Evidence map›Paper›PMID 34590114›Full record

SynthesisThe American journal of clinical nutrition2021

Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials.

K Ryan Wessells, Charles D Arnold, Christine P Stewart, Elizabeth L Prado, Souheila Abbeddou, Seth Adu-Afarwuah, Benjamin F Arnold, Per Ashorn, Ulla Ashorn, Elodie Becquey and 32 more

Registry-linked trialOpen access · hybridAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The American journal of clinical nutrition, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07592260 (OptiMAx), which is not on this map. Cited by 36 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 6 pooled it
4.0field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07592260 narecruitingnot on this mapstarted 2025, after this paper: background citation

OptiMAx: Incentivizing EPI Vaccination Via Distribution of SQ-LNS Nutritional Supplementation to Children From Age 6-11 Months Until 18 Months of Age in Rural Chad and Niger, With a Cost Effectiveness Analysis Protocol for a Research Study Nested in the OptiMA Research Study in Ngouri Health District, Lake Region, Chad and Mirriah Health District, Zinder Region, Niger

TypeinterventionalSponsorAlliance for International Medical ActionRan2025 to 2026Enrolled20,000ConditionsMalnutrition Severe, VaccinationArmssmall quantity lipid-based supplement (SQ-LNS)
3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 6 syntheses or guidelines pooled it, 46 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Trial
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Trial
  13. Trial
  14. Trial
  15. Article
  16. Article
  17. Review
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

42 authors at 20 institutions in 10 countries.

K Ryan WessellsInstitute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.ORCID 0000-0002-5485-7144
Charles D ArnoldInstitute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.ORCID 0000-0001-6510-3172
Christine P StewartInstitute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.ORCID 0000-0003-4575-8571
Elizabeth L PradoInstitute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.ORCID 0000-0002-5388-081X
Souheila AbbeddouPublic Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium.ORCID 0000-0002-1363-0170
Seth Adu-AfarwuahDepartment of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.ORCID 0000-0002-2720-5474
Benjamin F ArnoldFrancis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.ORCID 0000-0001-6105-7295
Per AshornCenter for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.ORCID 0000-0003-2311-2593
Ulla AshornCenter for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.ORCID 0000-0002-1720-868X
Elodie BecqueyPoverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.ORCID 0000-0002-8748-7637
Kenneth H BrownInstitute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.ORCID 0000-0001-6498-3120
Kendra A ByrdWorldFish, Bayan Lepas, Penang, Malaysia.ORCID 0000-0003-4528-752X
Rebecca K CampbellDivision of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA.ORCID 0000-0002-6466-1516
Parul ChristianProgram in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID 0000-0002-2908-1030
Lia C H FernaldSchool of Public Health, University of California, Berkeley, Berkeley, CA, USA.ORCID 0000-0003-1555-4607
Yue-Mei FanCenter for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.ORCID 0000-0002-3241-6225
Emanuela GalassoDevelopment Research Group, World Bank, Washington, DC, USA.ORCID 0000-0001-8620-057X
Sonja Y HessInstitute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.ORCID 0000-0002-4661-277X
Lieven HuybregtsPoverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.ORCID 0000-0002-3068-2853
Josh M JorgensenNutrition Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.ORCID 0000-0001-8299-2530
Marion KiprotichOne Acre Fund, Nairobi, Kenya.ORCID 0000-0003-4373-1252
Emma KortekangasCenter for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.ORCID 0000-0003-2568-1941
Anna LarteyDepartment of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.ORCID 0000-0002-7870-2606
Agnes Le PortIndependent consultant, Dakar, Senegal.ORCID 0000-0002-8337-6569
Jef L LeroyPoverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.ORCID 0000-0001-9371-3832
Audrie LinSchool of Public Health, University of California, Berkeley, Berkeley, CA, USA.ORCID 0000-0002-3877-3469
Kenneth MaletaDepartment of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.ORCID 0000-0002-2536-3938
Susana L MatiasDepartment of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA.ORCID 0000-0002-3635-7445
Mduduzi N N MbuyaZvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.ORCID 0000-0003-1230-2367
Malay K MridhaCenter for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh.ORCID 0000-0001-9226-457X
Kuda MutasaZvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.ORCID 0000-0003-4158-6282
Abu M NaserInternational Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh.
Rina R PaulCenter for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh.ORCID 0000-0002-1186-4854
Harriet OkronipaDepartment of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.ORCID 0000-0002-5373-6754
Jean-Bosco OuédraogoHealth Sciences Research Institute (IRSS), Bobo-Dioulasso, Burkina Faso.ORCID 0000-0003-0412-8733
Amy J PickeringSchool of Engineering, Tufts University, Medford, MA, USA.ORCID 0000-0001-6193-2221
Mahbubur RahmanInternational Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh.ORCID 0000-0003-0520-2683
Kerry SchulzeProgram in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID 0000-0003-3235-2695
Laura E SmithDepartment of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA.ORCID 0000-0002-4793-2791
Ann M WeberDivision of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA.ORCID 0000-0001-8130-5858
Amanda ZongroneIndependent consultant, Washington, DC, USA.ORCID 0000-0003-1134-088X
Kathryn G DeweyInstitute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.ORCID 0000-0002-4185-3451
University of California, Davis · USTampere University · FIInternational Food Policy Research Institute · USBerkeley Public Health Division · USJohns Hopkins University · USUniversity of Ghana · GHAmerican Society for Nutrition · USCornell University · USEmory University · USGhent University · BEHelen Keller International · USIndependent Sector · USInstitut de Recherche en Sciences de la Santé · BFInternational Centre for Diarrhoeal Disease Research · BDInternational School of Dakar · SNOregon State University · USTufts University · USUniversity at Buffalo, State University of New York · USUniversity of California, Berkeley · USUniversity of California, San Francisco · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSmall-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design.

objectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes.

methodsWe conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers.

resultsSQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics.

conclusionsSQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.

Indexed as

Dietary SupplementsInfant Nutritional Physiological PhenomenaNutritional StatusAfrica South of the SaharaAnemiaAnemia, Iron-DeficiencyBangladeshChild, PreschoolEffect Modifier, EpidemiologicFemaleHumansInfantLipidsMaleMicronutrientsRandomized Controlled Trials as TopicLipidsMicronutrientsanemiachild undernutritioncomplementary feedinghome fortificationiron deficiencymicronutrient statusnutrient supplements

Identifiers

PMID34590114
PMCPMC8560313
OpenAlexW3204135798

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.