المؤلفون: Larson, Leila M., Feuerriegel, Daniel, Hasan, Mohammed Imrul, Braat, Sabine, Jin, Jerry, Uddin Tipu, S. M. Mulk, Shiraji, Shamima, Tofail, Fahmida, Biggs, Beverley-Ann, Hamadani, Jena D., Johnson, Katherine A., Bode, Stefan, Pasricha, Sant-Rayn

المصدر: American Journal of Clinical Nutrition; Jan2023, Vol. 117 Issue 1, p73-82, 10p

مصطلحات موضوعية: BRAIN physiology, EVOKED potentials (Electrophysiology), CONFIDENCE intervals, ELECTROENCEPHALOGRAPHY, IRON, IRON in the body, COGNITION, HEALTH outcome assessment, REGRESSION analysis, DIETARY supplements, RANDOMIZED controlled trials, MICRONUTRIENTS, BANGLADESHIS

مصطلحات جغرافية: BANGLADESH

مستخلص: Background: Iron deficiency and anemia have been associated with poor cognition in children, yet the effects of iron supplementation on neurocognition remain unclear. Objective: We aimed to examine the effects of supplementation with iron on neural indices of habituation using auditory event-related brain potentials (ERPs). Methods: This substudy was nested within a 3-arm, double-blind, double-dummy, individual randomized trial in Bangladesh, in which 3300 8-mo-old children were randomly selected to receive 3 mo of daily iron syrup (12.5 mg iron), multiple micronutrient powders (MNPs) (including 12.5 mg iron), or placebo. Children were assessed after 3 mo of intervention (mo 3) and 9 mo thereafter (mo 12). The neurocognitive substudy comprised a randomly selected subset of children from the main trial. Brain activity elicited during an auditory roving oddball task was recorded using electroencephalography to provide an index of habituation. The differential response to a novel (deviant) compared with a repeated (standard) sound was examined. The primary outcome was the amplitude of the mismatch response (deviant minusstandard tone waveforms) at mo 3. Secondary outcomes included the deviant and standard tone-evoked amplitudes, N2 amplitude differences, and differences in mean amplitudes evoked by deviant tones presented in the second compared with first half of the oddball sequence at mo 3 and 12. Results: Data were analyzed from 329 children at month 3 and 363 at mo 12. Analyses indicated no treatment effects of iron interventions compared with placebo on the amplitude of the mismatch response (iron syrup compared with placebo: mean difference (MD) = 0.07µV [95% CI: -1.22, 1.37]; MNPs compared with placebo: MD = 0.58µV [95% CI: -0.74, 1.90]) nor any secondary ERP outcomes at mo 3 or 12, despite improvements in hemoglobin and ferritin concentrations from iron syrup and MNPs in this nested substudy. Conclusion: In Bangladeshi children with >40% anemia prevalence, iron or MNP interventions alone are insufficient to improve neural indices of habituation. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12617000660381. [ABSTRACT FROM AUTHOR]

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المؤلفون: Liu, Enju, Wang, Dongqing, Darling, Anne M, Perumal, Nandita, Wang, Molin, Ahmed, Tahmeed, Christian, Parul, Dewey, Kathryn G, Kac, Gilberto, Kennedy, Stephen, Subramoney, Vishak, Briggs, Brittany, Fawzi, Wafaie W, Consortium, members of the GWG Pooling Project

المصدر: American Journal of Clinical Nutrition; Dec2022, Vol. 116 Issue 6, p1864-1876, 13p, 4 Charts, 4 Graphs

مصطلحات موضوعية: WEIGHT gain in pregnancy, RELATIVE medical risk, MIDDLE-income countries, META-analysis, CONFIDENCE intervals, SYSTEMATIC reviews, IRON, PREGNANT women, IRON in the body, DIETARY supplements, TREATMENT effectiveness, LOW-income countries, DESCRIPTIVE statistics, PRENATAL care, MICRONUTRIENTS, FOLIC acid, LIPIDS

