Ashorn Per, Alho Lotta, Ashorn Ulla, Cheung Yin Bun, Dewey Kathryn G, Gondwe Austrida, Harjunmaa Ulla, Lartey Anna, Phiri Nozgechi, Phiri Thokozani E, Vosti Stephen A, Zeilani Mamane, Maleta Kenneth
Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland;
Department for International Health, University of Tampere School of Medicine, Tampere, Finland;
J Nutr. 2015 Jun;145(6):1345-53. doi: 10.3945/jn.114.207225. Epub 2015 Apr 29.
Intrauterine growth restriction may be reduced by supplementing maternal diets during pregnancy, but few studies have assessed the impact of combined prenatal and postnatal interventions on child growth.
We tested a hypothesis that provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers in pregnancy and 6 mo postpartum and to their infants from 6 to 18 mo of age would promote infant and child growth in the study area in rural Malawi.
We enrolled 869 pregnant women in a randomized trial in Malawi. During pregnancy and 6 mo thereafter, the women received daily 1 capsule of iron-folic acid (IFA), 1 capsule containing 18 micronutrients (MMN), or one 20-g sachet of SQ-LNS [lipid-based nutrient supplements (LNS), containing 21 MMN, protein, carbohydrates, essential fatty acids, and 118 kcal]. Children in the IFA and MMN groups received no supplementation; children in the LNS group received SQ-LNSs from 6 to 18 mo. Primary outcome was child length at 18 mo.
At 18 mo, the mean length in the IFA, MMN, and LNS groups was 77.0, 76.9, and 76.8 cm (P = 0.90), respectively, and the prevalence of stunting was 32.7%, 35.6%, and 37.9% (P = 0.54), respectively. No intergroup differences were found in the mean weight, head circumference, or midupper arm circumference or the proportions with low z scores for these variables (P > 0.05). Covariate adjustment did not change the analysis results, and the associations between the intervention and child length were not modified by maternal parity, age, or nutritional status (P > 0.10).
The findings do not support a hypothesis that provision of SQ-LNSs to women in pregnancy and postpartum and to children from 6 to 18 mo of age would promote child growth in this Malawian study area. This trial was registered at clinicaltrials.gov as NCT01239693.
孕期补充孕妇饮食可能会减少胎儿宫内生长受限，但很少有研究评估产前和产后联合干预对儿童生长的影响。
我们检验了一个假设，即在马拉维农村的研究地区，为孕期和产后6个月的母亲以及6至18个月大的婴儿提供小剂量的脂质营养补充剂（SQ-LNS）将促进婴幼儿生长。
我们在马拉维的一项随机试验中招募了869名孕妇。在孕期及之后的6个月里，这些女性每天服用1粒铁叶酸（IFA）胶囊、1粒含18种微量营养素的胶囊（MMN）或1袋20克的SQ-LNS[脂质营养补充剂（LNS），含21种MMN、蛋白质、碳水化合物、必需脂肪酸和118千卡热量]。IFA组和MMN组的儿童不接受补充剂；LNS组的儿童在6至18个月期间接受SQ-LNS。主要结局是18个月时儿童的身长。
在18个月时，IFA组、MMN组和LNS组的平均身长分别为77.0、76.9和76.8厘米（P = 0.90），发育迟缓患病率分别为32.7%、35.6%和37.9%（P = 0.54）。在平均体重、头围、上臂中部周长或这些变量的低z评分比例方面未发现组间差异（P > 0.05）。协变量调整未改变分析结果，干预措施与儿童身长之间的关联不受母亲产次、年龄或营养状况的影响（P > 0.10）。
在这项马拉维研究地区的研究中，研究结果不支持为孕期和产后女性以及6至18个月大儿童提供SQ-LNS会促进儿童生长这一假设。该试验已在clinicaltrials.gov注册，注册号为NCT01239693。
