or micronutrient capsules Limited knowledge exists on sustained adherence to small-quantity lipid-based nutrient supplements for pregnant and lactating women ( LNS-PL ) and how this compares with that of other prenatal supplements . To address these gaps , a r and om sub sample of women ( n = 360 ) during pregnancy , early ( 6- to 12-week post-partum ) and late ( 12- to 24-week post-partum ) lactation , from an ongoing effectiveness trial in Bangladesh , was selected for in-home interviews about LNS-PL or iron/folic acid ( IFA ) use and preferences . Prevalence of high adherence ( ≥70 % of the recommendation ) based on self-reported supplement consumption was 67 % , 68 % and 81 % among LNS-PL recipients during pregnancy , early and late lactation , and was 87 % and 71 % among IFA recipients during pregnancy and early lactation , respectively ( P = 0.044 ) . Programmatic factors ( e.g. distribution and visits by programme staff ) were consistently statistically significantly associated with reported high adherence . Among LNS-PL recipients , high overall supplement acceptability score [ odds ratio ( OR ) : 8.62 ; 95 % confidence interval ( CI ) 3.53 , 20.83 ] and use of reminder techniques ( OR : 4.41 ; 95%CI 1.65 , 11.76 ) were positively associated , and reported vomiting at enrollment was negatively associated ( OR : 0.34 ; 95%CI 0.14 , 0.80 ) , with reported high adherence . Selected women ( n = 16 ) and key informants ( n = 18 ) participated in in-depth interviews about perceptions and acceptability of LNS-PL . Women perceived benefits of taking LNS-PL , but some faced barriers to consumption including aversion to odour and taste during pregnancy , forgetfulness and disruptions in supply . To achieve high adherence , results from this study suggest that maternal supplementation programmes should focus on programmatic barriers and consider incorporating reminder techniques . Organoleptic acceptability  of LNS-PL , particularly during pregnancy , may also need to be addressed Abstract  Perinatal depression  is highly prevalent in low‐ and ‐middle‐income countries and has been linked to poor child health . Suboptimal maternal nutrition may be a risk factor for perinatal depression . In this r and omised‐controlled trial conducted in rural Malawi , we set out to test the hypothesis that women taking a fatty acid‐rich lipid‐based nutrient supplement ( LNS )  would have fewer depressive symptoms postpartum than those taking iron‐folate ( IFA ) or multiple‐micronutrient ( MMN ) capsules . Women were recruited from antenatal clinics and r and omised to receive  LNS or MMN during pregnancy and for 6 months postpartum , or IFA during pregnancy only . Maternal depressive symptoms were measured using vali date d translations of the Self Reporting Question naire ( SRQ ) and Edinburgh Postnatal Depression Scale ( EPDS ) , antenatally ( SRQ only ) and at 6 months postpartum ( SRQ and EPDS ) . Analysis was by modified intention to treat . One thous and three hundred and ninety one women were r and omised ( LNS = 462 , MMN = 466 , IFA = 463 ) . The groups were similar across a range of baseline variables . At 6 months postpartum , 1078 ( 77.5 % ) had SRQ completed ; mean ( SD ) scores were LNS 1.76(2.73 ) , MMN 1.92(2.75 ) , IFA 1.71(2.66 ) , P = 0.541 . One thous and and fifty seven ( 76.0 % ) had EPDS completed ; mean ( SD ) scores were LNS 5.77(5.53 ) , MMN 5.43(4.97 ) , IFA 5.52(5.18 ) , P = 0.676 . There were no statistically significant differences between the groups on SRQ or EPDS scores ( continuous or dichotomised ) in unadjusted or adjusted models . In conclusion , fortification of maternal diet with LNS compared with MMN or IFA did not reduce postnatal depressive symptoms in this study BACKGROUND Maternal undernutrition and low macro- and micronutrient intake and weight gain during pregnancy have been reported in Bangladesh . OBJECTIVE We aim ed to determine the effects of lipid-based nutrient supplements for pregnant and lactating women ( LNS-PL ) on weight gain and midupper arm circumference ( MUAC ) during pregnancy . METHODS The Rang-Din Nutrition Study , a cluster-r and omized effectiveness trial conducted in Bangladesh , enrolled 4011 pregnant women at ≤20 wk gestation who received either 60 mg Fe + 400 μg folic acid/d or 20 g LNS-PL/d ( 118 kcal ) containing essential fatty acids and vitamins and minerals until delivery . At 36 wk gestation , women were interviewed at home and then attended a follow-up examination at local clinics ( n = 2877 ) , where anthropometric measurements were taken . RESULTS No significant differences between intervention groups in maternal weight gain per week , low weight gain per week , or MUAC at 36 wk gestation were observed in the full sample . However , among multiparous women aged ≥25 y , those in the LNS-PL group gained 34 g/wk more than their counterparts in the iron and folic acid ( IFA ) group ( P = 0.001 ) , whereas no differences were seen in the other parity/age subgroups . Women aged ≥25 y in the LNS-PL group had a 0.4-cm greater MUAC than their counterparts in the IFA group ( P = 0.003 ) ; no significant differences were observed in the other age groups . Among women whose height at baseline was in the lowest quartile of the distribution , those in the LNS-PL group had a 0.1 - 0.3-cm greater MUAC at 36 wk gestation than those in the IFA group ( P = 0.004 - 0.014 ) . CONCLUSIONS Lipid-based nutrient supplements provided during pregnancy did not affect maternal anthropometric indicators in the overall sample but increased MUAC among women aged ≥25 y and those with lower stature and weight gain among multiparous women aged ≥25 y. This trial was registered at clinical trials.gov as NCT01715038 Background Malaria and undernutrition frequently coexist , especially in pregnant women and young children .  Nutrient supplementation of these vulnerable groups might reduce their susceptibility to malaria by improving immunity . Methods Antibody immunity to antigens expressed by a placental-binding parasite isolate , a non-placental binding parasite isolate , merozoites and schizonts at enrolment ( before 20 gestation weeks ) and at 36 gestation weeks were measured in 1,009 Malawian pregnant women receiving a daily lipid-based nutrient supplement , multiple micronutrients or iron and folic acid , who were participants in a r and omized clinical trial assessing the effects of nutrient supplementation on pregnancy outcomes and child development ( registration ID : NCT01239693 ) . Results Antibodies to placental-binding isolates significantly increased while antibodies to most merozoite antigens declined over pregnancy . Overall , after adjustment for covariates , the type of supplementation did not influence antibody levels at 36 gestation weeks or the rate of change in antibody levels from enrolment to 36 weeks . A negative association between maternal body mass index and opsonizing antibodies to placental-binding antigens ( coefficient ( 95 % CI ) -1.04 ( −1.84 , −0.24 ) , was observed . Similarly , women with higher socioeconomic status had significantly lower IgG and opsonizing antibodies to placental-binding antigens . Neither of these associations was significantly influenced by the supplementation type . Conclusions In the current cohort nutrient supplementation did not affect anti-malarial antibody responses , but poor and undernourished mothers should be a priority group in future trials BACKGROUND High circulating cortisol is associated with miscarriage , preterm birth , and low birth weight . Research in nonpregnant individuals suggests that improved nutrition may lower cortisol concentrations . It is unknown whether nutritional supplementation during pregnancy lowers cortisol . OBJECTIVE Our objective was to determine whether women receiving a lipid-based nutrient supplement ( LNS ) throughout pregnancy would have lower salivary cortisol at 36 wk gestation compared with women receiving other nutrient supplements . METHODS We conducted a r and omized controlled trial in 1320 pregnant