Impact of early supplementation with lipid-based nutrients on cardiovascular health and later child development in rural Malawian children, Version 2.0
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Date
2021-12-01
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Kamuzu University of Health Sciences
Abstract
Type of research study: Prospective observational study
The Problem:
In 2011 an estimated 161 million children less than 5 years of age in low- and middle-income
countries experienced stunting (measured as-2 SD from the length-for-age/height-for-age World
Health Organization Child Growth Standards median). It is well established that the initial years of
life are critical for cognitive, motor and social development and adverse growth environment may
lead to compromised development (Sudfeld et al., 2015). New estimates indicate that 43% of under‐
5‐year‐old children in low‐income and middle‐income countries are at risk of not reaching their
developmental potential because of adversities throughout prenatal and early life, which can disrupt
brain development. Nutritional supplementation may mitigate these adverse outcomes. Lipid‐based
nutrient supplements (LNS) is a novel family of micronutrient–fortified, ready‐to‐use products that
may boost length gain and reduce growth failure. However, whilst adding SQ‐LNS to the diets of
the mothers and their children may carry beneficial effects on neural function status and functional
outcomes, it can potentially have adverse effects on their cardiometabolic health.
We have completed a clinical trial (iLiNS‐DYAD‐M) in Malawi, testing the health and growth
impacts of small quantity lipid‐based nutrient supplement (SQ‐LNS) provision to pregnant and
lactating women and their offspring from 6 to 18 months of age. This cohort of 781 intensively
monitored women and children offers a unique possibility to assess the impact of SQ‐LNS
intervention on child development and to evaluate its potential negative impacts on cardiometabolic
health. Importantly, the supplement’s essential fatty acid (EFA) content was designed to promote
neurodevelopmental processes (e.g. myelination) and facilitate cognitive and functional processes
that typically manifest only later in childhood. Unlike linear growth, brain myelination is not
affected by the child’s infections, which were common in the study sample. Therefore, even though
the intervention did not affect children’s linear growth in the first 18 months, there are good reasons
to predict beneficial impact on key aspects of early brain development and, by consequence,
children’s long‐term cognitive outcome.
Broad Objectives:
To evaluate whether the nutritional supplementation with SQ-LNS provided during gestation and
early childhood had an impact on cardiometabolic health, and neurodevelopment. Specific objectives:
Objective 1: To evaluate the effect of SQ-LNS supplementation to mother‐infant pairs on key
components of cardiometabolic health: body composition, blood pressure and plasma lipids.
Objective 2: To determine if SQ‐LNS supplementation to mother‐infant pairs improves the
children’s neural function, cognitive skills, and academic achievement later in childhood.
Objective 3: To develop a comprehensive concept map, illustrating how various antenatal and
postnatal exposures influence neural function, cognitive skills and educational attainment by 9 years
of age.
Methodology: This is a follow-up of children whose mothers were recruited in the International
Lipid-Based Nutrients Supplement (iLiNS-DYAD) trial, a three-arm randomized controlled trial.
Participants of the randomized controlled iLiNS‐DYAD‐M trial, last seen at 2.5 years of age, will
be re‐invited to three follow‐up visits when they will be about 9 years old. On visit 1 and 2, we will
assess children’s neural function, and cognitive and academic outcomes. On visit 3, we will assess
child size with standard anthropometrics, her/his body composition with bioimpedance
measurements, respiratory health by spirometry and hemodynamics with oscillometric blood
pressure monitoring system. Additionally, we will collect a blood sample to study lipid and glucose
metabolism.
Expected findings and their dissemination: The project is expected to produce results on possible
cardiometabolic effects of supplementation provided during gestation and early childhood which
can guide future programs. Additionally, we will produce information on the impact of SQ‐LNS
supplementation and other exposures on child development, thus facilitating designing and adoption
of interventions that can promote human capacity and child wellbeing. We will add to the evidence
base on neurocognitive research methods as well as hemodynamics. Results from the study will be
disseminated locally (at Mangochi District Hospital), nationally (College of Medicine, Ministry of
Health, College of Medicine Research and Ethics Committee COMREC) and in international
meetings and journals.