Small-quantity lipid-based nutrient supplements do not affect plasma or milk retinol concentrations among Malawian mothers, or plasma retinol concentrations among young Malawian or Ghanaian children in two randomized trials

Authors: HASKELL, MAJORIE - University Of California, Davis; YOUNG, REBECCA - University Of California, Davis; LARTEY, ANNA - University Of Ghana; EYRAM TEIKO OKRONIPA, HARRIET - University Of Ghana; MALETA, KENNETH - University Of Malawi; ASHORN, ULLA - University Of Tampere; JORGENSEN, JOSH - University Of California, Davis; YUE-MEI, FAN - University Of Tampere; ARNOLD, CHARLES - University Of California, Davis; Allen, Lindsay - A; PER, ASHORN - Tampere University Hospital; DEWEY, KATHRYN - University Of California, Davis

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/15/2020
Publication Date: 2/9/2021
Citation: Haskell, M.J., Young, R., Lartey, A., Eyram Teiko Okronipa, H., Maleta, K., Ashorn, U., Jorgensen, J.M., Yue-Mei, F., Arnold, C., Allen, L.H., Per, A., Dewey, K.G. 2021. Small-quantity lipid-based nutrient supplements do not affect plasma or milk retinol concentrations among Malawian mothers, or plasma retinol concentrations among young Malawian or Ghanaian children in two randomized trials. Journal of Nutrition. 151(4):1029-1037. https://doi.org/10.1093/jn/nxaa439.
DOI: https://doi.org/10.1093/jn/nxaa439

Interpretive Summary: Abstract Background: Vitamin A deficiency is prevalent in preschool aged children in sub-Saharan Africa. Objective: To assess the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6-18 mo of age on women’s plasma and milk retinol concentrations in Malawi, and children’s plasma retinol concentration in Malawi and Ghana. Methods: Pregnant women (=20 wk gestation) were randomized to receive daily either: 1) iron and folic acid (IFA) during pregnancy only; 2) multiple micronutrients (MMN; 800 µg RE/capsule) or 3) SQ-LNS (800 µg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 µg RE/20 g) from 6-18 mo of age; children of mothers in the IFA or MMN groups received no supplement. Plasma retinol was measured in mothers at =20 wk gestation, 36 wk gestation, and 6 mo postpartum; and in children at 6 mo and 18 mo of age. Milk retinol was measured at 6 mo postpartum. Results: Among Malawian mothers, geometric mean (GM) (95% CI) plasma retinol concentrations at 36 wk gestation and 6 mo postpartum were 0.97 µmol/L (0.94, 1.01), and 1.35 µmol/L (1.31, 1.39), respectively; GM (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 µmol/L (0.97, 1.13); results did not differ by intervention group. GM (95% CI) plasma retinol concentrations for Malawian children at 6 mo and 18 mo of age were 0.78 µmol/L (0.75, 0.81), and 0.81 µmol/L (0.78, 0.85), respectively; and for Ghanaian children, 0.85 µmol/L (0.82, 0.88), and 0.88 µmol/L (0.85, 0.91); respectively; results did not differ by intervention group in either setting. Conclusions: SQ-LNS had no effect on vitamin A status of mothers or children, possibly because of low sensitivity of plasma retinol and milk retinol (when unadjusted for milk fat).

Technical Abstract: Background: Vitamin A deficiency is prevalent in preschool aged children in sub-Saharan Africa. Objective: To assess the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6-18 mo of age on women’s plasma and milk retinol concentrations in Malawi, and children’s plasma retinol concentration in Malawi and Ghana. Methods: Pregnant women (=20 wk gestation) were randomized to receive daily either: 1) iron and folic acid (IFA) during pregnancy only; 2) multiple micronutrients (MMN; 800 µg RE/capsule) or 3) SQ-LNS (800 µg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 µg RE/20 g) from 6-18 mo of age; children of mothers in the IFA or MMN groups received no supplement. Plasma retinol was measured in mothers at =20 wk gestation, 36 wk gestation, and 6 mo postpartum; and in children at 6 mo and 18 mo of age. Milk retinol was measured at 6 mo postpartum. Results: Among Malawian mothers, geometric mean (GM) (95% CI) plasma retinol concentrations at 36 wk gestation and 6 mo postpartum were 0.97 µmol/L (0.94, 1.01), and 1.35 µmol/L (1.31, 1.39), respectively; GM (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 µmol/L (0.97, 1.13); results did not differ by intervention group. GM (95% CI) plasma retinol concentrations for Malawian children at 6 mo and 18 mo of age were 0.78 µmol/L (0.75, 0.81), and 0.81 µmol/L (0.78, 0.85), respectively; and for Ghanaian children, 0.85 µmol/L (0.82, 0.88), and 0.88 µmol/L (0.85, 0.91); respectively; results did not differ by intervention group in either setting. Conclusions: SQ-LNS had no effect on vitamin A status of mothers or children, possibly because of low sensitivity of plasma retinol and milk retinol (when unadjusted for milk fat).