Ghanaian women at ≤20 wk gestation who were assigned to receive daily throughout pregnancy : 1 ) 60 mg iron + 400 μg folic acid ( IFA ) , 2 ) multiple micronutrients ( MMNs ) , or 3 ) 20 g LNS ( containing 118 kcal , 22 micronutrients , and protein ) . Morning salivary cortisol was collected from a sub sample at baseline and at 28 and 36 wk gestation . RESULTS A total of 758 women had cortisol measurements  at 28 or 36 wk gestation . Salivary cortisol at 36 wk gestation did not differ between groups and was ( mean ± SE ) 7.97 ± 0.199 in the IFA group , 7.84 ± 0.191 in the MMN group , and 7.77 ± 0.199 nmol/L in the LNS group , when adjusted for baseline cortisol , time of waking , and time between waking and saliva collection ( P = 0.67 ) . There was an interaction between supplementation group and women 's age ( continuous variable , P-interaction = 0.03 ) ; and when age was dichotomized by the median , significant differences in salivary cortisol concentrations between groups were seen in women ≤26 y of age ( IFA = 8.23 ± 0.284 nmol/L , MMN = 8.20 ± 0.274 nmol/L , and LNS = 7.44 ± 0.284 nmol/L ; P = 0.03 ) but not in women > 26 y old ( IFA = 7.71 ± 0.281 nmol/L , MMN = 7.50 ± 0.274 nmol/L , and LNS = 8.08 ± 0.281 nmol/L ; P = 0.13 ) . CONCLUSIONS We conclude that supplementation with LNSs or MMNs during pregnancy did not affect the cortisol concentration in the study population as a whole , in comparison with IFA , but that LNS consumption among younger women may lead to lower cortisol at 36 wk gestation . This trial was registered at clinical trials.gov as NCT00970866 BACKGROUND Small birth size , often associated with insufficient maternal nutrition , contributes to a large share of global child undernutrition , morbidity , and mortality . We developed a small-quantity lipid-based nutrient supplement ( SQ-LNS ) to enrich the diets of pregnant women . OBJECTIVE The objective was to test a hypothesis that home fortification of pregnant women 's diets with SQ-LNS would increase birth size in an African community . DESIGN We enrolled 1391 women with uncomplicated pregnancies ( < 20 gestational weeks ) in a r and omized controlled trial in Malawi . The women were provided with one daily iron-folic acid ( IFA ) capsule , one capsule containing multiple micronutrients ( MMNs ) , or one 20-g sachet of SQ-LNS ( LNS , containing 118 kcal , protein , carbohydrates , essential fatty acids , and 21 micronutrients ) . Primary outcomes were birth weight and newborn length . Secondary outcomes included newborn weight , head and arm circumference , and pregnancy duration . Analysis was by intention to treat . RESULTS The mean ± SD birth weight and newborn length were 2948 ± 432 , 2964 ± 460 , and 3000 ± 447 g ( P = 0.258 ) and 49.5 ± 2.4 , 49.7 ± 2.2 , and 49.9 ± 2.1 cm ( P = 0.104 ) in the IFA , MMN , and LNS groups , respectively . For newborn weight-for-age , head circumference , and arm circumference , the point estimate for the mean was also highest in the LNS group , intermediate in the MMN group , and lowest in the IFA group , but except for midupper arm circumference ( P = 0.024 ) , the differences were not statistically significant . The prevalence of low birth weight ( < 2500 g ) was 12.7 % , 13.5 % , and 12.1 % ( P = 0.856 ) , respectively ; newborn stunting ( length-for-age z score < -2 ) was 19.2 % , 14.0 % , and 14.9 % ( P = 0.130 ) , respectively ; and newborn small head circumference ( head circumference-for-age z score < -2 ) was 5.8 % , 3.0 % , and 3.1 % ( P = 0.099 ) , respectively . The associations between the intervention and the outcomes were not modified by maternal parity , age , or nutritional status ( P > 0.100 ) . CONCLUSION The study findings do not support a hypothesis that provision of SQ-LNS to all pregnant women would increase the mean birth size in rural Malawi . The trial was registered at clinical trials.gov as NCT01239693 BACKGROUND Prenatal multiple micronutrient ( MMN ) or balanced energy and protein supplementation has a limited effect on birth size of the offspring . OBJECTIVE The objective was to determine whether a prenatal MMN-fortified food supplement ( FFS ) improves anthropometric measures at birth compared with supplementation with an MMN pill alone . DESIGN We conducted a nonblinded , individually r and omized controlled trial in 1296 pregnant women in 2 villages in rural Burkina Faso . Supplements were provided on a daily basis , and compliance was closely verified by using a community-based network of home visitors . RESULTS Anthropometric measures at birth were available for analysis for 87 % of the 1175 live singleton deliveries enrolled . After adjustment for gestational age at birth , the FFS group had a significantly higher birth length ( + 4.6 mm ; P = 0.001 ) . FFS supplementation result ed in a modestly higher birth weight ( + 31 g ; P = 0.197 ) . Subgroup analyses showed clinical ly important treatment effects on birth length ( + 12.0 mm ; P = 0.005 ) and on birth weight ( + 111 g ; P = 0.133 ) for underweight [ body mass index ( in kg/m(2 ) ) < 18.5 ] pregnant women . Women with early pregnancy anemia who received FFS gave birth to longer newborns ( + 7.3 mm ; P = 0.002 ) than did those who received MMN supplementation . CONCLUSIONS The provision of FFS to pregnant women result ed in higher birth length than did MMN supplementation . For women with a suboptimal prepregnancy nutritional status , MMN supplementation should be complemented with a balanced energy and protein supplement to produce a clinical effect on birth size . The trial was registered at clinical trials.gov as NCT00909974 Background : Nutrition during the first 1000 d is critical for brain development . Objective : We evaluated the effects on child development of home fortification with lipid-based nutrient supplements ( LNSs ) for mothers and /or children or micronutrient powder ( MNP ) for children . Design : We conducted a cluster-r and omized effectiveness trial with 4 arms : 1 ) LNSs during pregnancy and the first 6 mo postpartum and LNSs for the offspring from 6 to 24 mo ( LNS-LNS ) , 2 ) iron and folic acid ( IFA ) during pregnancy and the first 3 mo postpartum and LNSs for the children from 6 to 24 mo ( IFA-LNS ) , 3 ) IFA ( as above ) and MNP for the offspring from 6 to 24 mo ( IFA-MNP ) , and 4 ) IFA ( as above ) and no child supplement ( IFA-Control ) . Women were enrolled at ≤20 wk of gestation ; children were assessed at 12 ( n = 3331 ) , 18 ( n = 3364 ) , and 24 ( n = 3379 ) mo . Results : Compared with the IFA-Control  group , motor development scores were higher in the LNS-LNS ( P = 0.016 ) and IFA-LNS groups ( P = 0.006 ) at 18 mo and in the IFA-MNP group ( P = 0.048 ) at 24 mo . Receptive language scores were higher for the LNS-LNS group ( P = 0.028 ) at 18 mo and for all 3 groups at 24 mo ( P = 0.008 for LNS-LNS , P = 0.022 for IFA-LNS , and P = 0.009 for IFA-MNP compared with IFA-Control ) . Expressive language scores did not differ at 18 mo ( P = 0.236 ) but were higher in the LNS-LNS ( P = 0.035 ) and IFA-MNP ( P = 0.002 ) groups than in the IFA-Control group at 24 mo . Groups did not differ in personal-social scores at 18 ( P = 0.233 ) or 24 ( P = 0.146 ) mo or in executive function score at 24 mo ( P = 0.467 ) . Conclusion : Prenatal LNSs , postnatal LNSs , or both , or postnatal MNP had a positive effect on motor and language development in Bangladeshi children . This trial was registered at clinical trials.gov as NCT01715038 Background : Human milk oligosaccharides ( HMOs ) and bioactive proteins are beneficial to infant health . Recent evidence suggests that maternal nutrition may affect the amount of HMOs and proteins in breast milk ; however , the effect of nutrient supplementation on HMOs and bioactive proteins has not yet been well studied . Objective : We aim ed to determine whether lipid-based nutrient supplements ( LNSs ) affect milk bioactive protein and HMO concentrations at 6 mo postpartum in women in rural Malawi . These are secondary outcomes of a previously published r and