Ramakrishnan Usha, Neufeld Lynnette M, Flores Rafael, Rivera Juan, Martorell Reynaldo
Nutrition and Health Sciences Program and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Am J Clin Nutr. 2009 Apr;89(4):1125-31. doi: 10.3945/ajcn.2008.26874. Epub 2009 Feb 18.
Micronutrient deficiencies are common, even in middle-income countries.
The objectives were to determine whether multiple micronutrient (MM) supplementation from 3 to 24 mo of age improves growth and whether the effect is modified by MM supplementation during pregnancy.
We conducted a randomized, double-blind, controlled trial in central Mexico. Singleton live births (n = 650) from a prenatal MM trial were randomly assigned to receive either MM supplements (1-1.5 times the Recommended Dietary Allowance of vitamins A, B-6, B-12, and C; folic acid; iron; zinc; and other nutrients) or supplements containing similar amounts of iron and vitamin A (Fe-A) within the maternal supplementation groups (MM and iron only) 6 d/wk from 3 to 24 mo of age. Anthropometric measurements were obtained at 3 and 24 mo of age.
There was no effect of supplement group on child growth in intention-to-treat analyses. However, infants who consumed MM supplements regularly (greater than the median compliance of 79%) were 0.8 (95% CI: -0.4, 1.9) and 1.6 (95% CI: 0.4, 2.8) cm taller at 24 mo in the maternal MM and iron-only groups, respectively, than were those in the Fe-A group; these differences were 0.2 (95% CI: -1.0, 1.4) and -0.5 (95% CI: -1.7, 0.7) cm among those with compliance below the median. Mean body mass index (in kg/m(2)) was significantly higher in those exposed to iron only in utero and Fe-A during childhood (16.2) than in the other groups (15.8).
MM supplements increased the length of children who consumed them regularly from 3 to 24 mo. Strategies that promote compliance through effective delivery of micronutrient interventions are needed.
即使在中等收入国家，微量营养素缺乏也很常见。
目的是确定3至24月龄补充多种微量营养素（MM）是否能促进生长，以及孕期补充MM是否会改变这种效果。
我们在墨西哥中部进行了一项随机、双盲、对照试验。将产前MM试验中的单胎活产婴儿（n = 650）随机分配，在3至24月龄期间，每周6天接受MM补充剂（维生素A、B - 6、B - 12和C、叶酸、铁、锌及其他营养素的膳食推荐摄入量的1 - 1.5倍）或含等量铁和维生素A的补充剂（Fe - A），母亲补充组（仅MM和仅铁）。在3和24月龄时进行人体测量。
在意向性分析中，补充剂组对儿童生长无影响。然而，在母亲MM组和仅铁组中，经常食用MM补充剂（依从性高于中位数79%）的婴儿在24月龄时分别比Fe - A组婴儿高0.8（95%CI： - 0.4，1.9）和1.6（95%CI：0.4，2.8）厘米；依从性低于中位数的婴儿中，差异分别为0.2（95%CI： - 1.0，1.4）和 - 0.5（95%CI： - 1.7，0.7）厘米。仅在子宫内接触铁且儿童期接触Fe - A的儿童平均体重指数（kg/m²）（16.2）显著高于其他组（15.8）。
MM补充剂增加了3至24月龄经常食用者的身高。需要通过有效提供微量营养素干预措施来提高依从性的策略。
