expert opinion

Lipid-based micronutrient supplementation shown to be effective in reducing stunting in newborn babies in Bangladesh

February 1, 2016

Professor Kathryn Dewey, Nutrition Department, University of California, Davis, USA

South Asia accounts for half of the globe’s low birth weight (LBW) babies. In Bangladesh, 37% of all babies are LBW, with 30% being wasted (low weight-for-length) and 20% stunted (low length-for-age). This poor start in life leads to poor subsequent growth and development during childhood, and a greatly increased vulnerability to chronic diseases during adulthood (2).

Whilst Bangladesh has been able to reduce child mortality, there has been little change recently in levels of stunting and wasting. In addition, the levels of micronutrient deficiency in women of childbearing age remain alarming. Iron and folic acid supplementation can reduce anemia and LBW (3), but using a more extensive multiple micronutrient (MMN) supplementation can provide additional benefits and has been found to reduce LBW by around 10% in low-income countries (4).

MMN can be provided in the form of an easy-to-consume lipid-based supplement where the dose is just 20 g per day. Mridha et al. (1) carried out a controlled trial in rural Bangladesh with pregnant and lactating women, where the lipid-based supplement was compared with interventions of a traditional MMN in powder form and a tablet of iron (60 mg) and folic acid (400 μg). The 20 g lipid supplement contained 50% fat and yielded 118 kcal. The lipid component was 46% linoleic acid and 5.9% alpha-linolenic acid. The vitamins used were A, C, thiamine, riboflavin, niacin, folic acid, pantothenic acid, B6, B12, D, E and K. The minerals used were zinc, copper, iron, calcium, phosphorous, potassium, magnesium, selenium, iodine and magnesium.

When considering all the mothers who consumed the lipid-based supplement, there was a 17% reduction in small head size, an 11% reduction in LBW and a 13% reduction in wasting of their newborn babies.

The most food-insecure participants were predictably those most assisted by the lipid-based multiple micronutrient supplement. Here, a 36% reduction in stunting was seen as well as a 0.5 week increase in the duration of pregnancy. The age of the mothers was also found to be very important as regards the effectiveness of the lipid-based multiple micronutrient supplement. Although the supplement reduced stunting in newborn babies by 21% in mothers aged 14 to 24 years, there was no significant effect observed in older women.

Professor Dewey and her team concluded that “lipid-based multiple micronutrient supplementation during pregnancy reduced newborn stunting, wasting, and small head size in the study population”.

References

  1. Mridha M.K., Matias S.L., Chaparro C.M., Paul R.R., Hussain S., Vosti S.A., Harding K.L., Cummins J.R., Day L.T., Saha S.L., Peerson J.M., and Dewey K.G.; “Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh”; Am J Clin Nutr 2015, Nov 25. pii: ajcn111336.
  2. De Onis M., Dewey K.G., Borghi E., Onyango A.W., Blössner M., Daelmans B., Piwoz E. and Branca F.; “The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions”; Matern Child Nutr 2013; 9 (suppl 2); 6–26.
  3. West K.P. Jr., Shamim A.A., Mehra S., Labrique A.B., Ali H., Shaikh S., Klemm R.D., Wu L.S., Mitra M., Haque R. et al.; “Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial”; JAMA 2014; 312: 2649–58.
  4. Schultink W.; “How to Improve Nutrition via Effective Programming” in Chapter 7 of “The Road to Good Nutrition”; Eds: Eggersdorfer M., Kraemer K., Ruel M. et al.; Karger, 2013.