Long Kurt Z, Rosado Jorge L, Fawzi Wafaie
Harvard School of Public Health, Department of Nutrition, Harvard School of Public Health, 1663 Tremont Street, Boston, MA 02115, USA.
Nutr Rev. 2007 May;65(5):218-32. doi: 10.1111/j.1753-4887.2007.tb00299.x.
Micronutrient supplementation offers one of the most cost-effective means of improving the health and survival of children in developing countries. However, the effects of supplementation with single micronutrients on diarrhea are not always consistent, and supplementation with multi-micronutrient supplements can have negative effects. These inconsistencies may result from the failure to consider the diverse etiological agents that cause diarrhea and the unique effects each micronutrient has on the immune response to each of these agents. This review examines the separate effects that supplementation with the B-complex vitamins, vitamin C, vitamin E, selenium, and iron have on diarrheal disease-related outcomes. Supplementation with iron may increase the risk of infection by invasive diarrheal pathogens, while supplementation with the remaining micronutrients may reduce this risk. These differences may be due to distinct regulatory effects each micronutrient has on the pathogen-specific immune response, as well as on the virulence of specific pathogens. The findings of these studies suggest that micronutrient supplementation of children must take into account the pathogens prevalent within communities as reflected by their diarrheal disease burdens. The effectiveness of combining multiple micronutrients into one supplement must also be reconsidered.
补充微量营养素是改善发展中国家儿童健康和生存状况最具成本效益的手段之一。然而，单一微量营养素补充剂对腹泻的影响并不总是一致的，而多种微量营养素补充剂可能会产生负面影响。这些不一致可能是由于未能考虑导致腹泻的多种病原体，以及每种微量营养素对针对这些病原体的免疫反应的独特影响。本综述探讨了补充复合维生素B、维生素C、维生素E、硒和铁对腹泻相关结局的单独影响。补充铁可能会增加侵袭性腹泻病原体感染的风险，而补充其余微量营养素可能会降低这种风险。这些差异可能是由于每种微量营养素对病原体特异性免疫反应以及特定病原体毒力具有不同的调节作用。这些研究结果表明，儿童微量营养素补充必须考虑到社区中流行的病原体，这反映在他们的腹泻疾病负担上。还必须重新考虑将多种微量营养素组合成一种补充剂的有效性。