مستخلص: Background Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. Methods A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I ², stratified analysis, and meta-regression. Results MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P  < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P  < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P  < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: −0.38%, 3.40%; P  = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Conclusions Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs. [ABSTRACT FROM AUTHOR]

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المؤلفون: Rempelos, Leonidas, Wang, Juan, Barański, Marcin, Watson, Anthony, Volakakis, Nikolaos, Hadall, Catherine, Hasanaliyeva, Gultakin, Chatzidimitriou, Eleni, Magistrali, Amelia, Davis, Hannah, Vigar, Vanessa, Średnicka-Tober, Dominika, Rushton, Steven, Rosnes, Kristin S, Iversen, Per O, Seal, Chris J, Leifert, Carlo

المصدر: American Journal of Clinical Nutrition; Nov2022, Vol. 116 Issue 5, p1278-1290, 13p, 1 Diagram, 5 Charts, 2 Graphs

مصطلحات موضوعية: DIET, METALS, RANDOMIZED controlled trials, FOOD, DESCRIPTIVE statistics, MICRONUTRIENTS, STATISTICAL sampling

مستخلص: Background Observational studies have linked Mediterranean Diets (MedDiets) and organic food consumption with positive health outcomes, which may be explained by higher mineral micronutrient and phenolic intake and lower dietary exposure to toxic compounds. Objectives We aimed to determine the effects of diet and food type (organic compared with conventional) on urinary excretion (UE) and/or plasma concentrations of mineral micronutrients, phenolics, and toxic metals. Methods Healthy adult participants were randomly allocated to a conventional (n  = 14) or an intervention (n  = 13) group. During a 2-wk period, the intervention group consumed a MedDiet made entirely from organic foods, whereas the conventional group consumed a MedDiet made from conventional foods. Before and after the intervention period, both groups consumed their habitual Western diets made from conventional foods. The primary outcome was UE and/or plasma concentrations of selected mineral micronutrients, toxic metals, and phenolic markers. In addition, we monitored diets using food diaries. The participants were aware of study group assignment, but the study assessors were not. Results Changing from a Western Diet to a MedDiet for 2 wk resulted in significant increases in UE of total phenolics and salicylic acid (by 46% and 45%, respectively), the mineral micronutrients Co, I, and Mn (by 211%, 70%, and 102%, respectively), and the toxic metal Ni (by 42%), and plasma Se concentrations (by 14%). However, no significant effects of food type (organic compared with conventional) were detected. Redundancy analysis identified vegetables, coffee, wine, and fruit as positive drivers for UE of phenolic markers and mineral micronutrients, and fish consumption as a positive driver for UE of Cd and Pb. Conclusions Although small effects of food type cannot be ruled out, our study suggests that only changing to a MedDiet with higher fruit and vegetable, and lower meat, consumption results in a large increase in phenolic and mineral micronutrient intakes. This trial was registered at clinicaltrials.gov as NCT03254537. [ABSTRACT FROM AUTHOR]

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المؤلفون: Akpan, Edifofon, Hossain, Sheikh J, Devine, Angela, Braat, Sabine, Hasan, Mohammed I, Tipu, S M Mulk Uddin, Bhuiyan, Mohammad Saiful Alam, Hamadani, Jena D, Biggs, Beverley-Ann, Pasricha, Sant-Rayn, Carvalho, Natalie

المصدر: American Journal of Clinical Nutrition; Nov2022, Vol. 116 Issue 5, p1303-1313, 11p, 5 Charts, 2 Graphs

مصطلحات موضوعية: CONFIDENCE intervals, RURAL conditions, LIFE expectancy, MEDICAL care costs, DIETARY supplements, TREATMENT effectiveness, RANDOMIZED controlled trials, ANEMIA, COST effectiveness, BLIND experiment, DESCRIPTIVE statistics, MICRONUTRIENTS, STATISTICAL sampling, PEOPLE with disabilities, IRON compounds, POWDERS, EVALUATION, CHILDREN

