Comparison of Layered "Nutrition-Plus" vs "Nutrition" Alone Interventions for Improving Growth in Children Under 5 in
Evaniya Shakya1, Zuyao Yang2, Nan Dou3
1Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, United States.
Context:
The persistence of child undernutrition in low- and middle-income countries (LMICs) highlights the need for more effective evidence-based multisectoral interventions.
Objective:
To examine whether combining direct nutritional interventions with indirect multisectoral interventions ("nutrition-plus") is more effective in improving growth outcomes in children under 5 than direct nutritional interventions ("nutrition") alone.
Data Sources:
A systematic search of PubMed, PsycINFO, and Web of Science from inception until July 17, 2024, identified 4377 unique articles.
Data Extraction:
We included 8 randomized controlled trials with a "nutrition-plus" group and a corresponding "nutrition" comparison, and examined at least 1 of the following outcomes: stunting, wasting, height-for-age z score (HAZ), and weight-for-height z score (WHZ) among children under 5 years.
Data Analysis:
Standardized mean differences and unadjusted odds ratios were calculated for continuous and dichotomous outcomes, respectively, and results were synthesized narratively. The 14-item National Heart, Lung, and Blood Institute Quality Assessment of Controlled Intervention Studies tool assessed the risk of bias.
Conclusion:
Three types of "nutrition-plus" interventions were identified: "nutrition plus cash transfer" (n = 3), "nutrition plus water, sanitation, and hygiene (WASH)" (n = 3), and "nutrition plus psychosocial stimulation" (n = 2). The additional impact of "nutrition-plus" interventions, compared with "nutrition" alone, was nonsignificant in most studies, particularly in those with comprehensive "nutrition" interventions. Only 2 studies reported a positive additive effect of "nutrition plus cash" on HAZ but inconsistent effects on WHZ. One study found a significant positive impact of "nutrition plus psychosocial stimulation" on WHZ among stunted children. Given the limited evidence, we cannot conclude that "nutrition-plus" strategies are more effective than "nutrition" alone strategies. The need for additional research to evaluate the effectiveness of multifactorial "nutrition-plus" strategies to optimize programs aimed at improving infant and child growth in LMICs is evident.
Systematic Review Registration:
PROSPERO registration no. CRD42022359012.
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