TABLE 5

Review of Key Impacts for Nutrition Interventions Delivered During Infancy and Childhood

Key InterventionsSummary Effects With Implications for Developmental Outcomes (Direct Developmental Effects)
Breastfeeding promotion, 2 SRs, HIC, and LMICImproved breastfeeding practices from a variety of promotion interventions: more early initiation of breastfeeding in the first hour (OR 1.25, 95% CI 1.19 to 1.32; 49 studies), improved exclusive breastfeeding at day 1 (RR 1.43, 95% CI 1.09 to 1.87; N = 10 409 in 15 studies), in the first 6 mo (OR 1.44, 95% CI 1.38 to 1.51; 130 studies), and at 1–5 mo in LMIC (RR 2.88, 95% CI 2.11 to 3.93; 29 studies)
Iron supplementation, 2 SRs, HIC, and LMICImproved iron status with intermittent supplementation: reduced risk of anemia (RR 0.51, 95% CI 0.37 to 0.72; N = 1824 in 10 studies) and iron deficiency (RR 0.24, 95% CI 0.06 to 0.91; N = 431 in 3 studies)
Mixed effects on development: improved motor quality (Behavior Rating Scale score MD 15.60, 95% CI 7.66 to 23.54; N = 172 in 1 study), improved psychomotor development (BSID II score MD 6.90, 95% CI 1.35 to 12.45; N = 172 in 1 study), reduced IQ (MD −3.00, 95% CI −5.96 to −0.04; N = 252 in 1 study), improved IQ (SMD 0.41, 95% CI 0.20 to 0.62; 9 studies), and improved mental development (combined score SMD 0.30, 95% CI, 0.15 to 0.46; 14 studies)
Nonsignificant effects: motor development score (SMD 0.09, 95% CI −0.08 to 0.26; N = 1246 in 10 studies)
MMN supplementation, 3 SRs, HIC, and LMICImproved iron status: reduced risk of anemia (RR 0.66, 95% CI 0.57–0.77; N = 2524 in 11 studies), iron deficiency anemia (RR 0.43, 95% CI 0.35 to 0.52; N = 1390 in 7 studies), and improved hemoglobin (SMD 0.98, 95% CI 0.55 to 1.40; N = 8354 in 14 studies)
Increased diarrhea: small significant increase in diarrheal risk (RR 1.04, 95% CI 1.01 to 1.06; N = 3371 in 4 studies)
Small cognitive and motor benefits: improved academic performance at ages 5–16 (SMD 0.30, 95% CI 0.01 to 0.58; 4 studies) and motor development milestone score (MD 1.1, 95% CI 0.3 to 1.9; N = 361 in 1 study)
Improved linear growth, weight gain, and hemoglobin was reported in 1 review with a low AMSTAR rating
Nonsignificant effects: fluid intelligence (SMD 0.14, 95% CI −0.02 to 0.29; 12 studies) and crystallized intelligence (SMD −0.03, 95% CI −0.21 to 0.14; 11 studies)
Vitamin A supplementation, 1 SR, HIC, and LMICImproved vitamin A status: reduced risk of vitamin A deficiency (RR 0.71, 95% CI 0.65 to 0.78; N = 2262 in 4 studies), night blindness (RR 0.32, 95% CI 0.21 to 0.50; N = 22 972 in 2 studies), and xerophthalmia (RR 0.31, 95% CI 0.22 to 0.45; N = 57 866 in 2 studies)
Reduced infectious disease morbidity: reduced incidence of diarrhea (RR 0.85, 95% CI 0.82 to 0.87; N = 37 710 in 13 studies), measles (RR 0.50, 95% CI 0.37 to 0.67; N = 19 566 in 6 studies), and malaria (RR 0.73, 95% CI 0.60 to 0.88; N = 480 in 1 study)
Complementary feeding education and provision, 1 SR, LMICImproved growth and nutrition status: reduced risk of stunting (RR 0.71, 95% CI 0.56 to 0.91; N = 1940 in 5 studies), and in food-secure populations improved height gain (SMD 0.35, 95% CI 0.08 to 0.62; 4 studies) and weight gain (SMD 0.40, 95% CI 0.02 to 0.78; 4 studies)
Improved growth and nutrition status: reduced risk of stunting (RR 0.33, 95% CI 0.11 to 1.00; N = 1652 in 7 studies) and being underweight (RR 0.35, 95% CI 0.16 to 0.77; N = 319 in 12 studies) in food-insecure populations
Reduced risk of respiratory infections (RR 0.67, 95% CI 0.49 to 0.91; N = 823 in 3 studies)
Supplementary feeding, 1 SR, HIC, and LMICImproved iron status in LMIC: increased hemoglobin (SMD 0.49, 95% CI 0.07 to 0.91; N = 300 in 5 studies)
Improved growth and nutrition status in LMIC: increased weight-for-age z score (MD 0.15, 95% CI 0.05 to 0.24; N = 1565 in 8 studies) and height-for-age z score (MD 0.15, 95% CI 0.06 to 0.24; N = 4544 in 9 studies)
Mixed effects on development in LMIC: increased psychomotor development score (SMD 0.41, 95% CI 0.10 to 0.72; N = 178 in 2 studies), reduced cognitive development score (SMD −0.40, 95% CI −0.79 to 0); N = 113 in 1 study), and increased cognitive development test battery score (SMD 0.58, 95% CI 0.17 to 0.98; N = 99 in 1 study)
Therapeutic foods for moderate and severe acute malnutrition, 2 SR, LMICImproved growth rate with therapeutic foods: increased rate of height gain (MD 0.14 mm per d, 95% CI 0.05 to 0.22; 3 studies), rate of weight gain (MD 1.27 g/kg per d, 95% CI 0.16 to 2.38; 3 studies) in severe acute malnutrition, and rate of mid-upper arm circumference gain in moderate acute malnutrition (MD 0.04 mm per d, 95% CI 0.02 to 0.06; N = 4568 in 4 studies)
  • BSID II, Bayley Scales of Infant Development, Second Edition; CI, confidence interval; HIC, high-income country; MD, mean difference; OR, odds ratio; RR, risk ratio; SMD, standard mean difference; SR, systematic review.