Interventions and public health nutrition

Efficacy of novel small-quantity lipid-based nutrient supplements in improving long-chain polyunsaturated fatty acid status of South African infants: a randomised controlled trial



The objective of this study was to investigate the efficacy of small-quantity lipid-based nutrient supplements (SQ-LNS) containing essential fatty acids (EFAs) with or without long-chain polyunsaturated fatty acids (LCPUFAs) in improving LCPUFA status in South African infants fed complementary food.


Six-month-old infants (n = 750) were randomised to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNSs contained micronutrients and EFAs. SQ-LNS-plus additionally contained the LCPUFAs arachidonic acid (AA) and docosahexaenoic acid (DHA), lysine, phytase and other nutrients. Plasma total phospholipid FA composition (% of total FAs) was measured at baseline (n = 353) and at 12 months (n = 293).


At baseline, geometric mean (95% CI) plasma DHA and AA were 4.1 (4.0–4.3) and 11.5 (11.2–11.8)% respectively, with significantly higher plasma DHA and AA in breastfed than non-breastfed infants. Infants receiving the SQ-LNS-plus had significantly higher plasma DHA (4.52 (4.3–4.9)) at 12 months than the controls (3.8 (3.6–4.0)), with a higher effect size in infants who no longer received breast milk (β = 1.148 (95% CI = 0.597, 1.699)) than in infants who were still breastfeeding (β = 0.544 (95% CI = 0.179, 0.909)). There was no effect of either of the two SQ-LNSs on plasma AA. Consequently, infants receiving the SQ-LNS-plus had a significantly lower plasma n-6 to n-3 PUFA ratio at 12 months than control infants did.


Our study suggests that the provision of SQ-LNS-plus is efficacious in improving plasma DHA status. Particularly, infants who are no longer breastfed may benefit most from LCPUFA-enriched SQ-LNS.

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We extend our utmost gratitude to all the caregivers and infants who participated in the study as well as all the fieldworkers for their hard work and dedication to the study. We also thank nurses Chrissie Lessing and Linda Lemmer for their invaluable clinical expertise as well as the laboratory team of the Centre of Excellence for Nutrition for their support and lab assistance.


Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland, funded the main Tswaka study. DSM & UNILEVER were co-funders. UNILEVER R&D Vlaardingen B.V. (Vlaardingen, The Netherlands) provided the SQ-LNS product. DSM Nutritional products Ltd supplied the SQ-LNS-plus.

Author information




CMS, JB and MF conceptualised and designed the study; CMS was the principal investigator of the Tswaka study and had overall responsibility for data collection. MF was the co-principal investigator of the Tswaka study, contributed to the study design and provided guidance on analysis of feeding practices. MR and TMM were the study co-ordinators of the Tswaka study and helped to execute the study. MR, TMM and LPS executed the study and collected data. LPS quantified the plasma phospholipid FAs. LPS and JB performed statistical analyses; CMS and JB provided guidance on statistical analysis and interpretation. LPS wrote the first draft of the manuscript and all authors read, revised and edited the manuscript.

Corresponding author

Correspondence to Cornelius M. Smuts.

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Conflict of interest

CMS received travel support from Unilever, DSM and Sight and Life; TMM received a speaking honorarium from DSM; LPS received travel support from DSM and Sight and Life. However, the principal investigator (CMS) made final decisions on the interpretation and dissemination of results. None of the other researchers has any conflict of interest.

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Siziba, L.P., Baumgartner, J., Rothman, M. et al. Efficacy of novel small-quantity lipid-based nutrient supplements in improving long-chain polyunsaturated fatty acid status of South African infants: a randomised controlled trial. Eur J Clin Nutr 74, 193–202 (2020).

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