Effects of lipid-based nutrient supplements on gut markers in stunted children: Secondary analysis of a randomised trial
Journal article, 2025
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.
cobalamin
malabsorption
stunting
environmental enteric dysfunction
citrulline
Author
Hannah Pesu
University of Copenhagen
Joseph Mbabazi
Makerere University
University of Copenhagen
Rolland Mutumba
Makerere University
University of Copenhagen
Otto Savolainen
Chalmers, Life Sciences, Infrastructures
Peter R. Johnsen
University of Copenhagen
Hanne Frøkiær
University of Copenhagen
Mette F. Olsen
University of Copenhagen
Rigshospitalet
Christian Mølgaard
University of Copenhagen
Kim F Michaelsen
University of Copenhagen
Christian Ritz
University of Southern Denmark
Suzanne Filteau
London School of Hygiene & Tropical Medicine
André Briend
University of Tampere
University of Copenhagen
Ezekiel Mupere
Makerere University
Henrik Friis
University of Copenhagen
Benedikte Grenov
University of Copenhagen
Journal of Pediatric Gastroenterology and Nutrition
0277-2116 (ISSN) 1536-4801 (eISSN)
Vol. In PressSubject Categories (SSIF 2025)
Pediatrics
Nutrition and Dietetics
DOI
10.1002/jpn3.70023