Kuusipalo Heli, Maleta Kenneth, Briend André, Manary Mark, Ashorn Per
Department of International Health, University of Tampere Medical School, Tampere, Finland.
J Pediatr Gastroenterol Nutr. 2006 Oct;43(4):525-32. doi: 10.1097/01.mpg.0000235981.26700.d3.
Fortified spreads (FSs) have proven effective in the rehabilitation of severely malnourished children. We examined acceptability, growth and change in blood haemoglobin (Hb) concentration among moderately underweight ambulatory infants given FS.
This was a randomised, controlled, parallel-group, investigator-blind clinical trial in rural Malawi. Six- to 17-month-old underweight infants (weight for age < -2), whose weight was greater than 5.5 kg and weight-for-height z score greater than -3 received for 12 weeks at home 1 of 8 food supplementation schemes: nothing, 5, 25, 50, or 75 g/day milk-based FS or 25, 50, or 75 g/day soy-based FS. Outcome measures included change in weight, length and blood Hb concentration.
A total of 126 infants started and 125 completed the intervention. All infants accepted the spread well, and no intolerance was recorded. Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS. Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS. All average gains were largest among infants receiving 50 g of FS daily: mean difference (95% confidence interval) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g (range, -130 to 700 g), 0.9 cm (range, -0.3 to 2.2 cm), and 17 g/L (range, 0 to 34 g/L) for weight, length and blood Hb concentration, respectively. In soy- vs milk-based FS groups, average outcomes were comparable.
Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants. Further trials should test this hypothesis.
强化涂抹酱已被证明对重度营养不良儿童的康复有效。我们研究了中度体重不足的门诊婴儿食用强化涂抹酱后的可接受性、生长情况以及血红蛋白（Hb）浓度的变化。
这是一项在马拉维农村地区进行的随机、对照、平行组、研究者盲法临床试验。6至17个月大的体重不足婴儿（年龄别体重＜-2），体重超过5.5千克且身高别体重z评分大于-3，在家中接受为期12周的8种食物补充方案中的一种：不补充、每天5克、25克、50克或75克的牛奶基强化涂抹酱，或每天25克、50克或75克的大豆基强化涂抹酱。观察指标包括体重、身长和血液Hb浓度的变化。
共有126名婴儿开始干预，125名完成干预。所有婴儿对涂抹酱的接受度良好，未记录到不耐受情况。每天接受25至75克强化涂抹酱的婴儿的平均体重和身长增加量高于仅接受0至5克强化涂抹酱的婴儿。未补充的对照组婴儿的平均Hb浓度保持不变，但接受任何强化涂抹酱的婴儿的平均Hb浓度增加了10至17克/升。所有平均增加量在每天接受50克强化涂抹酱的婴儿中最大：50克牛奶基强化涂抹酱组婴儿与未补充组婴儿在12周内的体重增加量平均差异（95%置信区间）为290克（范围为-130至700克），身长增加量为0.9厘米（范围为-0.3至2.2厘米），血液Hb浓度增加量为17克/升（范围为0至34克/升）。在大豆基与牛奶基强化涂抹酱组中，平均结果相当。
每天补充25至75克高度强化涂抹酱是可行的，可能促进中度营养不良婴儿的生长并缓解贫血。进一步的试验应验证这一假设。
