Neurobehavioral impacts in adolescence from early life nutrition supplementation: 10-year follow-up to a cluster randomized trial in Bangladesh (RDNS-Teen Study)
Over 250 million children under the age of 5 years worldwide do not achieve their developmental potential, leaving them unprepared for school, at higher risk of poor academic performance, and less able to cope with stress, all of which carry long-term consequences on work productivity and mental health. A key determinant of poor development is undernutrition, a condition faced by many children in low-income settings, including rural Bangladesh. Indicators of undernutrition in Bangladesh point to a substantial potential for early life nutrition supplementation to benefit children.
A systematic review and meta-analysis led by Dr. Elizabeth Prado and Dr. Leila Larson showed that few trials of macro- and micro-nutrient supplementation in early life have followed children beyond age 5, and none of these were conducted in South Asia, highlighting an important gap in our understanding of the long-term benefits of early life interventions. South Asia is an important context to study given the region’s high burden of malnutrition and suboptimal infant and young child feeding practices. Many settings across the world face similar adversities to those in rural Bangladesh, and rates of malnutrition and food insecurity are predicted to increase with global threats such as extreme weather events.
In July 2026, our team was awarded a 5-year NIH grant to follow up 3,400 participants at 13-15 years old, who were enrolled in an early life cluster randomized nutrition supplementation trial in Bangladesh. The original Rang-Din Nutrition Study (RDNS), led by Dr. Kathryn Dewey and Dr. Malay Mridha, provided nutrition supplementation to women during pregnancy and the first 6 months postpartum and to their offspring from 6 to 24 months of age, beginning in 2012. Clusters were randomized to one of four study arms: 1) women and children both received small-quantity lipid-based nutrient supplements (SQ-LNS), 2) women received iron and folic acid (IFA) and children received SQ-LNS, 3) women received IFA and children received micronutrient powders, and 4) women received IFA and children received no supplements. Immediately post-intervention, children who received SQ-LNS had improved motor and language development, growth, and reduced anemia and iron deficiency, compared to control groups. At a follow-up at 3-5 years of age, sustained effects were observed on global child development and growth. These short- and medium-term benefits suggest that enhanced nutrition in early life establishes an important foundation for children’s development, but little is known about how these improvements are sustained long-term into adolescence.
The current study will be the first randomized trial in South Asia to examine the long-term effects of nutrition supplementation with macro- and micro-nutrients in pregnancy and early childhood on neurobehavioral and neurophysiological outcomes into adolescence. This follow-up study in the Badarganj and Chirirbandar subdistricts of northwest Bangladesh will examine indicators of socio-emotional and cognitive development, brain function (e.g., attentional processes, brain activity and plasticity), and brain structure (e.g., white and grey matter) that could have been affected by early life nutrition supplementation, and importantly, are associated with long term success. Our study brings together experts from the BRAC James P Grant School of Public Health at BRAC University (Dr. Malay Mridha); the International Center for Diarrheal Disease Research in Bangladesh (Dr. Fahmida Tofail); McGill University (Dr. Leila Larson); the University of South Carolina (Dr. Hala Ghattas, Dr. Edward Frongillo, Dr. John Richards); the University of California Davis (Dr. Paul Hastings, Charles Arnold, Dr. Kathryn Dewey); and Binghamton University (Dr. Stefania Conte).