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.

Randomized controlled trial in rural Malawi among pregnant women and their singleton children, followed from pregnancy through 18 months of age. The active LNS arm included 281 randomized participants and was compared with standard iron and folic acid or multiple micronutrient regimens.

In the active LNS arm, mothers received small-quantity lipid-based nutrient supplements during pregnancy and for 6 months postpartum as 1 daily 20 g sachet taken orally, providing 118 kcal and 21 micronutrients plus additional minerals, protein, and fat. Their children then received SQ-LNS from 6 to 18 months of age as 1 daily 20 g sachet mixed with porridge.

Overall, the combined maternal and child SQ-LNS regimen did not improve child growth by 18 months. Mean length was similar across groups at 18 months: 76.8 cm in the LNS arm versus 77.0 cm with iron and folic acid and 76.9 cm with multiple micronutrients; mean LAZ was also similar at -1.69, -1.63, and -1.64, respectively. There were no meaningful differences in weight, head circumference, midupper arm circumference, or stunting prevalence. A slower postnatal length gain in the LNS group versus the iron and folic acid group was observed, but it attenuated after adjustment for birth size; serious adverse events were evenly distributed and were not considered likely related to the trial products.

Single-site rural Malawi trial with a high-burden setting of food insecurity and maternal undernutrition, which may limit generalizability. The intervention also failed to show benefit across several growth endpoints, and one apparent difference in length gain was not robust after adjustment for birth size.