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J Nutr. 2015 Jun;145(6):1345-53. doi: 10.3945/jn.114.207225. Epub 2015 Apr 29.

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.

Author information

Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland;
Department for International Health, University of Tampere School of Medicine, Tampere, Finland;
Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore;
Departments of Nutrition and.
Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi;
Department of Nutrition & Food Science, University of Ghana, Accra, Ghana; and.
Agricultural and Resource Economics, University of California, Davis, Davis, CA;
Department for External Research and Nutrition Strategies Nutriset S.A.S., Malaunay, France.



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.


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.


We enrolled 869 pregnant women in a randomized 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.


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).


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 as NCT01239693.


LNS; Sub-Saharan Africa; dietary supplementation; infant; linear growth failure; postnatal intervention; prenatal intervention; stunting

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