مصطلحات جغرافية: BANGLADESH

مستخلص: Background Universal provision of iron supplements or iron-containing multiple micronutrient powders (MNPs) is widely used to prevent anemia in young children in low- and middle-income countries. The BRISC (Benefits and Risks of Iron Interventions in Children) trial compared iron supplements and MNPs with placebo in children <2 y old in rural Bangladesh. Objectives We aimed to assess the cost-effectiveness of iron supplements or iron-containing MNPs among young children in rural Bangladesh. Methods We did a cost-effectiveness analysis of MNPs and iron supplements using the BRISC trial outcomes and resource use data, and programmatic data from the literature. Health care costs were assessed from a health system perspective. We calculated incremental cost-effectiveness ratios (ICERs) in terms of US$ per disability-adjusted life-year (DALY) averted. To explore uncertainty, we constructed cost-effectiveness acceptability curves using bootstrapped data over a range of cost-effectiveness thresholds. One- and 2-way sensitivity analyses tested the impact of varying key parameter values on our results. Results Provision of MNPs was estimated to avert 0.0031 (95% CI: 0.0022, 0.0041) DALYs/child, whereas iron supplements averted 0.0039 (95% CI: 0.0030, 0.0048) DALYs/child, over 1 y compared with no intervention. Incremental mean costs were $0.75 (95% CI: 0.73, 0.77) for MNPs compared with no intervention and $0.64 ($0.62, $0.67) for iron supplements compared with no intervention. Iron supplementation dominated MNPs because it was cheaper and averted more DALYs. Iron supplementation had an ICER of $1645 ($1333, $2153) per DALY averted compared with no intervention, and had a 0% probability of being the optimal strategy at cost-effectiveness thresholds of $200 (reflecting health opportunity costs in Bangladesh) and $985 [half of gross domestic product (GDP) per capita] per DALY averted. Scenario and sensitivity analyses supported the base case findings. Conclusions These findings do not support universal iron supplementation or micronutrient powders as a cost-effective intervention for young children in rural Bangladesh. This trial was registered at anzctr.org.au as ACTRN1261700066038 and trialsearch.who.int as U1111-1196-1125. [ABSTRACT FROM AUTHOR]

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المؤلفون: Wegmüller, Rita, Musau, Kelvin, Vergari, Lucie, Custer, Emily, Anyango, Hellen, Donkor, William E S, Kiprotich, Marion, Siegal, Kim, Petry, Nicolai, Wirth, James P, Lewycka, Sonia, Woodruff, Bradley A, Rohner, Fabian

المصدر: American Journal of Clinical Nutrition; Aug2022, Vol. 116 Issue 2, p446-459, 14p, 1 Diagram, 5 Charts, 1 Graph

مصطلحات موضوعية: EGGS, POULTRY, CONFIDENCE intervals, AGRICULTURE, CHILD development, NUTRITION, IRON, DIET, TOXIC substance exposure, FAMILIES, IRON in the body, BEHAVIOR, HUMAN services programs, RANDOMIZED controlled trials, DESCRIPTIVE statistics, STATISTICAL sampling, MICRONUTRIENTS, CHLORINE, ONIONS, NUTRITIONAL status, AGRICULTURAL laborers