omized controlled trial . Methods : Women were r and omly assigned to consume either an iron and folic acid capsule ( IFA ) daily from ≤20 wk gestation until delivery , followed by placebo daily from delivery to 6 mo postpartum , or a multiple micronutrient ( MMN ) capsule or LNS daily from ≤20 wk gestation to 6 mo postpartum . Breast milk concentrations of total HMOs , sialylated HMOs , fucosylated HMOs , lactoferrin , lactalbumin , lysozymes , antitrypsin , immunoglobulin A , and osteopontin were analyzed at 6 mo postpartum ( n = 647 ) . Between-group differences in concentrations and in proportions of women classified as having low concentrations were tested . Results : HMO and bioactive protein concentrations did not differ between groups ( P > 0.10 for all comparisons ) . At 6 mo postpartum , the proportions of women with low HMOs or bioactive proteins were not different between groups except for osteopontin . A lower proportion of women in the IFA group had low osteopontin compared with the LNS group after adjusting for covariates ( OR : 0.5 ; 95 % CI : 0.3 , 0.9 ; P = 0.016 ) . Conclusion : The study findings do not support the hypothesis that supplementation with an LNS or MMN capsule during pregnancy and postpartum would increase HMO or bioactive milk proteins at 6 mo postpartum among Malawian women . This trial was registered at clinical trials.gov as NCT01239693 The Breastfeeding , Antiretrovirals , and Nutrition Study evaluated the effect of daily consumption of lipid-based nutrient supplements ( LNS ) by 2121 lactating , HIV-infected mothers on the growth of their exclusively breast-fed , HIV-uninfected infants from 0 to 24 wk . The study had a 2 × 3 factorial design . Malawian mothers with CD4(+ ) ≥250 cells/mm(3 ) , hemoglobin ≥70 g/L , and BMI ≥17 kg/m(2 ) were r and omized within 36 h of delivery to receive either no LNS or 140 g/d of LNS to meet lactation energy and protein needs , and mother-infant pairs were assigned to maternal antiretroviral drugs ( ARV ) , infant ARV , or no ARV . Sex-stratified , longitudinal , r and om effects models were used to estimate the effect of the 6 study arms on infant weight , length , and BMI . Logistic regression models were used to calculate the odds of growth faltering [ decline in weight-for-age Z-score ( WAZ ) or length-for-age Z-score ( LAZ ) > 0.67 ] using the control arm as the reference . Although some differences between study arms emerged with increasing infant age in boys , there were no consistent effects of the maternal supplement across the 3 growth outcomes in longitudinal models . At the ages where differences were observed , the effects on weight and BMI were quite small ( ≤200 g and ≤0.4 kg/m(2 ) ) and unlikely to be of clinical importance . Overall , 21 and 34 % of infants faltered in WAZ and LAZ , respectively . Maternal supplementation did not reduce the odds of infant weight or length faltering from 0 to 24 wk in any arm . These results indicate that blanket supplementation of HIV-infected lactating women may have little impact on infant growth It is unknown whether a novel small-quantity lipid-based nutrient supplement ( SQ-LNS ) containing alpha-linolenic ( ALA ) and linoleic acids impacts  maternal plasma lipids and fatty acid status .  We measured plasma fatty acids ( wt% ) and lipid concentrations at 36 wk gestation and breast milk fatty acids ( wt% ) at 6 months postpartum in a sub sample of women enrolled in a r and omized controlled trial study ing the effects of SQ-LNS on birth outcomes and child growth . Women≤20 wk gestation in Ghana ( n=1,320 ) and Malawi ( n=1,391 ) were assigned to receive daily either : 1 ) iron-folic acid ( pregnancy ) ; 2 ) multiple micronutrients ( pregnancy and lactation ) ; or 3 ) SQ-LNS ( pregnancy and lactation ) . At 36 wk , plasma ALA levels were higher in those receiving SQ-LNS . SQ-LNS  increased breast milk ALA in Ghana but not Malawi . There was no effect on plasma lipids or other selected fatty acids . SQ-LNS may impact plasma and breast milk ALA levels depending on the population Background : Childhood stunting usually begins in utero and continues after birth ; therefore , its reduction must involve actions across different stages of early life . Objective : We evaluated the efficacy of small-quantity , lipid-based nutrient supplements ( SQ-LNSs ) provided during pregnancy , lactation , and infancy on attained size by 18 mo of age . Design : In this partially double-blind , individually r and omized trial , 1320 women at ≤20 wk of gestation received st and ard iron and folic acid ( IFA group ) , multiple micronutrients ( MMN group ) , or SQ-LNS ( LNS group ) daily until delivery , and then placebo , MMNs , or SQ-LNS , respectively , for 6 mo postpartum ; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age ( endline ) . The primary outcome was child length by 18 mo of age . Results : At endline , data were available for 85 % of 1228 infants enrolled ; overall mean length and length-for-age z score ( LAZ ) were 79.3 cm and −0.83 , respectively , and 12 % of the children were stunted ( LAZ < −2 ) . In analysis based on the intended treatment , mean ± SD length and LAZ for the LNS group ( 79.7 ± 2.9 cm and −0.69 ± 1.01 , respectively ) were significantly greater than for the IFA ( 79.1 ± 2.9 cm and −0.87 ± 0.99 ) and MMN ( 79.1 ± 2.9 cm and −0.91 ± 1.01 ) groups ( P = 0.006 and P = 0.009 , respectively ) . Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference , and the prevalence of stunting in the LNS group was 8.9 % , compared with 13.7 % in the IFA group and 12.9 % in the MMN group ( P = 0.12 ) . In analysis based on actual supplement provided at enrollment , stunting prevalences were 8.9 % compared with 15.1 % and 11.5 % , respectively ( P = 0.045 ) . Conclusion : Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child ’s attained length by age 18 mo in similar setting s. This trial was registered at clinical trials.gov as NCT00970866 Background Over half of the world ’s children suffer from poor nutrition , and as a consequence they experience delays in physical and mental health , and cognitive development . There is little data evaluating the effects of delivery of lipid-based , nutrition supplementation on growth and development during pregnancy and early childhood within the context of a scaled-up program . Furthermore , there is limited evidence on effects of scaled-up , home-visiting programs that focus on the promotion of child development within the context of an existing , national nutrition program . Methods / Design The MAHAY ( " smart " in Malagasy ) study uses a multi-arm r and omized-controlled trial ( RCT ) to test the effects and cost-effectiveness of combined interventions to address chronic malnutrition and poor child development . The arms of the trial are : ( T0 ) existing program with monthly growth monitoring and nutritional/hygiene education ; ( T1 ) is T0 + home visits for intensive nutrition counseling within a behavior change framework ; ( T2 ) is T1 + lipid-based supplementation ( LNS ) for children 6–18 months old ; ( T3 ) is T2 + LNS supplementation of pregnant/lactating women ; and ( T4 ) is T1 + intensive home visiting program to support child development . There are anticipated to be n = 25 communities in each arm ( n = 1250 pregnant women , n = 1250 children 0–6 months old , and n = 1250 children 6–18 months old ) . Primary outcomes include growth ( length/height-for-age z-scores ) and child development ( mental , motor and social development ) . Secondary outcomes include care-giver reported child morbidity , household food security and diet diversity , micro-nutrient status , maternal knowledge of child care and feeding practice s , and home stimulation practice s. We will estimate unadjusted and adjusted intention-to-treat effects . Study protocol s have been review ed and approved by the Malagasy Ethics Committee at the Ministry of Health in Madagascar and by the institutional review board at the University of California , Davis . This study is funded by