Institute of Child Health, University College London, London, United Kingdom.
Department of Community Health and Human Development, School of Public Health, University of California, Berkeley, Berkeley, California.
Ann N Y Acad Sci. 2014 Jan;1308:11-32. doi: 10.1111/nyas.12284. Epub 2013 Nov 4.
We conducted a systematic review of studies that examined the effect of interventions combining a child development component with a nutrition one; in some cases the nutrition interventions also included health-promotion components. Only papers with both child development and nutrition outcomes and rated as moderate-to-good quality were included. Eleven efficacy and two nonrandomized trials, and eight program evaluations were identified. Only six trials examined interventions separately and combined. The trials showed nutritional interventions usually benefited nutritional status and sometimes benefited child development. Stimulation consistently benefited child development. There was no significant loss of any effect when interventions were combined, but there was little evidence of synergistic interaction between nutrition and stimulation on child development. Only three trials followed up the children after intervention. All at-scale program evaluations were combined interventions. Five benefited child development, but one did not, and two showed deficits. There was generally little benefit of at-scale programs to nutritional status. We found no rigorous evaluations of adding stimulation to health and nutrition services at scale and there is an urgent need for them. There is also a need to establish quality-control mechanisms for existing scaled-up programs and to determine their long-term effects. There is also a need to determine if there are any sustained benefits for the children after programs finish.
我们对研究进行了系统评价，这些研究考察了将儿童发展部分与营养部分结合起来的干预措施的效果；在某些情况下，营养干预还包括促进健康的内容。仅纳入了同时具有儿童发展和营养结果且评为中等到良好质量的论文。确定了 11 项疗效和 2 项非随机试验以及 8 项方案评估。只有 6 项试验分别和联合研究了干预措施。这些试验表明，营养干预通常有益于营养状况，有时有益于儿童发展。刺激始终有益于儿童发展。当干预措施联合使用时，没有任何效果明显丧失，但营养和刺激对儿童发展的协同作用证据很少。只有 3 项试验在干预后对儿童进行了随访。所有大规模的方案评估都是综合干预措施。有 5 项有利于儿童发展，但有 1 项没有，还有 2 项显示出缺陷。总体而言，大规模方案对营养状况的益处不大。我们没有发现严格评估在大规模卫生和营养服务中增加刺激的效果的研究，因此迫切需要这些研究。还需要为现有的扩大规模的方案建立质量控制机制，并确定其长期效果。还需要确定方案结束后儿童是否有任何持续的获益。