مصطلحات جغرافية: KENYA

مستخلص: Background Stunting rates remain unacceptably high in many regions, including sub-Saharan Africa. Agricultural programs have led to increased yields and household incomes but showed limited success in improving nutritional status. Objectives We assessed whether linear growth could be improved through a potentially scalable, integrated program adding nutrition-specific and nutrition-sensitive components to an existing agricultural program. Methods In this cluster-randomized controlled trial in rural Western Kenya, we randomized children aged 6–35 months from farming families to an agricultural intervention without (control group) or with a bundle of interventions (intervention group), including distribution of micronutrient powders (MNP), poultry to increase egg consumption, seeds of greens and onions, and soap and chlorine solution, as well as provision of monthly behavior change trainings. The primary outcome was the change in height-for-age z -score (HAZ) over 2 years of follow-up. We assessed safety through active morbidity and passive adverse event monitoring. We conducted an intention-to-treat analysis, followed by per-protocol and prespecified subgroup analyses. Results From March to April 2018, we enrolled 1927 children from 126 clusters (control, 942 children in 63 clusters; intervention, 985 children in 63 clusters). Data on HAZ were available for 1672 (86.6%) children after 2 years. Adherence was >80% for use of MNP, chlorine, and greens and receipt of soap, and ∼40% for egg and red onion consumption. The intention-to-treat analysis indicated a greater change in HAZ over 2 years in the intervention group (adjusted effect size, 0.11; 95% CI: 0.02–0.19). We found a slightly stronger effect in the per-protocol analysis (adjusted effect size, 0.15; 95% CI: 0.06–0.24). Dietary diversity and consumption of iron-rich foods were improved in the intervention group, and reported instances of fever, lower respiratory tract infections, and diarrheal episodes were lower in the intervention group. Conclusions This study found a modest improvement in linear growth, indicating the need for multiple, integrated interventions to achieve benefits. The trial was registered with clinicaltrials.gov as NCT03448484. [ABSTRACT FROM AUTHOR]

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المؤلفون: Bliznashka, Lilia, Sudfeld, Christopher R, Garba, Souna, Guindo, Ousmane, Soumana, Issaka, Adehossi, Irène, Langendorf, Céline, Grais, Rebecca F, Isanaka, Sheila

المصدر: American Journal of Clinical Nutrition; Mar2022, Vol. 115 Issue 3, p738-748, 11p, 2 Diagrams, 3 Charts, 3 Graphs

مصطلحات موضوعية: HUMAN growth, CONFIDENCE intervals, CHILD development, RURAL conditions, DIETARY supplements, RANDOMIZED controlled trials, BLIND experiment, DESCRIPTIVE statistics, PRENATAL care, MICRONUTRIENTS, DATA analysis software, LIPIDS, SECONDARY analysis

مصطلحات جغرافية: NIGERIA

مستخلص: Background Prenatal multiple micronutrient supplementation (MMS) and lipid-based nutrient supplementation (LNS) can improve birth outcomes relative to iron-folic acid supplementation (IFA); however, effects on child postnatal growth remain unclear. Objectives The aim was to compare the effect of prenatal MMS, medium-quantity LNS (MQ-LNS), and IFA on child growth up to 2 y of age. Methods We conducted a cluster randomized controlled trial of prenatal nutritional supplementation in Madarounfa, Niger. Villages were randomly assigned for pregnant women to receive IFA (17 villages, 1105 women), MMS (18 villages, 1083 women) or MQ-LNS (18 villages, 1144 women). Pregnant women received nutritional supplements weekly until delivery, and children were followed up monthly from 6-8 wk to 24 mo of age. We assessed the effect of prenatal MMS and MQ-LNS compared with IFA and the effect of prenatal MMS compared with MQ-LNS on child length-for-age z scores (LAZ), weight-for-age z scores (WAZ), and weight-for-length z scores (WLZ) at 24 mo of age using generalized linear models. In secondary analyses, we used mixed-effects models to assess the trajectories of anthropometric z scores longitudinally from 6–8 wk to 24 mo. Results Compared with IFA, MMS and MQ-LNS had no effect on child LAZ, WAZ, or WLZ at 24 mo of age (P > 0.05). Children in the MQ-LNS arm had significantly higher mid-upper arm circumference at 24 mo than children in the MMS arm: mean difference 0.50 cm (95% CI 0.10, 0.91 cm). WAZ and WLZ trajectories were more negative in the MQ-LNS arm compared with IFA and MMS, with lower z scores from 14 to 20 mo of age. However, WAZ and WLZ trajectories converged after 20 mo of age, and there were no differences by 24 mo of age. Conclusions Prenatal MMS and MQ-LNS had limited effect on anthropometric measures of child growth up to 24 mo of age as compared with IFA in rural Niger. [ABSTRACT FROM AUTHOR]

