Effect of Small‐Quantity Lipid‐Based Nutrient Supplementation on Children's Cortisol Concentration

ABSTRACT This study investigated the role of early‐life nutrition supplementation in regulating the development of hypothalamic‐pituitary‐adrenal (HPA) axis activity, as evidenced by hair cortisol concentration (HCC), in the iLiNS‐DYAD randomized controlled trial in Ghana. Pregnant women were randomized to one of three conditions: (1) iron and folic acid (IFA) during pregnancy and placebo 0‐6 mo postpartum; (2) multiple micronutrients (MMN) during pregnancy and 0–6 mo postpartum; or (3) small‐quantity lipid‐based nutrient supplements (SQ‐LNS) during pregnancy and 0–6 mo postpartum and for their children from 6 to 18 mo. At 9–11 y of age, usable hair samples were obtained from 680 children from which cortisol was assayed. ANCOVA models assessed differences between groups and potential effect modifiers, including maternal education, household asset index, pre‐pregnancy BMI, child sex, child BMI, and pubertal stage. HCC did not differ between SQ‐LNS and control groups in adjusted and unadjusted models (p > 0.10), but maternal education was a significant effect modifier (P‐interaction = 0.043). Children exposed to SQ‐LNS had lower HCC than control children among those whose mothers had 0–5 years schooling (Median (interquartile range): 6.3 (4.8, 9.9) vs. 7.8 (5.3, 9.9); p = 0.031) but not among those whose mothers had > 5 years of schooling (p = 0.949). No other interactions were significant. Although these findings should be viewed with caution, they suggest that early‐life SQ‐LNS may buffer physiological stress in children of less educated mothers, highlighting its potential to compensate for socioeconomic disadvantage with regard to HPA axis regulation. Trial Registration: Clinical Trial Registry number and website: clinicaltrials.gov as NCT00970866 https://clinicaltrials.gov/ct2/show/record/NCT00970866.