Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

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

European Journal of Clinical Nutrition volume 74, pages 193–202 (2020)Cite this article

Subjects

Abstract

Background/objectives

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.

Subjects/methods

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).

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Carlson SE, Colombo J. Docosahexaenoic acid and arachidonic acid nutrition in early development. Adv Pediatr 2016;63:453–71.

    Article  Google Scholar 

  2. Innis SM. Fatty acids and early human development. Early Hum Dev 2007;83:761–6.

    Article  CAS  Google Scholar 

  3. Koletzko B, Lien E, Agostoni C, Böhles H, Campoy C, Cetin I, et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med [Internet]. 2008;36:5–14.

    CAS  Google Scholar 

  4. World Health Organization (WHO), United Nations Children Fund (UNICEF). Global strategy for infant and young child feeding. World Health Organization; 2003.

  5. Libuda L, Mesch CM, Stimming M, Demmelmair H, Koletzko B, Warschburger P, et al. Fatty acid supply with complementary foods and LC-PUFA status in healthy infants: results of a randomised controlled trial. Eur J Nutr 2016;55:1633–44.

    Article  CAS  Google Scholar 

  6. Michaelsen KF, Hoppe C, Roos N, Kaestel P, Stougaard M, Lauritzen L, et al. Choice of foods and ingredients for moderately malnourished children 6 months to 5 years of age. Food Nutr Bull 2009;30:S343–404.

    Article  Google Scholar 

  7. EFSA Panel on Dietetic Products N and A (NDA). Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA J 2013;11:3408.

    Google Scholar 

  8. Forsyth S, Gautier S, Salem JrN. Estimated dietary intakes of arachidonic sacid and docosahexaenoic acid in infants and young Children living in developing countries. Ann Nutr Metab 2016;69:64–74.

    Article  CAS  Google Scholar 

  9. Michaelsen KF, Dewey KG, Perez-Exposito AB, Nurhasan M, Lauritzen L, Roos N. Food sources intake n-6 n-3 Fat acids low-income countries Emphas infants, Young- child (6-24 Mon), pregnant Lactating women. Matern child Nutr 2011;7:124–40.

    Article  Google Scholar 

  10. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013;382:452–77.

    Article  Google Scholar 

  11. Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr 2007;86:412–20.

    Article  CAS  Google Scholar 

  12. Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, et al. Complementary feeding with fortified spread and incidence of severe stunting in 6-to 18-month-old rural Malawians. Arch Pediatr Adolesc Med 2008;162:619–26.

    Article  Google Scholar 

  13. Prado EL, Abbeddou S, Yakes Jimenez E, Somé JW, Ouédraogo ZP, Vosti SA, et al. Lipid-based nutrient supplements plus malaria and diarrhea treatment increase infant development scores in a cluster-randomized trial in Burkina Faso. J Nutr 2015;146:814–22.

    Article  Google Scholar 

  14. Prado EL, Maleta K, Ashorn P, Ashorn U, Vosti SA, Sadalaki J, et al. Effects of maternal and child lipid-based nutrient supplements on infant development: a randomized trial in Malawi. Am J Clin Nutr 2016;103:784–93.

    Article  CAS  Google Scholar 

  15. Matias SL, Mridha MK, Tofail F, Arnold CD, Khan MSA, Siddiqui Z, et al. Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial. Am J Clin Nutr 2017;105:958–69.

    Article  CAS  Google Scholar 

  16. Smuts CM, Matsungo TM, Malan L, Kruger HS, Rothman M, Kvalsvig, JD, et al. Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial. Ameri J Clin Nutr 2019;109:55–68.

    Article  Google Scholar 

  17. Rothman M, Berti C, Smuts CM, Faber M, Covic N. Acceptability of novel small-quantity lipid-based nutrient supplements for complementary feeding in a peri-urban south african communityy. Food Nutr Bull 2015;36:455–66.

    Article  Google Scholar 

  18. World health Organisation. Physical Status: The Use and Interpretation of Anthropometry. ‘Report of a WHO expert committee’. World Health Organ Tech Rep Ser 1995;854:1–452.

    Google Scholar 

  19. World Health Organization (WHO). WHO child growth standards: length/height for age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age, methods and development. World Health Organization; 2006.

  20. Siziba LP, Baumgartner J, Ricci C, Jacobs A, Rothman M, Matsungo TM, et al. Associations of plasma total phospholipid fatty acid patterns with feeding practices, growth and psychomotor development in six-month-old South African infants. Matern Child Nutr 2018;15:e12763.

  21. Makrides M, Hawkes JS, Neumann MA, Gibson RA. Nutritional effect of including egg yolk in the weaning diet of breast-fed and formula-fed infants: a randomized controlled trial. Am J Clin Nutr 2002;75:1084–92.