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المؤلفون: Soofi, Sajid Bashir, Ariff, Shabina, Khan, Gul Nawaz, Habib, Atif, Kureishy, Sumra, Ihtesham, Yasir, Hussain, Masawar, Rizvi, Arjumand, Sajid, Muhammad, Akbar, Naveed, Garzon, Cecilia, de Pee, Saskia, Bhutta, Zulfiqar A

المصدر: American Journal of Clinical Nutrition; Feb2022, Vol. 115 Issue 2, p492-502, 11p, 1 Diagram, 7 Charts

مصطلحات موضوعية: FOOD habits, FOOD relief, EVALUATION of human services programs, CONFIDENCE intervals, SOCIAL change, DIETARY supplements, RANDOMIZED controlled trials, COMMUNICATION, DESCRIPTIVE statistics, MICRONUTRIENTS, STATISTICAL sampling, LIPIDS, GROWTH disorders, BEHAVIOR modification, HEALTH promotion

مصطلحات جغرافية: PAKISTAN

مستخلص: Background In Pakistan, the prevalence of stunting among children younger than 5 y has remained above WHO critical thresholds (≥30%) over the past 2 decades. Objectives We hypothesized that an unconditional cash transfer (UCT) combined with lipid-based nutrient supplement (LNS) and/or social and behavior change communication (SBCC) will prevent stunting among children 6–23 mo of age. Methods This was a 4-arm, community-based cluster randomized controlled trial conducted in the district of Rahim Yar Khan, Pakistan. A total of 1729 children (UCT, n  = 434; UCT + SBCC, n  = 433; UCT + LNS, n  = 430; and UCT + LNS + SBCC, n  = 432) were enrolled at 6 mo of age and measured monthly for 18 mo until the age of 24 mo. Results At 24 mo of age, children who received UCT + LNS [rate ratio (RR): 0.85; 95% CI: 0.74, 0.97; P  = 0.015) and UCT + LNS + SBCC (RR: 0.86; 95% CI: 0.77, 0.96; P  = 0.007) had a significantly lower risk of being stunted compared with the UCT arm. No significant difference was noted among children who received UCT + SBCC (RR: 1.03; 95% CI: 0.91, 1.16; P  = 0.675) in the risk of being stunted compared with the UCT arm. The pooled prevalence of stunting among children aged 6–23 mo was 41.7%, 44.8%, 38.5%, and 39.3% in UCT, UCT + SBCC, UCT + LNS, and UCT + LNS + SBCC, respectively. In pairwise comparisons, a significant impact on stunting among children in UCT + LNS (P  = 0.029) and UCT + LNS + SBCC (P = <0.001) was noted compared with the UCT arm. Conclusions UCT combined with LNS and UCT + LNS + SBCC were effective in reducing the prevalence of stunting among children aged 6–23 mo in marginalized populations. UCT + SBCC was not effective in reducing the child stunting prevalence. This trial was registered at clinicaltrials.gov as NCT03299218. [ABSTRACT FROM AUTHOR]

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المؤلفون: Taneja, Sunita, Upadhyay, Ravi P, Chowdhury, Ranadip, Kurpad, Anura V, Bhardwaj, Himani, Kumar, Tivendra, Dwarkanath, Pratibha, Bose, Beena, Devi, Sarita, Kumar, Gunjan, Kaur, Baljeet, Bahl, Rajiv, Bhandari, Nita

المصدر: American Journal of Clinical Nutrition; Jan2022, Vol. 115 Issue 1, p83-93, 11p, 1 Diagram, 6 Charts, 1 Graph

