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Maternal and Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial.
J Nutr. 2019 01 01; 149(1):149-158.JN

Abstract

Background

Interventions are needed to address iron deficiency in low-income settings.

Objective

This secondary outcome analysis aimed to compare the hemoglobin (Hb) and iron status [zinc protoporphyrin (ZPP)] of children born to women enrolled in the iLiNS-DYAD trial in Ghana.

Methods

Women ≤20 wk pregnant (n = 1320) were assigned to receive 60 mg Fe/d and 400 µg folic acid/d until delivery and placebo thereafter, and no supplementation for infants (IFA group); or multiple micronutrients containing 20 mg Fe/d until 6 mo postpartum and no supplementation for infants (MMN); or small-quantity lipid-based nutrient supplements (SQ-LNSs) containing 20 mg Fe/d until 6 mo postpartum, and SQ-LNSs for infants from 6 to 18 mo of age (LNS). We compared infants' Hb (g/L) and ZPP (µmol/mol heme) at 6 and 18 mo of age.

Results

At 6 mo of age, groups did not differ in mean ± SD Hb (overall: 113 ± 9.9 g/L) or geometric mean (95% CI) ZPP [overall: 62.6 (60.6, 64.7)]. At 18 mo of age, mean ± SD Hb (overall: 112 ± 10.4 g/L) did not differ significantly between groups, whereas geometric mean (95% CI) ZPP was lower (P = 0.031) in the LNS group [53.9 (50.7, 57.3)] than the IFA [60.4 (56.7, 64.3)] but not the MMN [58.8 (55.6, 62.2)] group. Further, the LNS group, compared with the IFA and MMN groups combined, had a lower prevalence of elevated (>70) ZPP (27.5% compared with 35%; P = 0.02) and a marginally lower prevalence of anemia (38.7% compared with 44.9%; P = 0.06). These results generally remained unchanged when controlling for prespecified covariates or correcting for inflammation.

Conclusions

In this setting, providing SQ-LNSs or multiple micronutrients with 20 mg Fe/d, compared with iron (60 mg/d) and folic acid, to pregnant women does not affect their infants' Hb or iron status at 6 mo of age, but maternal and infant supplementation with SQ-LNSs increases infants' iron status at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT00970866.

Authors+Show Affiliations

Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA.Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana. Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA.Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI.Intake-Center for Dietary Assessment, FHI 360, Washington, DC.Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA.

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30624674

Citation

Adu-Afarwuah, Seth, et al. "Maternal and Infant Supplementation With Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: a Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial." The Journal of Nutrition, vol. 149, no. 1, 2019, pp. 149-158.
Adu-Afarwuah S, Young RT, Lartey A, et al. Maternal and Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial. J Nutr. 2019;149(1):149-158.
Adu-Afarwuah, S., Young, R. T., Lartey, A., Okronipa, H., Ashorn, P., Ashorn, U., Oaks, B. M., Arimond, M., & Dewey, K. G. (2019). Maternal and Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial. The Journal of Nutrition, 149(1), 149-158. https://doi.org/10.1093/jn/nxy225
Adu-Afarwuah S, et al. Maternal and Infant Supplementation With Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: a Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial. J Nutr. 2019 01 1;149(1):149-158. PubMed PMID: 30624674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal and Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial. AU - Adu-Afarwuah,Seth, AU - Young,Rebecca T, AU - Lartey,Anna, AU - Okronipa,Harriet, AU - Ashorn,Per, AU - Ashorn,Ulla, AU - Oaks,Brietta M, AU - Arimond,Mary, AU - Dewey,Kathryn G, PY - 2018/05/24/received PY - 2018/08/10/accepted PY - 2019/1/10/pubmed PY - 2019/11/7/medline PY - 2019/1/10/entrez SP - 149 EP - 158 JF - The Journal of nutrition JO - J Nutr VL - 149 IS - 1 N2 - Background: Interventions are needed to address iron deficiency in low-income settings. Objective: This secondary outcome analysis aimed to compare the hemoglobin (Hb) and iron status [zinc protoporphyrin (ZPP)] of children born to women enrolled in the iLiNS-DYAD trial in Ghana. Methods: Women ≤20 wk pregnant (n = 1320) were assigned to receive 60 mg Fe/d and 400 µg folic acid/d until delivery and placebo thereafter, and no supplementation for infants (IFA group); or multiple micronutrients containing 20 mg Fe/d until 6 mo postpartum and no supplementation for infants (MMN); or small-quantity lipid-based nutrient supplements (SQ-LNSs) containing 20 mg Fe/d until 6 mo postpartum, and SQ-LNSs for infants from 6 to 18 mo of age (LNS). We compared infants' Hb (g/L) and ZPP (µmol/mol heme) at 6 and 18 mo of age. Results: At 6 mo of age, groups did not differ in mean ± SD Hb (overall: 113 ± 9.9 g/L) or geometric mean (95% CI) ZPP [overall: 62.6 (60.6, 64.7)]. At 18 mo of age, mean ± SD Hb (overall: 112 ± 10.4 g/L) did not differ significantly between groups, whereas geometric mean (95% CI) ZPP was lower (P = 0.031) in the LNS group [53.9 (50.7, 57.3)] than the IFA [60.4 (56.7, 64.3)] but not the MMN [58.8 (55.6, 62.2)] group. Further, the LNS group, compared with the IFA and MMN groups combined, had a lower prevalence of elevated (>70) ZPP (27.5% compared with 35%; P = 0.02) and a marginally lower prevalence of anemia (38.7% compared with 44.9%; P = 0.06). These results generally remained unchanged when controlling for prespecified covariates or correcting for inflammation. Conclusions: In this setting, providing SQ-LNSs or multiple micronutrients with 20 mg Fe/d, compared with iron (60 mg/d) and folic acid, to pregnant women does not affect their infants' Hb or iron status at 6 mo of age, but maternal and infant supplementation with SQ-LNSs increases infants' iron status at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT00970866. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/30624674/Maternal_and_Infant_Supplementation_with_Small_Quantity_Lipid_Based_Nutrient_Supplements_Increases_Infants'_Iron_Status_at_18_Months_of_Age_in_a_Semiurban_Setting_in_Ghana:_A_Secondary_Outcome_Analysis_of_the_iLiNS_DYAD_Randomized_Controlled_Trial_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.1093/jn/nxy225 DB - PRIME DP - Unbound Medicine ER -