    Article  CAS  Google Scholar 

  22. Hoffman DR, Birch EE, Castañeda YS, Fawcett SL, Wheaton DH, Birch DG, et al. Visual function in breast-fed term infants weaned to formula with or without long-chain polyunsaturates at 4 to 6 months: a randomized clinical trial. J Pediatr 2003;142:669–77.

    Article  CAS  Google Scholar 

  23. Hoffman DR, Theuer RC, Castañeda YS, Wheaton DH, Bosworth RG, O’Connor AR, et al. Maturation of visual acuity is accelerated in breast-fed term infants fed baby food containing DHA-enriched egg yolk. J Nutr 2004;134:2307–13.

    Article  CAS  Google Scholar 

  24. Grote V, Verduci E, Vecchi F, Contarini G, Giovannini M, Koletzko B, et al. Breast milk composition and infant nutrient intakes during the first 12 months of life. Eur J Clin Nutr 2016;70:250–6.

    Article  CAS  Google Scholar 

  25. Brenna JT, Varamini B, Jensen RG, Diersen-Schade DA, Boettcher JA, Arterburn LM. Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. Am J Clin Nutr 2007;85:1457–64.

    Article  CAS  Google Scholar 

  26. Brenna JT. Arachidonic acid needed in infant formula when docosahexaenoic acid is present. Nutr Rev 2016;74:329–36.

    Article  Google Scholar 

  27. Hadley K, Ryan A, Forsyth S, Gautier S, Salem N. The essentiality of arachidonic acid in infant development. Nutrients 2016;8:216.

    Article  Google Scholar 

  28. Forsyth JS. Long chain polyunsaturated fatty acid supplementation in infant formula and blood pressure in later childhood: follow up of a randomised controlled trial. BMJ 2003;326:953–953.

    Article  CAS  Google Scholar 

  29. Colombo J, Carlson SE, Cheatham CL, Fitzgerald-Gustafson KM, Kepler A, Doty T. Llong-chain polyunsaturated fatty acid supplementation in infancy reduces heart rate and positively affects distribution of attention. Pediatr Res 2011;70:406–10.

    Article  CAS  Google Scholar 

  30. Forsyth S, Gautier S, Salem N. The importance of dietary DHA and ARA in early life: a public health perspective. Proc Nutr Soc 2017;76:568–73.

    Article  CAS  Google Scholar 

  31. Innis SM. Impact of maternal diet on human milk composition and neurological development of infants. Am J Clin Nutr 2014;99:734S–41S.

    Article  CAS  Google Scholar 

  32. Gibson RA, Neumann MA, Lien EL, Boyd KA, Tu WC. Docosahexaenoic acid synthesis from alpha-linolenic acid is inhibited by diets high in polyunsaturated fatty acids. Prostaglandins, Leukot Essent Fat Acids 2013;88:139–46.

    Article  CAS  Google Scholar 

  33. Hess SY, Abbeddou S, Jimenez EY, Somé JW, Vosti SA, Ouédraogo ZP, et al. Small-quantity lipid-based nutrient supplements, regardless of their zinc content, increase growth and reduce the prevalence of stunting and wasting in young Burkinabe children: a cluster-randomized trial. PloS ONE 2015;10:e0122242.

    Article  Google Scholar 

  34. Harris WS, Thomas RM. Biological variability of blood omega-3 biomarkers. Clin Biochem 2010;43:338–40.

    Article  CAS  Google Scholar 

  35. Harris WS, Varvel SA, Pottala JV, Warnick GR, McConnell JP. Comparative effects of an acute dose of fish oil on omega-3 fatty acid levels in red blood cells versus plasma: implications for clinical utility. J Clin Lipidol 2013;7:433–40.

    Article  Google Scholar 

  36. Harris WS, Pottala JV, Sands SA, Jones PG. Comparison of the effects of fish and fish-oil capsules on the n–3 fatty acid content of blood cells and plasma phospholipids–. Am J Clin Nutr 2007;86:1621–5.

    Article  CAS  Google Scholar 

  37. Cao J, Schwichtenberg KA, Hanson NQ, Tsai MY. Incorporation and clearance of omega-3 fatty acids in erythrocyte membranes and plasma phospholipids. Clin Chem 2006;52:2265–72.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

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.

Funding

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

Authors and Affiliations

  1. Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520, Potchefstroom, South Africa

    Linda P. Siziba, Jeannine Baumgartner, Marinel Rothman, Tonderayi M. Matsungo & Cornelius M. Smuts

  2. Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

    Mieke Faber

Authors
  1. Linda P. Siziba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeannine Baumgartner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marinel Rothman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tonderayi M. Matsungo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mieke Faber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cornelius M. Smuts
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Ethics declarations

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.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1038/s41430-019-0482-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-019-0482-1

Search

Advanced search

Quick links