مصطلحات موضوعية: HUMAN growth, INFANT development, FAT content of food, COUNSELING, INFANT care, CONFIDENCE intervals, BREAST milk, ANTHROPOMETRY, INGESTION, DIETARY supplements, TREATMENT effectiveness, RANDOMIZED controlled trials, COMPARATIVE studies, FOOD animals, MILK proteins, DESCRIPTIVE statistics, BREASTFEEDING, GRAIN, STATISTICAL sampling, MICRONUTRIENTS, DIETARY proteins, ARM circumference

مصطلحات جغرافية: INDIA

مستخلص: Background A large proportion of infants in low- and middle-income countries are stunted. These infants are often fed complementary foods that are low-quality, primarily in terms of protein and micronutrients. Objectives We aimed to test 2 milk–cereal mixes supplemented with modest and high amounts of protein during 6–12 mo of age, compared with no supplementation, for their effect on length-for-age z score (LAZ) at 12 mo of age. Methods Eligible infants (6 mo plus ≤29 d) were randomly assigned to either of the 2 interventions (modest- and high-protein) or a no supplement group. The milk–cereal mixes provided ∼125 kcal, 30%–45% energy from fats, and 80%–100% RDA of multiple micronutrients (MMN). The modest-protein group received 2.5 g protein [protein energy ratio (PER): 8%; 0.75 g from milk source] and the high-protein group received 5.6 g protein (PER: 18%, 1.68 g from milk source). One packet was given daily for 180 d. Counseling on continued breastfeeding and optimal infant-care practices was provided to all. Results We enrolled 1548 infants (high-protein: n  = 512; modest-protein: n  = 519; and no supplement: n  = 517). Compared with the no supplement group, there was an improvement in LAZ [adjusted mean difference (MD): 0.08; 95% CI: 0.01, 0.15], weight-for-age z score (MD: 0.12; 95% CI: 0.06, 0.19), weight-for-length z score (MD: 0.11; 95% CI: 0.02, 0.19), and midupper arm circumference z score (MD: 0.10; 95% CI: 0.02, 0.18) in the high-protein group at 12 mo of age. No significant differences for these anthropometric indicators were noted between the modest-protein and no supplement groups or between the high- and modest-protein groups. Conclusions Cereal mixes with higher amounts of milk-based protein and MMN may lead to improvement in linear growth and other anthropometric indexes in infants, compared with no supplementation. This trial was registered at ctri.nic.in as CTRI/2018/04/012932. [ABSTRACT FROM AUTHOR]

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المؤلفون: Nguyen, Phuong H, Young, Melissa F, Tran, Lan Mai, Khuong, Long Quynh, Duong, Thai Hong, Nguyen, Hoang Cong, Truong, Truong Viet, DiGirolamo, Ann M, Martorell, Reynaldo, Ramakrishnan, Usha

المصدر: American Journal of Clinical Nutrition; May2021, Vol. 113 Issue 5, p1199-1208, 10p, 1 Diagram, 3 Charts, 1 Graph

مصطلحات موضوعية: MOTHERS, ANALYSIS of variance, CONFIDENCE intervals, CHILD development, IRON, COGNITION, NUTRITIONAL requirements, DIETARY supplements, PREGNANCY outcomes, RANDOMIZED controlled trials, INTELLECT, BLIND experiment, MICRONUTRIENTS, STATISTICAL sampling, FOLIC acid, PRECONCEPTION care

