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产前补充多种微量营养素对尼泊尔儿童中期人体测量和血压的影响:一项双盲随机对照试验的随访。

Effect of antenatal multiple micronutrient supplementation on anthropometry and blood pressure in mid-childhood in Nepal: follow-up of a double-blind randomised controlled trial.

机构信息

Institute for Global Health, University College London, London, UK.

Mother and Infant Research Activities, Kathmandu, Nepal.

出版信息

Lancet Glob Health. 2014 Nov;2(11):e654-63. doi: 10.1016/S2214-109X(14)70314-6. Epub 2014 Oct 22.


DOI:10.1016/S2214-109X(14)70314-6
PMID:25442690
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4224012/
Abstract

BACKGROUND: In 2002-04, we did a randomised controlled trial in southern Nepal, and reported that children born to mothers taking multiple micronutrient supplements during pregnancy had a mean birthweight 77 g greater than children born to mothers taking iron and folic acid supplements. Children born to mothers in the study group were a mean 204 g heavier at 2·5 years of age and their systolic blood pressure was a mean 2·5 mm Hg lower than children born to mothers in the control group. We aimed to follow up the same children to mid-childhood (age 8·5 years) to investigate whether these differences would be sustained. METHODS: For this follow-up study, we identified children from the original trial and measured anthropometry, body composition with bioelectrical impedance (with population-specific isotope calibration), blood pressure, and renal dimensions by ultrasound. We documented socioeconomic status, household food security, and air pollution. Main outcomes of the follow-up at 8 years were Z scores for weight-for-age, height-for-age, and body-mass index (BMI)-for-age according to WHO Child Growth Standards for children aged 5-19 years, and blood pressure. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN88625934. FINDINGS: Between Sept 21, 2011, and Dec 7, 2012, we assessed 841 children (422 in the control group and 419 in the intervention group). Unadjusted differences (intervention minus control) in Z scores were 0·05 for weight-for-age (95% CI -0·09 to 0·19), 0·02 in height-for-age (-0·10 to 0·15), and 0·04 in BMI-for-age (-0·09 to 0·18). We recorded no difference in blood pressure. Adjusted differences were similar for all outcomes. INTERPRETATION: We recorded no differences in phenotype between children born to mothers who received antenatal multiple micronutrient or iron and folate supplements at age 8·5 years. Our findings did not extend to physiological differences or potential longer-term effects. FUNDING: The Wellcome Trust.

摘要

背景:2002-04 年,我们在尼泊尔南部进行了一项随机对照试验,并报告称,怀孕期间服用多种微量营养素补充剂的母亲所生的儿童的平均出生体重比服用铁和叶酸补充剂的母亲所生的儿童高 77 克。在研究组中出生的儿童在 2.5 岁时的平均体重重 204 克,其收缩压平均比对照组低 2.5 毫米汞柱。我们的目的是随访同一批儿童到幼儿期(8.5 岁),以调查这些差异是否会持续存在。

方法:为了进行这项随访研究,我们从原始试验中确定了儿童,并通过生物电阻抗(具有人群特异性同位素校准)测量了人体测量学、身体成分、血压和肾脏超声检查。我们记录了社会经济状况、家庭粮食安全和空气污染情况。8 岁时随访的主要结局是根据世卫组织儿童生长标准,5-19 岁儿童的体重与年龄、身高与年龄和体重与年龄的 Z 分数,以及血压。这项研究在国际标准随机对照试验注册中心注册,编号为 ISRCTN88625934。

结果:2011 年 9 月 21 日至 2012 年 12 月 7 日,我们评估了 841 名儿童(对照组 422 名,干预组 419 名)。未经调整的 Z 分数差异(干预组减去对照组)为体重与年龄 0.05(95%CI -0.09 至 0.19)、身高与年龄 0.02(-0.10 至 0.15)和体重与年龄的 BMI 0.04(-0.09 至 0.18)。我们没有记录到血压的差异。所有结果的调整差异相似。

解释:我们没有记录到在 8.5 岁时接受产前多种微量营养素或铁和叶酸补充剂的母亲所生的儿童在表型上的差异。我们的发现并没有扩展到生理差异或潜在的长期影响。

资金来源:惠康信托基金会。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/546f/4224012/5b0623dcd096/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/546f/4224012/5b0623dcd096/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/546f/4224012/5b0623dcd096/gr1.jpg

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本文引用的文献

[1]
Control of household air pollution for child survival: estimates for intervention impacts.

BMC Public Health. 2013

[2]
Biomass fuel use and the exposure of children to particulate air pollution in southern Nepal.

Environ Int. 2014-2-15

[3]
Intrauterine calorie restriction affects placental DNA methylation and gene expression.

Physiol Genomics. 2013-5-21

[4]
Methyl donor supplementation blocks the adverse effects of maternal high fat diet on offspring physiology.

PLoS One. 2013-5-2

[5]
Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies.

Lancet. 2013-3-28

[6]
Combined food and micronutrient supplements during pregnancy have limited impact on child blood pressure and kidney function in rural Bangladesh.

J Nutr. 2013-3-20

[7]
Early invitation to food and/or multiple micronutrient supplementation in pregnancy does not affect body composition in offspring at 54 months: follow-up of the MINIMat randomised trial, Bangladesh.

Matern Child Nutr. 2015-7

[8]
Multiple-micronutrient supplementation for women during pregnancy.

Cochrane Database Syst Rev. 2012-11-14

[9]
Maternal diets trigger sex-specific divergent trajectories of gene expression and epigenetic systems in mouse placenta.

PLoS One. 2012-11-5

[10]
Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child.

Am J Clin Nutr. 2012-10-17

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