Join the debate about micronutrient supplements and the prevention of undernutrition
You are invited to participate in a debate about an article we published in the journal World Nutrition
Is “small quantity lipid nutrition supplement” (SQ-LNS) a sustainable and pragmatic strategy to prevent malnutrition?
Young child malnutrition and food insecurity is the result of many factors including social and economic inequities, disempowerment of women, inadequate support for breastfeeding, degraded environments, poor sanitation, unsafe water, violence and conflict. In this complex context, humanitarian agencies have a responsibility to guard against unintended consequences and ensure that the promotion of “quick fix” interventions do no harm. One such intervention is the Small Quantity Lipid Nutrition Supplement (SQ-LNS), that UNICEF is recommending for introduction into national nutrition programs to reduce mortality. The authors believe this recommendation is based on questionable evidence. They point to a fundamental flaw that trials compared “an intervention (SQ-LNS)” with “no comparable food-based intervention.” In effect, a pre-determined outcome. Also present is a conflict of interest, with support and intellectual input coming from interested food companies. Many other concerns are listed: SQ-LNS is an ultra-processed food (UPF), as defined by Nova Classification; daily feeding to children with poor diets will not improve dietary diversity and may undermine confidence in more culturally appropriate and nutritious family foods; the double burden of malnutrition and the emerging pandemic of overnutrition; the environmental impact of packaging and most importantly the clear potential for commercial exploitation. The widespread use of SQ-LNS in the face of food poverty is viewed as an unsustainable, unsafe and nutritionally inappropriate response. UN and humanitarian agencies should use their considerable diplomatic influence to challenge corporate-led food systems and support governments in their efforts to protect, promote and support breastfeeding and the provision of diverse complementary foods.
Why small-quantity lipid-based nutrient supplements should be integrated into comprehensive strategies to prevent child undernutrition in nutritionally vulnerable populations: response to Gupta et al.’s commentary
Response to Dewey et al.’s Letter
PDFs are available at the DOI and attached for convenience. The editor Dr Ted Greiner requests for your participation in his introduction.
“World Nutrition has always sought to generate dialog and healthy debate within the global public health nutrition community. The first literature review published in the journal, The Great Vitamin A Fiasco, by the late Professor Michael Latham, resulted in dozens of letters to the editor. Responses from our readership have been tamer since then, but the current issue may be the source of new controversy. In our previous issue, Gupta et al. wrote a criticism of “small quantity lipid nutrition supplements” (SQ-LNS), and how they are being promoted for prevention, not just treatment of malnutrition. In a commentary in the present issue, Dewey and a remarkable 43 co-authors respond, with a detailed explanation of what the product is, the evidence base behind it, and their opinion of why they believe it should be used to prevent malnutrition in vulnerable populations. As is common practice when a journal author is criticized, Gupta et al. were sent the Dewey et al. article before the current issue of the journal was published. Gupta et al. have in turn have submitted a letter to the editor in rebuttal.
After reading all of this, if you are like me, you find yourself in a state of cognitive dissonance. Of course, part of this is not directly disagreement, but a focus on different aspects of the issues. But in any case, clearly further input/debate is needed, and we invite readers to submit here letters to the editor, weighing in on the complex issues involved”.