Peer-reviewed article
Effects of lipid-based nutrient supplements on gut markers in stunted children: Secondary analysis of a randomised trial.
Hannah Pesu, Joseph Mbabazi, Rolland Mutumba, Otto Savolainen, Peter R Johnsen et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested lipid-based nutrient supplements (LNS) with different protein and carbohydrate combinations in 750 stunted Ugandan children aged 12–59 months over 12 weeks. The supplements did not improve markers of gut health or enterocyte mass. Interestingly, fecal inflammation markers decreased naturally in children who received no supplement but not in those given LNS, suggesting the supplements may have hindered this improvement. The supplements' benefit for vitamin B12 status was reduced in children with poor gut function.
Key points
- Lipid-based nutrient supplements containing milk protein or whey permeate had no effect on plasma citrulline or fecal myeloperoxidase
- Fecal myeloperoxidase (intestinal inflammation marker) decreased over time in control children but not in those receiving LNS
- Gut status markers did not modify the effect of LNS on growth or most micronutrient outcomes
- LNS effect on cobalamin (vitamin B12) status was reduced in children with low plasma citrulline (low enterocyte mass)
- Study included 750 children with mean height-for-age Z-score of -3.02, indicating severe stunting
Limitations
This is a secondary analysis examining gut markers and their role as modifiers of intervention effects; it does not explain the biological mechanisms behind why LNS appeared to inhibit natural improvement in intestinal inflammation markers. The study does not report on whether the observed suppression of inflammation improvement had clinical consequences for child growth or health outcomes.
Abstract
OBJECTIVES: To examine the effects of lipid-based nutrient supplements (LNS) containing milk protein (MP) and/or whey permeate (WP) on markers of intestinal inflammation and enterocyte mass among stunted children. Furthermore, to explore whether gut status modifies effects of LNS on growth and micronutrient status. METHODS: In a 2 × 2 factorial trial 12-59 months-old Ugandan children with stunting were randomized to four LNS formulations (100 g/day for 12 weeks) containing MP or soy protein and WP or maltodextrin, or to no supplementation. Linear mixed-effects models were used to explore faecal myeloperoxidase (f-MPO) and plasma citrulline (p-cit) as outcomes and modifiers of the intervention effects (ISRCTN13093195). RESULTS: Of 750 children, mean ± SD age was 32.0 ± 11.7 months and height-for-age Z-score was -3.02 ± 0.74. Neither MP nor WP had effects on p-cit or f-MPO. f-MPO decreased over time among controls (ratio of change 0.54, 95% confidence interval [CI]: 0.35, 0.84), but not among those given LNS (0.99, 95% CI: 0.79, 1.23) (p = 0.016). In contrast, LNS had no effect on p-cit (p = 0.27). The effect of LNS on cobalamin (B12) status was reduced in children with p-cit <20 µmol/L; whereby there was 20% (95% CI: 2, 35) lower increase in plasma cobalamin and 59% (95% CI: 13, 125) smaller decrease in plasma methylmalonic acid. p-cit or f-MPO did not modify the effects of LNS on growth or other micronutrient markers. CONCLUSION: LNS had no effect on enterocyte mass and possibly increased intestinal inflammation. The effect of LNS on cobalamin status was reduced in those with low enterocyte mass.