the Strategic Impact Evaluation Fund ( SIEF ) , the World Bank Innovation Grant , the Early Learning Partnership Grant , the Japan Scaling-up for Nutrition Trustfund , and Gr and Challenges Canada . The implementation of the study is financed by Madagascar 's National Nutrition Office . Trial registration Current Controlled Trials IS RCT N14393738 . Registered June 23 , 2015 BACKGROUND Maternal undernutrition and newborn stunting [ birth length-for-age z score ( LAZ ) < -2 ] are common in Bangladesh . OBJECTIVE The objective was to evaluate the effect of lipid-based nutrient supplements for pregnant and lactating women ( LNS-PLs ) on birth outcomes . DESIGN We conducted a cluster-r and omized effectiveness trial ( the Rang-Din Nutrition Study ) within a community health program in rural Bangladesh . We enrolled 4011 pregnant women at ≤20 gestational weeks ; 48 clusters received iron and folic acid ( IFA ; 60 mg Fe + 400 μg folic acid ) and 16 clusters received LNS-PLs ( 20 g/d , 118 kcal ) containing essential fatty acids and 22 vitamins and minerals . Both of the supplements were intended for daily consumption until delivery . Primary outcomes were birth weight and length . RESULTS Infants in the LNS-PL group had higher birth weights ( 2629 ± 408 compared with 2588 ± 413 g ; P = 0.007 ) , weight-for-age z scores ( -1.48 ± 1.01 compared with -1.59 ± 1.02 ; P = 0.006 ) , head-circumference-for-age z scores ( HCZs ; -1.26 ± 1.08 compared with -1.34 ± 1.12 ; P = 0.028 ) , and body mass index z scores ( -1.57 ± 1.05 compared with -1.66 ± 1.03 ; P = 0.005 ) than those in the IFA group ; in adjusted models , the differences in length ( 47.6 ± 0.07 compared with 47.4 ± 0.04 cm ; P = 0.043 ) and LAZ ( -1.15 ± 0.04 compared with -1.24 ± 0.02 ; P = 0.035 ) were also significant . LNS-PLs  reduced the risk of newborn stunting ( 18.7 % compared with 22.6 % ; RR : 0.83 ; 95 % CI : 0.71 , 0.97 ) and small head size ( HCZ < -2 ) ( 20.7 % compared with 24.9 % ; RR : 0.85 ; 95 % CI : 0.73 , 0.98 ) . The effects  of LNS-PL on newborn stunting were greatest in infants born before a 10-wk interruption in LNS-PL distribution ( n = 1301 ; 15.7 % compared with 23.6 % ; adjusted RR : 0.69 ; 95 % CI : 0.53 , 0.89 ) and in infants born to women ≤24 y of age or with household food insecurity . CONCLUSION Prenatal lipid-based nutrient supplements can improve birth outcomes in Bangladeshi women , especially those at higher risk of fetal growth restriction . This trial was registered at clinical trials.gov as NCT01715038 OBJECTIVE To compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread ( FS ) or micronutrient-fortified maize-soy flour ( likuni phala [ LP ] ) . DESIGN R and omized , controlled , single-blind trial . SETTING Rural Malawi . PARTICIPANTS A total of 182 six-month-old infants . INTERVENTION Participants were r and omized to receive 1 year of daily supplementation with 71 g of LP ( 282 kcal ) , 50 g of FS ( FS50 ) ( 256 kcal ) , or 25 g of FS ( FS25 ) ( 130 [ corrected ] kcal ) . OUTCOME MEASURES Weight and length gains and the incidences of severe stunting , underweight , and wasting . RESULTS Mean weight and length gains in the LP , FS50 , and FS25 groups were 2.37 , 2.47 , and 2.37 kg ( P = .66 ) and 12.7 , 13.5 , and 13.2 cm ( P = .23 ) , respectively . In the same groups , the cumulative 12-month incidence of severe stunting was 13.3 % , 0.0 % , and 3.5 % ( P = .01 ) , of severe underweight was 15.0 % , 22.5 % , and 16.9 % ( P = .71 ) , and of severe wasting was 1.8 % , 1.9 % , and 1.8 % ( P > .99 ) . Compared with LP-supplemented infants , those given FS50 gained a mean of 100 g more weight and 0.8 cm more length . There was a significant interaction between baseline length and intervention ( P = .04 ) ; in children with below-median length at enrollment , those given FS50 gained a mean of 1.9 cm more than individuals receiving LP . CONCLUSION One-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants , but it is likely to boost linear growth in the most disadvantaged individuals and , hence , decrease the incidence of severe stunting Inadequate micronutrient intake during pregnancy , lactation and infancy is a major problem in many developing countries . Lipid-based nutrient supplements ( LNS ) can improve micronutrient status , growth and development of infants , and also have potential to improve nutritional status of pregnant and lactating women . The objective of the study was to test the acceptability of LNS design ed for infants ( LNS-20gM ) and pregnant or lactating women ( LNS-P&L ) . Participants were infants ( n = 22 , mean age = 8 months ) and pregnant or lactating women ( n = 24 ) attending routine services at a hospital in Ghana . Infants consumed 45 g of a test meal consisting of one part LNS-20gM and three parts fermented maize porridge , while women consumed 50 g of a similar test meal containing LNS-P&L instead . Participants also used their respective LNS at home for 14 days . Primary outcome was the proportion of the test meal consumed . On average , infants consumed 76.2 % of the test meal [ 95 % ( confidence interval ) CI : 65.7 , 86.7 ] , while women consumed 87.1 % ( 95 % CI : 82.6 , 91.6 ) . During the 14-day period , median daily consumption of LNS-20gM was 19.3 g , very close to the recommended 20 g d(-1 ) , while that of LNS-P&L was one sachet , as recommended . We conclude that LNS-20gM and LNS-P&L were well accepted Although widely used , there is little information concerning the efficacy of corn-soy blend ( CSB ) supplementation in the treatment of moderate underweight in African children .  Lipid-based nutrient supplements ( LNS ) , which have proven to be beneficial treatment for severely wasted children , could offer benefits to less severely affected individuals . We conducted a clinical r and omized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children . A total of 182 underweight [ weight-for-age Z-score ( WAZ ) < -2 ] 6- to 15-mo-old children were r and omized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB , providing 1189 and 921 kJ , respectively , or no supplementation ( control ) . The primary outcome was weight change ; secondary outcomes included changes in anthropometric indices , hemoglobin levels , and morbidity . The body weight increases ( mean ± SD ) did not differ and were 620 ± 470 , 510 ± 350 , and 470 ± 350 g in the LNS , CSB , and control groups , respectively ( P = 0.11 ) . Compared with controls , infants and children in the LNS group gained more weight [ mean ( 95 % CI ) = 150 g ( 0 - 300 g ) ; P = 0.05 ] and had a greater increase in WAZ [ 0.33 ( -0.02 - 0.65 ) ; P = 0.04 ] . Weight and WAZ changes did not differ between the control and CSB groups . In exploratory stratified analysis , the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [ 250 g ( 60 - 430 g ; P = 0.01 ] . Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ Background : Pregnancy and childbirth complications and cesarean delivery are common in Bangladesh . Objective : We evaluated the effect of lipid-based nutrient supplements for pregnant and lactating women ( LNS-PL ) on pregnancy and childbirth complications and cesarean delivery . Methods : We conducted the Rang-Din Nutrition Study , a cluster-r and omized controlled effectiveness trial within a community health program in rural Bangladesh . We enrolled 4011 pregnant women in early pregnancy . Women in 48 clusters received iron and folic acid ( IFA ; 60 mg Fe + 400 μg folic acid/d ) and women in 16 clusters received LNS-PL ( 20 g/d , 118 kcal ) containing essential fatty acids and 22 vitamins and minerals . Pregnancy and childbirth complications and the cesarean delivery rate were secondary outcomes of the study . Results : Women in the LNS-PL group did not differ significantly from the IFA group with respect to mean systolic blood pressure at 36 wk gestation ( 113 and 112 mm Hg ; P = 0.17 ) , diastolic blood pressure at 36 wk gestation ( 68.9 and 68.7 mmHg ; P = 0.88 ) , or mean total number of pregnancy and childbirth complications ( 0.32 and 0.31 ; P = 0.86 ) . They also did not differ significantly with respect to the prevalence of high blood pressure at 36 wk ( 1.74 % and 2.03 % ; P = 0.62 ) , antepartum hemorrhage ( 0.83 % and 1.39 % ; P = 0.21 ) , prolonged labor ( 8.34 % and 8.79 % ; P = 0.68 ) , early rupture of membranes ( 9.30 % and 8.45 % ; P = 0.43 ) , convulsions ( 1.57 % and 1.08 % ; P = 0.24 ) , high blood pressure in labor ( 1.54 % and 1.19 % ; P = 0.46 ) , obstructed labor ( 2.83 % and 2.91 % ; P = 0.90 ) , any complications during pregnancy or childbirth ( 35.9 % and 37.1 % ; P = 0.64 ) , episiotomy ( 6.31 % and 6.44 % ; P = 0.90 ) , or cesarean delivery ( 15.6 % and 14.2 % ; P = 0.48 ) . Conclusion : Compared with IFA , antenatal LNS-PL did not increase or decrease pregnancy and childbirth complications or cesarean  delivery among women in rural Bangladesh . This trial was registered at clinical trials.gov as NCT01715038 Abstract Prenatal supplementation with protein‐energy ( PE ) and /or multiple‐micronutrients ( MMNs ) may improve fetal growth , but trials of lipid‐based nutritional supplements ( LNSs ) have reported inconsistent results . We conducted a post‐hoc analysis of non‐ primary outcomes in a trial in Gambia , with the aim to test the associations of LNS with fetal growth and explore how efficacy varies depending on nutritional status . The sample comprised 620 pregnant women in an individually r and omized , partially blinded trial with four arms : ( a ) iron and folic acid ( FeFol ) tablet ( usual care , referent group ) , ( b ) MMN tablet , ( c ) PE LNS , and ( d ) PE + MMN LNS . Analysis of variance examined unadjusted differences in fetal biometry z‐scores at 20 and 30 weeks and neonatal anthropometry z‐scores , while regression tested for modification of intervention‐ outcome associations by season and maternal height , body mass index , and weight gain . Despite evidence of between‐arm differences in some fetal biometry , z‐scores at birth were not greater in the intervention arms than the FeFol arm ( e.g. , birth weight z‐scores  : FeFol −0.71 , MMN −0.63 , PE −0.64 , PE + MMN −0.62 ; group‐wise p = .796 ) . In regression analyses , intervention associations with birth weight and head circumference were modified by maternal weight gain between booking and 30 weeks gestation ( e.g. , PE + MMN associations with birth weight were + 0.462 z‐scores ( 95 % CI [ 0.097 , 0.826 ] ) in the highest quartile of weight gain but –0.099 z‐scores ( −0.459 , 0.260 ) in the lowest ) . In conclusion , we found no strong evidence that a prenatal LNS intervention was associated with better fetal growth in the whole sample BACKGROUND Maternal and infant undernutrition is associated with poor infant development ; however , few studies have examined the impact of combined pre- and postnatal dietary supplementation on infant development . OBJECTIVE Our objective was to determine whether provision of small-quantity lipid-based nutrient supplements ( SQ-LNSs ) to mothers during pregnancy and the first 6 mo postpartum , and to children aged 6 - 18 mo , improves infant development in Malawi . DESIGN We r and omly assigned 869 pregnant women to receive one of the following daily : an iron and folic acid ( IFA ) capsule , a multiple micronutrient ( MMN ) capsule containing 18 micronutrients , or a 20-g sachet of SQ-LNSs containing 22 vitamins and minerals , protein , carbohydrates , essential fatty acids , and 118 kcal . Children in the lipid-based nutrient supplement ( LNS ) group only received SQ-LNSs from 6 to 18 mo of age . We monitored the acquisition of 11 developmental milestones monthly by maternal report ; observed the attainment of 7 motor milestones at 6 , 12 , and 18 mo of age ; and conducted a comprehensive assessment of motor , language , and socioemotional development and executive function at 18 mo of age . The primary analysis was by intention-to-treat . RESULTS By maternal report , children in the LNS group achieved walking alone ( B = 0.53 ; 95 % CI : 0.11 , 0.94 ; P = 0.034 ) and waving goodbye ( B = 0.60 ; 95 % CI : 0.12 , 1.08 ; P = 0.040 ) earlier than the IFA group and st and ing with assistance earlier than the MMN group ( B = 0.51 ; 95 % CI : 0.12 , 0.89 ; P = 0.029 ) . By research er observation , there was a trend ( P = 0.052 ) for a greater percentage of children in the LNS group ( 58 % ) to walk alone at age 12 mo than in the IFA ( 49 % ) and MMN ( 49 % ) groups . At age 18 mo , there were no significant differences between groups in any scores . CONCLUSION Although provision of SQ-LNSs to pregnant women and infants in Malawi may affect the age of acquisition of certain developmental milestones , it did not affect our assessment s of motor , language , socioemotional , or executive function skills at 18 mo of age . This trial was registered at clinical trials.gov as NCT01239693 BACKGROUND Selenium is found in soils and is essential for human antioxidant defense and immune function . In Malawi , low soil selenium and dietary intakes coupled with low plasma selenium concentrations in HIV infection could have negative consequences for the health of HIV-infected mothers and their exclusively breastfed infants . OBJECTIVE We tested the effects of lipid-based nutrient supplements ( LNS ) that contained 1.3 times the Recommended Dietary Allowance of sodium selenite and antiretroviral drugs ( ARV ) on maternal plasma and breast-milk selenium concentrations . DESIGN HIV-infected Malawian mothers in the Breastfeeding , Antiretrovirals , and Nutrition study were r and omly assigned at delivery to receive : LNS , ARV , LNS and ARV , or a control . In a sub sample of 526 mothers and their uninfected infants , we measured plasma and breast-milk selenium concentrations at 2 or 6 ( depending on the availability of infant sample s ) and 24 wk postpartum . RESULTS Overall , mean ( ± SD ) maternal ( range : 81.2 ± 20.4 to 86.2 ± 19.9 μg/L ) and infant ( 55.6 ± 16.3 to 61.0 ± 15.4 μg/L ) plasma selenium concentrations increased , whereas breast-milk selenium concentrations declined ( 14.3 ± 11.5 to 9.8 ± 7.3 μg/L ) from 2 or 6 to 24 wk postpartum ( all P < 0.001 ) . Compared with the highest baseline selenium tertile , low and middle tertiles were positively associated with a change in maternal plasma or breast-milk selenium from 2 or 6 to 24 wk postpartum ( both P < 0.001 ) . With the use of linear regression , we showed that LNS that contained selenium and ARV were not associated with changes in maternal plasma and breast-milk selenium , but maternal selenium concentrations were positively associated with infant plasma selenium at 2 or 6 and 24 wk postpartum ( P < 0.001 ) regardless of the study arm . CONCLUSIONS Selenite supplementation of HIV-infected Malawian women was not associated with a change in their plasma or breast-milk selenium concentrations . Future research should examine effects of more readily incorporated forms of selenium ( ie , selenomethionine ) in HIV-infected breastfeeding women BACKGROUND Breastfeeding increases metabolic dem and s on the mother , and excessive postnatal weight loss increases maternal mortality . OBJECTIVE We evaluated the efficacy of a lipid-based nutrient supplement ( LNS ) for prevention of excess weight loss in breastfeeding , HIV-infected women . DESIGN The BAN ( Breastfeeding , Antiretrovirals , and Nutrition ) Study was a r and omized controlled trial in Lilongwe , Malawi . At delivery , HIV-infected mothers and their infants were r and omly assigned according to a 2-arm ( with and without LNS ) by 3-arm ( maternal triple-antiretroviral prophylaxis , infant-nevirapine prophylaxis , or neither ) factorial design . The 28-wk LNS intervention provided daily energy ( 700 kcal ) , protein ( 20 g ) , and micronutrients ( except for vitamin A ) to meet lactation needs . Women were counseled to breastfeed exclusively for 24 wk and to wean by 28 wk . Weight change ( 0 - 28 wk ) was tested in an intent-to-treat analysis by using 2-factor ANOVA and with longitudinal mixed-effects models . RESULTS