Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
J Nutr. 2011 Nov;141(11):2042-8. doi: 10.3945/jn.111.146480. Epub 2011 Sep 28.
In Nepal, antenatal iron-folic acid supplementation improved aspects of intellectual, executive, and fine motor function among school-age children. We examined the impact of added zinc to the maternal antenatal supplement (M-IFAZn) and preschool supplementation from 12 to 36 mo with iron-folic acid (C-IFA) ± zinc (C-IFAZn) on cognitive outcomes compared to maternal iron-folic acid (M-IFA) alone. Children 7-9 y old (n = 780) who participated in early childhood micronutrient supplementation trial during 2001-2004 and whose mothers participated in an antenatal micronutrient supplementation between 1999 and 2001 were followed for cognitive assessments in 2007-2009. Using multivariate analysis of variance and adjusting for confounders, M-IFA with child supplementation (either C-IFA or C-IFAZn) did not impact scores on the tests of general intelligence (Universal Nonverbal Intelligence Test), and executive function (Stroop and go/no go tests) relative to the M-IFA alone. However, children in the C-IFAZn group had slightly lower scores on the backward digit span (-0.29, 95% CI: -0.55, -0.04) and Movement Assessment Battery for Children (1.33, 95% CI: 0.26, 2.40) relative to the referent group, whereas both C-IFA (-1.92, 95% CI: -3.12, -0.71) and C-IFAZn (-1.78, 95% CI: -2.63, -0.92) produced somewhat lower finger tapping test scores (fine motor skills). The combination of M-IFAZn and C-IFA or C-IFAZn did not lead to any outcome differences relative to M-IFA alone. Preschool iron-folic acid ± zinc to children exposed to iron-folic acid in utero or addition of zinc to maternal iron-folic acid conferred no additional benefit to cognitive outcomes assessed in early school age. The late timing of supplementation during preschool may explain the lack of impact of iron and/or zinc.
在尼泊尔，产前补充铁叶酸改善了学龄儿童的智力、执行和精细运动功能等方面。我们研究了在母体产前补充（M-IFAZn）中添加锌与从 12 至 36 月龄用铁叶酸（C-IFA）±锌（C-IFAZn）补充对认知结果的影响，与仅用母体铁叶酸（M-IFA）相比。2001-2004 年期间参加儿童早期微量营养素补充试验的 7-9 岁儿童（n=780）及其母亲在 1999 年至 2001 年期间参加了产前微量营养素补充试验，2007-2009 年进行了认知评估。采用方差的多元分析并调整混杂因素后，与仅用 M-IFA 相比，M-IFA 与儿童补充（C-IFA 或 C-IFAZn）对一般智力（通用非语言智力测验）和执行功能（Stroop 和 go/no go 测验）的测试分数没有影响。然而，与参照组相比，C-IFAZn 组的儿童在后向数字跨度测试中得分略低（-0.29，95%CI：-0.55，-0.04）和运动评估电池为儿童（1.33，95%CI：0.26，2.40），而 C-IFA（-1.92，95%CI：-3.12，-0.71）和 C-IFAZn（-1.78，95%CI：-2.63，-0.92）均产生了略低的手指敲击测试分数（精细运动技能）。与仅用 M-IFA 相比，M-IFAZn 和 C-IFA 或 C-IFAZn 的联合应用并未导致任何结果差异。在幼儿期暴露于铁叶酸的儿童中补充学前铁叶酸±锌或在母体铁叶酸中添加锌并未对早期学龄期评估的认知结果带来额外益处。在幼儿期后期补充的时间可能解释了铁和/或锌缺乏影响的原因。