مصطلحات جغرافية: VIETNAM

مستخلص: Background Although there is growing evidence on the role of preconception nutrition for birth outcomes, very few studies have evaluated the long-term effects of nutrition interventions during the preconception period on offspring cognitive outcomes. Objective We evaluate the impact of preconception weekly multiple micronutrients (MMs) or iron and folic acid (IFA) supplementation compared with folic acid (FA) alone on offspring intellectual functioning at age 6–7 y. Methods We followed 1599 offspring born to women who participated in a double-blinded randomized controlled trial of preconception supplementation in Vietnam. Women received weekly supplements containing either 2800 μg FA only, 60 mg iron and 2800 μg FA, or MMs (15 micronutrients including IFA) from baseline until conception, followed by daily prenatal IFA supplements until delivery. We used the Wechsler Intelligence Scale for Children to measure full-scale IQ (FSIQ) and 4 related domains of intellectual functioning [Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI) scores] at 6–7 y. Group comparisons were done using ANOVA tests for all children and the subgroup born to women who consumed the supplements ≥26 wk before conception (per-protocol analyses). Results The final sample with data at 6–7 y (n  = 1321) was similar for baseline maternal and offspring birth characteristics and age at follow-up by treatment group. Compared with the offspring in the FA group, those in the MM group had higher FSIQ (β = 1.7; 95% CI: 0.1, 3.3), WMI (β = 1.7; 95% CI: 0.2, 3.2), and PSI (β = 2.5; 95% CI: 0.9, 4.1). Similar findings were observed in the per-protocol analyses. There were no significant differences by treatment group for VCI and PRI. Conclusions Preconception supplementation with MMs improved certain domains of intellectual functioning at age 6–7 y compared with FA. These findings suggest the potential for preconception micronutrient interventions to have long-term benefits for offspring cognition. [ABSTRACT FROM AUTHOR]

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المؤلفون: Taneja, Sunita, Upadhyay, Ravi Prakash, Chowdhury, Ranadip, Kurpad, Anura V, Bhardwaj, Himani, Kumar, Tivendra, Dwarkanath, Pratibha, Bose, Beena, Devi, Sarita, Kumar, Gunjan, Kaur, Baljeet, Bahl, Rajiv, Bhandari, Nita

المصدر: American Journal of Clinical Nutrition; Apr2021, Vol. 113 Issue 4, p884-894, 11p, 2 Diagrams, 6 Charts

مصطلحات موضوعية: MOTHERS, LACTATION, INFANT development, CONFIDENCE intervals, HEMOGLOBINS, INGESTION, DIET therapy, DIETARY supplements, RANDOMIZED controlled trials, BREASTFEEDING, STATISTICAL sampling, MICRONUTRIENTS, BODY mass index, NUTRITIONAL status

مصطلحات جغرافية: INDIA

مستخلص: Background In lower-middle-income settings, growth faltering in the first 6 mo of life occurs despite exclusive breastfeeding. Objective The aim was to test the efficacy of an approach to improve the dietary adequacy of mothers during lactation and thus improve the growth of their infants. Methods Eligible mother–infant dyads (infants ≤7 d of age) were randomly assigned to either intervention or control groups. Mothers in the intervention group received snacks that were to be consumed daily, which provided 600 kcal of energy—with 25–30% of energy derived from fats (150–180 kcal) and 13% of energy from protein (80 kcal). Micronutrients were supplemented as daily tablets. We provided counseling on breastfeeding and infant-care practices to mothers in both groups. The primary outcome was attained infant length-for-age z scores (LAZ) at 6 mo of age. Secondary outcomes included exclusive breastfeeding proportion reported by the mother, maternal BMI and midupper arm circumference (MUAC), hemoglobin concentrations in mothers and infants, and the proportion of anemic infants at 6 mo of age. Results We enrolled 816 mother–infant dyads. The intervention did not achieve a significant effect on LAZ at 6 mo (adjusted mean difference: 0.09; 95% CI: −0.03, 0.20). Exclusive breastfeeding at 5 mo was higher (45.1% vs. 34.5%; RR: 1.31; 95% CI: 1.04, 1.64) in the intervention group compared with the controls. There were no significant effects on mean hemoglobin concentration or the proportion of anemic infants at 6 mo of age compared with the control group. We noted significant effects on maternal nutritional status (BMI, MUAC, hemoglobin concentration, and proportion anemic). Conclusions Postnatal supplementation of 600 kcal energy, 20 g protein, and multiple micronutrients daily to lactating mothers did not affect infant LAZ at age 6 mo. Such supplementation may improve maternal nutritional status. This trial was registered at Clinical Trials Registry–India as CTRI/2018/04/013095. [ABSTRACT FROM AUTHOR]

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