At delivery , the LNS ( n = 1184 ) and control ( n = 1185 ) groups had similar mean weights and BMI s. Women receiving the LNS had less 0 - 28-wk weight loss ( -1.97 compared with -2.56 kg , P = 0.003 ) . This difference remained significant after adjustment for maternal antiretroviral drug therapy and baseline BMI . Women receiving antiretroviral drugs had more weight loss than did those not receiving antiretroviral drugs ( -2.93 compared with -1.90 kg , P < 0.001 ) . The benefit of the LNS for reducing weight loss was observed both in those receiving antiretroviral drugs ( -2.56 compared with -3.32 kg , P = 0.019 ) and in those not receiving antiretroviral drugs ( -1.63 compared with -2.16 kg , P = 0.034 ) . CONCLUSIONS The LNS reduced weight loss among HIV-infected , breastfeeding women , both in those taking maternal antiretroviral prophylaxis to prevent postnatal HIV transmission and in those not receiving antiretroviral prophylaxis . Provision of an LNS may benefit HIV-infected , breastfeeding women in re source -limited setting s. This trial was registered at clinical trials.gov as NCT00164762 Background : Stunting in linear growth occurs mainly during the first 1000 d , from conception through 24 mo of age . Despite the recognition of this critical period , there have been few evaluations of the growth impact of interventions that cover most of this window . Objective : We evaluated home fortification approaches for preventing maternal and child undernutrition within a community-based health program . We hypothesized that small-quantity lipid-based nutrient supplements ( LNSs ) provided to women during pregnancy and the first 6 mo postpartum , LNSs provided to their offspring from 6 to 24 mo of age , or both would result in greater child length-for-age z score ( LAZ ) at 24 mo than iron and folic acid ( IFA ) provided to women during pregnancy and postpartum plus micronutrient powder ( MNP ) or no supplementation for their offspring from 6 to 24 mo . Design : We conducted a cluster-r and omized effectiveness trial with 4 arms : 1 ) women and children both received LNSs ( LNS-LNS group ) , 2 ) women received IFA and children received LNSs ( IFA-LNS group ) , 3 ) women received IFA and children received MNP ( IFA-MNP group ) , and 4 ) women received IFA and children received no supplements ( IFA-Control group ) . We enrolled 4011 women at ≤20 wk of gestation within 64 clusters , each comprising the supervision area of a community health worker . Analyses were primarily performed by using ANCOVA F tests and Tukey-Kramer-corrected pairwise comparisons . Results : At 24 mo , the LNS-LNS group had significantly higher LAZ ( + 0.13 compared with the IFA-MNP group ) and head circumference ( + 0.15 z score compared with the IFA-Control group ) ; these outcomes did not differ between the other groups . Stunting prevalence ( LAZ < -2 ) was lower in the LNS-LNS group at 18 mo than in the IFA-MNP group ( OR : 0.70 ; 95 % CI : 0.53 , 0.92 ) , but the difference diminished by 24 mo ( OR : 0.81 ; 95 % CI : 0.63 , 1.04 ) . Conclusion : Home fortification with small-quantity LNSs , but not MNP , during the first 1000 d improved child linear growth and head size in rural Bangladesh . This trial was registered at clinical trials.gov as NCT01715038 BACKGROUND The International Lipid-Based Nutrient Supplements Project developed a small-quantity ( 20 g/d ) lipid-based nutrient supplement ( LNS ) for pregnant and lactating women . OBJECTIVE We evaluated the effects of prenatal LNS supplementation on fetal growth . DESIGN In a community-based , partially double-blind , individually r and omized controlled trial , 1320 women ≤20 wk pregnant received 60 mg Fe/400 μg folic acid ( IFA ) , or 1 - 2 Recommended Dietary Allowances of 18 micronutrients , including 20 mg Fe ( MMN ) , or LNS with the same micronutrients as the MMN group , plus 4 minerals and macronutrients contributing 118 kcal ( LNS ) daily until delivery . Fetal growth was compared across groups by using intention-to-treat analysis . The primary outcome was birth length . RESULTS This analysis included 1057 women ( IFA = 349 , MMN = 354 , LNS = 354 ) . Groups did not differ significantly in mean birth length , length-for-age z score ( LAZ ) , head circumference , or percentage low birth length but differed in mean birth weight ( P = 0.044 ) , weight-for-age z score ( WAZ ; P = 0.046 ) , and BMI -for-age z score ( BMI Z ; P = 0.040 ) , with a trend toward differences in low birth weight ( P = 0.069 ) . In pairwise comparisons , the LNS group had greater mean birth weight ( + 85 g ; P = 0.040 ) , WAZ ( + 0.19 ; P = 0.045 ) , and BMI Z ( + 0.21 ; P = 0.035 ) and a lower risk of low birth weight ( RR : 0.61 , 95 % CI : 0.39 , 0.96 ; P = 0.032 ) than did the IFA group . The other group differences were not significant . The effect of intervention was modified by mother 's parity , age , height , baseline hemoglobin , household food insecurity , and child sex , with parity being the most consistent modifier . Among primiparous women ( IFA = 131 ; MMN = 110 ; LNS = 128 ) , the LNS group had greater mean birth length ( + 0.91 cm ; P = 0.001 ) , LAZ ( + 0.47 ; P = 0.001 ) , weight ( + 237 g ; P < 0.001 ) , WAZ ( + 0.56 ; P < 0.001 ) , BMI Z ( + 0.52 ; P < 0.001 ) , head circumference ( 0.50 cm ; P = 0.017 ) , and head circumference-for-age z score ( + 0.40 ; P = 0.022 ) than did the IFA group ; similar differences were found when comparing the LNS and MMN groups among primiparous women , and no group differences were found among multiparous women . CONCLUSION Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana , particularly primiparous women . This trial was registered at clinical trials.gov as NCT00970866 BACKGROUND Intrauterine growth restriction may be reduced by supplementing maternal diets during pregnancy , but few studies have assessed the impact of combined prenatal and postnatal interventions on child growth . OBJECTIVE We tested a hypothesis that provision of small-quantity lipid-based nutrient supplements ( SQ-LNSs ) to mothers in pregnancy and 6 mo postpartum and to their infants from 6 to 18 mo of age would promote infant and child growth in the study area in rural Malawi . METHODS We enrolled 869 pregnant women in a r and omized trial in Malawi . During pregnancy and 6 mo thereafter , the women received daily 1 capsule of iron-folic acid ( IFA ) , 1 capsule containing 18 micronutrients ( MMN ) , or one 20-g sachet of SQ-LNS [ lipid-based nutrient supplements ( LNS ) , containing 21 MMN , protein , carbohydrates , essential fatty acids , and 118 kcal ] . Children in the IFA and MMN groups received no supplementation ; children in the LNS group received SQ-LNSs from 6 to 18 mo . Primary outcome was child length at 18 mo . RESULTS At 18 mo , the mean length in the IFA , MMN  , and LNS groups was 77.0 , 76.9 , and 76.8 cm ( P = 0.90 ) , respectively , and the prevalence of stunting was 32.7 % , 35.6 % , and 37.9 % ( P = 0.54 ) , respectively . No intergroup differences were found in the mean weight , head circumference , or midupper arm circumference or the proportions with low z scores for these variables ( P > 0.05 ) . Covariate adjustment did not change the analysis results , and the associations between the intervention and child length were not modified by maternal parity , age , or nutritional status ( P > 0.10 ) . CONCLUSIONS The findings do not support a hypothesis that provision of SQ-LNSs to women in pregnancy and postpartum and to children from 6 to 18 mo of age would promote child growth in this Malawian study area . This trial was registered at clinical trials.gov as NCT01239693 Background : Maternal iodine deficiency during pregnancy and lactation is common in Bangladesh . Objective : We evaluated the effect of lipid-based nutrient supplements for pregnant and lactating women ( LNS-PL ) on urinary iodine concentration ( UIC ) . Methods : We conducted a cluster-r and omized controlled effectiveness trial in which we enrolled 4011 pregnant women at ≤20 gestational