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Small-Quantity Lipid-Based Nutrient Supplements for severe malnutrition

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This is a summary of the following programming guidance: UNICEF (2023) Small Supplements for the Prevention of Malnutrition in Early Childhood: Brief Guidance Note. https://www.unicef.org/documents/nutrition/SQLNS-Guidance

Recently, there has been a renewed focus on the use of Small-Quantity Lipid-Based Nutrient Supplements (SQ-LNS) (Box 1), due to the increasing body of evidence regarding their effectiveness and the inclusion of SQ-LNS in the Lancet 2021 series on Maternal and Child Undernutrition1 updated list of recommended interventions. In response, UNICEF have produced programming guidance to support the appropriate use of the intervention.

Evidence shows SQ-LNS can reduce the prevalence of stunting by 12% to 14%, severe stunting by 17% and the prevalence of severe wasting by around one-third in children aged 6–24 months, with greater effects observed in areas with greater burdens of wasting or stunting, or with poorer water quality or sanitation (Dewey et al, 2022). SQ-LNS can also lower the prevalence of micronutrient deficiencies (Wessells et al, 2021) and may support child development equivalent to one to five IQ points (Prado et al, 2021). Initial evidence supports the cost effectiveness of SQ-LNS (Adams et al, 2022).

Box 1: What are SQ-LNS?

Yet another acronym in the humanitarian lexicon, SQ-LNS are nutrition supplements incorporated into a small amount of food paste (around 20 g per sachet). SQ-LNS provide 24 micronutrients and macronutrients and are designed to be used as a form of home fortification, comparable in scope to multiple micronutrient powders. They can be mixed with complementary foods or eaten as they are straight from the sachet, as they do not need mixing with water. SQ-LNS have been shown to be highly acceptable to children and their caregivers, and high compliance rates have been observed. They are designed to be part of a toolkit to prevent undernutrition and micronutrient deficiencies in early childhood in contexts of significant nutrient gaps and where micronutrient deficiencies are common.

UNICEF’s guidance document highlights that SQ-LNS should be used as part of an integrated approach targeting younger child in contexts that are food-insecure and with high burdens of undernutrition (wasting, stunting and micronutrient deficiencies). The provision of SQ-LNS should be part of a larger effort to promote growth and improve the diets of infants and young children. A table of criteria and justifications is provided to guide decision-making around the use of SQ-LNS in any given context, and considerations for their integration within existing preventive interventions are outlined.

References

Dewey K, Arnold C, Wessells K et al (2022) Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 116, 5. https://pubmed.ncbi.nlm.nih.gov/36045000/

Wessells K, Arnold C, Stewart C et al (2021) Characteristics that modify the effect of
small-quantity lipid-based nutrient supplementation on child anaemia and micronutrient status: An individual participant data meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 114, 68S-94S.

Prado E, Arnold C, Wessells, K et al (2021) Small-quantity lipid-based nutrient supplements for children age 6–24 months: A systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. American Journal of Clinical Nutrition, 114, 43S–67S.

Adams KP, Vosti SA, Arnold C et al (2022) The cost-effectiveness of small-quantity lipid-based nutrient supplements for prevention of child death and malnutrition and promotion of healthy development: Modeling results for Uganda. MedRxiv. https://www.medrxiv.org/content/10.1101/2022.05.27.22275713v1

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Small-Quantity Lipid-Based Nutrient Supplements for severe malnutrition. Field Exchange 69, May 2023. p30. www.ennonline.net/fex/69/small-quantity-lipid-based-nutrient-supplements-for-severe-malnutrition

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