weeks . Women in 48 clusters received iron and folic acid ( IFA ; 60 mg Fe/d + 400 μg folic acid/d ) and women in 16 clusters received LNS-PL ( 20 g/d , 118 kcal ) containing 22 vitamins and minerals ( including 250 μg I ) . We r and omly selected a sub sample of 1159 women for repeated urine sample collection , i.e. , at enrollment , at 36 wk of gestation , and at 6 mo postpartum , for UIC analysis , a secondary outcome of the trial . Results : The geometric mean UIC at 36 wk of gestation and at 6 mo postpartum did not differ significantly between the IFA and LNS-PL groups . The median ( quartile 1 , quartile 3 ) UIC at 36 wk was 27.4 μg/L ( 16.9 , 52.7 μg/L ) in the IFA group and 30.2 μg/L ( 17.7 , 56.6 μg/L ) in the LNS-PL group ; at 6 mo , these were 23.0 μg/L ( 10.0 , 45.9 μg/L ) in the IFA group and 22.2 μg/L ( 9.1 , 50.4 μg/L ) in the LNS-PL group . Conclusion : Daily consumption of LNS-PL containing 250 μg I did not increase the UICs of pregnant and lactating women in Bangladesh . Iodine from lipid-based nutrient supplements may have been stored in the thyroid gl and or secreted in breast milk instead of being excreted in urine . Additional research that uses other biomarkers of iodine status is needed to determine how to meet the iodine requirements of pregnant and lactating women in Bangladesh and similar setting s. This trial was registered at clinical trials.gov as NCT01715038 Abstract We examined hemoglobin ( Hb , g/L ) , iron status ( zinc protoporphyrin , ZPP , & mgr;mol/mol heme , and transferrin receptor , TfR , mg/L ) and inflammation ( C‐reactive protein , CRP and alpha‐1 glycoprotein , AGP ) in pregnant Ghanaian women who participated in a r and omized controlled trial . Women ( n = 1320 ) received either 60 mg Fe + 400‐&mgr;g folic acid ( IFA ) ; 18 micronutrients including 20‐mg Fe ( MMN ) or small‐quantity lipid‐based nutrient supplements ( SQ‐LNS , 118 kcal/d ) with the same micronutrient levels as in MMN , plus four additional minerals ( LNS ) daily during pregnancy . Intention‐to‐treat analysis included 349 , 354 and 354 women in the IFA , MMN and LNS groups , respectively , with overall baseline mean Hb and anemia ( Hb < 100 ) prevalence of 112 and 13.3 % , respectively . At 36 gestational weeks , overall Hb was 117 , and anemia prevalence was 5.3 % . Compared with the IFA group , the LNS and MMN groups had lower mean Hb ( 120 ± 11 vs. 115 ± 12 and 117 ± 12 , respectively ; P < 0.001 ) , higher mean ZPP ( 42 ± 30 vs. 50 ± 29 and 49 ± 30 ; P = 0.010 ) and TfR ( 4.0 ± 1.3 vs. 4.9 ± 1.8 and 4.6 ± 1.7 ; P < 0.001 ) , and greater prevalence of anemia ( 2.2 % vs. 7.9 % and 5.8 % ; P = 0.019 ) , elevated ZPP ( > 60 ) [ 9.4 % vs. 18.6 % and 19.2 % ; P = 0.003 ] and elevated TfR ( > 6.0 ) [ 9.0 % vs. 19.2 % and 15.1 % ; P = 0.004 ] . CRP and AGP concentrations did not differ among groups . We conclude that among pregnant women in a semi‐urban setting in Ghana , supplementation with SQ‐LNS or MMN containing 20 mg iron result ed in lower Hb and iron status but had no impact on inflammation , when compared with iron ( 60 mg ) plus folic acid ( 400 & mgr;g ) . The amount of iron in such supplements that is most effective for improving both maternal Hb/iron status and birth outcomes requires further evaluation . This trial was registered at Clinical Trials.gov as : NCT00970866 Background : It is unknown whether self-reported measures of household food insecurity change in response to food-based nutrient supplementation . Objective : We assessed the impacts of providing lipid-based nutrient supplements ( LNSs ) to women during pregnancy and postpartum and /or to their children on self-reported household food insecurity in Malawi [ DOSE and DYAD trial in Malawi ( DYAD-M ) ] , Ghana [ DYAD trial in Ghana ( DYAD-G ) ] , and Bangladesh [ Rang-Din Nutrition Study ( RDNS ) trial ] . Methods : Longitudinal household food-insecurity data were collected during 3 individually r and omized trials and 1 cluster-r and omized trial testing the efficacy or effectiveness of LNSs ( generally 118 kcal/d ) . Seasonally adjusted Household Food Insecurity Access Scale ( HFIAS ) scores were constructed for 1127 DOSE households , 732 DYAD-M households , 1109 DYAD-G households , and 3671 RDNS households . The impact of providing LNSs to women during pregnancy and the first 6 mo postpartum and /or to their children from 6 to 18–24 mo on seasonally adjusted HFIAS scores was assessed by using negative binomial models ( DOSE , DYAD-M , and DYAD-G trials ) and mixed-effect negative binomial models ( RDNS trial ) . Results : In the DOSE and DYAD-G trials , seasonally adjusted HFIAS scores were not different between the LNS and non-LNS groups . In the DYAD-M trial , the average household food-insecurity scores were 14 % lower ( P = 0.01 ) in LNS households than in non-LNS households . In the RDNS trial , compared with non-LNS households , food-insecurity scores were 17 % lower ( P = 0.02 ) during pregnancy and the first 6 mo postpartum and 15 % lower ( P = 0.02 ) at 6–24 mo postpartum in LNS households . Conclusions : The daily provision of LNSs to mothers and their children throughout much of the “ first 1000 d ” may improve household food security in some setting s , which could be viewed as an additional benefit that may accrue in households should policy makers choose to invest in LNSs to promote child growth and development . These trials were registered at clinical trials.gov as NCT00945698 ( DOSE ) NCT01239693 ( DYAD-M ) , NCT00970866 ( DYAD-G ) and NCT01715038 ( RDNS ) BACKGROUND Maternal and infant undernutrition is negatively associated with infant development . AIMS We tested the hypothesis that provision of small-quantity lipid-based nutrient supplements ( SQ-LNS ) to pregnant women and infants positively affects infant development . STUDY DESIGN In a partially double-blind r and omized controlled trial , we compared the following daily maternal supplements during pregnancy and until 6months post-partum : iron/folic acid capsule ( IFA ) , capsule containing 18 micronutrients ( MMN ) , or 20 g SQ-LNS .  Children in the SQ-LNS group also received SQ-LNS from age 6 to 18months . The study is registered as NCT00970866 . SUBJECTS 1320 pregnant women in Ghana enrolled in the trial ; 1173 of their children participated in developmental assessment . OUTCOME MEASURES We monitored the acquisition of 10 developmental milestones monthly by parental report , observed the attainment of 6 motor milestones at 6 , 12 , and 18months , and conducted detailed assessment of motor , language , socio-emotional , and executive function at 18months . RESULTS By research er observation , a greater percentage of children in the SQ-LNS group ( 53 % ) was able to walk alone at 12months than in the IFA group ( 43 % ; RR=1.23 , 95 % CI=1.02 - 1.49 ; p=0.025 ) . We found no significant differences between groups in milestone acquisition by parent report or in any scores at 18months . The difference in mean z-scores between groups ranged from 0.03 - 0.13 for motor ( p=0.84 ) , 0.01 - 0.08 for language ( p=0.46 ) , 0.01 - 0.02 for socio-emotional ( p=0.75 ) , and 0.00 - 0.02 for executive function ( p=0.95 ) . CONCLUSION While provision of maternal and child SQ-LNS in Ghana may affect walking at 12months , it did not affect infant development at 18months Background Prenatal micronutrient supplements have been found to increase birth weight , but mechanisms for increased growth are poorly understood . Our hypotheses were that 1 ) women who receive lipid-based nutrient supplements ( LNS )  during pregnancy would have lower mean salivary cortisol concentration at 28 wk and 36 wk gestation compared to the multiple micronutrient ( MMN ) and iron-folic acid ( IFA ) supplement groups and 2 ) both salivary cortisol and perceived stress during pregnancy would be associated with shorter duration of gestation and smaller size at birth . Methods Women were enrolled in the trial in early pregnancy and r and omized to receive LNS , MMN , or iron-folic acid ( IFA ) supplements daily throughout pregnancy . At enrollment , 28 wk and 36 wk gestation , saliva sample s were collected and their cortisol concentration was measured . Self-report of perceived stress was measured using question naires . Gestation duration was indicated by ultrasound dating and newborn anthropometric measurements ( weight , length , head circumference ) provided indicators of intrauterine growth . Results Of the 1391 women enrolled in the trial , 1372 , 906 and 1049 saliva sample s were collected from women at baseline , 28 wk and 36 wk , respectively . There were no significant differences in mean cortisol concentrations by intervention group at 28 wk or 36 wk gestation . Cortisol concentrations were negatively associated with duration of gestation ( Baseline : β = −0.05 , p = 0.039 ; 36 wk : β = −0.04 , p = 0.037 ) and birth weight ( 28 wk : β = −0.08 , p = 0.035 ; 36 wk : β = −0.11 , p = 0.003 ) but not associated with length-for-age or head circumference-for-age z-scores . Perceived stress at 36 wk was significantly associated with shorter newborn LAZ ( p = 0.001 ) . There were no significant associations with the risk of small for gestational age , preterm birth , or low birth weight . Conclusions Maternal salivary cortisol concentration was strongly associated with birth weight and duration of gestation in rural Malawi , but these data do not support the hypothesis that LNS provision to pregnant women would influence their salivary cortisol concentrations . Trial registration Clinical trials.gov identifier BACKGROUND Maternal nutritional status is a major determinant of low birth weight and fluctuates across seasons . Seasonality may influence the outcome of prenatal nutrition interventions that aim to enhance fetal growth . OBJECTIVE This study investigated seasonal modifications of the efficacy of a r and omized controlled prenatal nutrition intervention trial in pregnant women to improve fetal growth in rural Burkina Faso . METHODS The second Micronutriments et Santé de la Mère et de l'Enfant study compared a lipid-based nutrient supplement ( LNS ) fortified with multiple micronutrients ( MMNs ) to an MMN supplement . Truncated Fourier series were used to characterize seasonality in birth outcomes . Models that included the Fourier series and newborn and maternal characteristics were used to assess seasonal effect modifications of prenatal supplementation on birth outcomes . RESULTS Birth weight , birth length , small for gestational age as a proxy for intrauterine growth retardation , and preterm birth were significantly related to date of birth and showed important seasonal variations . LNSs , which supply energy in addition to MMNs , result ed in a significant increase in birth length ( + 13.5 mm , 95 % CI : 6.5 , 20.5 mm ) at the transition from rain to dry season ( September to November ) compared to MMNs alone . CONCLUSIONS The climatologic and agricultural seasonal patterns in Burkina Faso affect the efficacy of prenatal LNSs on birth length . In this context , prenatal MMN supplementation programs should be complemented by energy supplementation during the annual rain season to promote fetal growth . This trial was registered at clinical trials.gov as NCT00909974 BACKGROUND Vitamin A deficiency remains a global public health problem . Daily supplementation with a lipid-based nutrient supplement ( LNS ) has potential for increasing milk vitamin A concentrations . OBJECTIVE The objective of this study was to determine whether daily supplementation with approximately the recommended daily intake of vitamin A in an LNS or a multiple-micronutrient supplement ( MMN ) during pregnancy and the first 6 mo postpartum has an effect on breast milk retinol concentration at 6 mo postpartum . METHODS Women ≤20 wk pregnant ( n = 1320 ) were r and omly assigned to receive either the MMN providing 18 micronutrients , including 800 μg retinol equivalents of vitamin A , or the LNS with the same nutrients as the MMN group , plus 4 minerals and macronutrients , until 6 mo postpartum ; a control group received iron and folic acid during pregnancy and a placebo ( calcium tablet ) during the first 6 mo postpartum . Breast milk sample s collected at 6 mo postpartum were analyzed for retinol and fat concentrations by HPLC and creamatocrit , respectively , in a sub sample of 756 women . RESULTS The breast milk retinol concentration was ( mean ± SD ) 56.3 ± 2.1 nmol/g fat , with no significant differences between groups [ iron and folic acid ( n = 243 ) : 59.1 ± 2.8 ; MMN ( n = 260 ) : 55.4 ± 2.5 ; LNS ( n = 253 ) : 54.7 ± 2.5 nmol/g fat ; P = 0.45 ] , regardless of whether the woman had or had not received a high-dose vitamin A supplement ( 200,000 IU ) soon after childbirth . Around 17 % of participants had low milk retinol ( ≤28 nmol/g fat ) . We estimated that 41 % of infants were potentially receiving vitamin A at amounts above the Tolerable Upper Intake Level ( 600 μg retinol activity equivalents/d ) , with no group differences in percentages with low or high milk retinol concentration . CONCLUSION Daily consumption of approximately the recommended intake of vitamin A did not increase breast milk retinol concentrations in this sample of Ghanaian women . This trial was registered at clinical trials.gov as NCT00970866 Background : It is unclear whether maternal supplementation with small-quantity lipid-based nutrient supplements ( SQ-LNSs ; 118 kcal/d ) affects maternal weight . Objective : We compared several secondary anthropometric measures between 3 groups of women in the iLiNS ( International Lipid-based Nutrient Supplements)-DYAD trial in Ghana . Methods : Women ( n = 1320 ; < 20 wk of gestation ) were r and omly assigned to receive 60 mg Fe + 400 μg folic acid/d ( IFA ) , 18 vitamins and minerals/d [ multiple micronutrients ( MMNs ) ] , or 20 g SQ-LNSs with 22 micronutrients/d ( LNS ) during pregnancy and a placebo ( 200 mg Ca/d ) , MMNs , or SQ-LNSs , respectively , for 6 mo postpartum . Weight , midupper arm circumference ( MUAC ) , and triceps skinfold ( TSF ) thickness at 36 wk of gestation and 6 mo postpartum were analyzed , as were changes from estimated prepregnancy values . We assessed the adequacy of estimated gestational weight gain ( GWG ) by using Institute of Medicine ( IOM ) and International Fetal and Newborn Growth St and ards for the 21st Century ( INTERGROWTH-21st ) guidelines . Results : The estimated prepregnancy prevalence of overweight or obesity was 38.5 % . By 36 wk of gestation , women ( n = 1015 ) had a mean ± SD weight gain of 7.4 ± 3.7 kg and changes of −1.0 ± 1.7 cm in MUAC and −2.8 ± 4.1 mm in TSF thickness . The LNS group had a lower prevalence of inadequate GWG on the basis of IOM guidelines ( 57.4 % ) than the MMN ( 67.2 % ) but not the IFA ( 63.1 % ) groups ( P = 0.030 ) , whereas the prevalence of adequate ( 26.9 % overall ) and excessive ( 10.4 % overall ) GWG did not differ by group . The percentages of normal-weight women ( in kg/m2 : 18.5 < body mass index < 25.0 ; n = 754 ) whose GWG was less than the third centile of the INTERGROWTH-21st st and ards were 23.0 % , 28.7 % , and 28.5 % for the LNS , MMN , and IFA groups , respectively ( P = 0.36 ) . At 6 mo postpartum , the prevalence of overweight or obesity was 45.3 % , and the risk of becoming overweight or obese did not differ by group . Conclusion : SQ-LNS supplementation is one potential strategy to address the high prevalence of inadequate GWG in women in setting s similar to Ghana , without increasing the risk of excessive GWG . This trial was registered at clinical trials.gov as NCT00970866
BACKGROUND Ready-to-use lipid-based nutrient supplements ( LNS ) are a highly nutrient-dense supplement , which could be a good source of macro- and micronutrients for pregnant women who need to supplement their nutrient intake .
OBJECTIVES To assess the effects of LNS for maternal , birth and infant outcomes in pregnant women .
Secondary objectives were to explore the most appropriate composition , frequency and duration of LNS administration .