Larson Leila Margaret, Yousafzai Aisha K
Emory University, Nutrition and Health Sciences Program, Laney Graduate School, Atlanta, Georgia, USA.
Aga Khan University, Department of Paediatrics and Child Health, Division of Women and Child Health, Karachi, Sindh, Pakistan.
Matern Child Nutr. 2017 Jan;13(1). doi: 10.1111/mcn.12229. Epub 2015 Nov 26.
Interventions to improve nutritional status of young children in low- and middle-income countries (LMIC) may have the added benefit of improving their mental and motor development. This meta-analysis updates and goes beyond previous ones by answering two important questions: (1) do prenatal and postnatal nutritional inputs improve mental development, and (2) are effects on mental development associated with two theoretically interesting mediators namely physical growth and motor development? The meta-analysis of articles on Medline, PsycINFO, Global Health and Embase was limited to randomized trials in LMICs, with mental development of children from birth to age two years as an outcome. The initial yield of 2689 studies was reduced to 33; 12 received a global quality rating of strong. Of the 10 prenatal and 23 postnatal nutrition interventions, the majority used zinc, iron/folic acid, vitamin A or multiple micronutrients, with a few evaluating macronutrients. The weighted mean effect size, Cohen's d (95% CI) for prenatal and postnatal nutrition interventions on mental development was 0.042 (-0.0084, 0.092) and 0.076 (0.019, 0.13), respectively. Postnatal supplements consisting of macronutrients yielded an effect size d (95% CI) of 0.14 (0.0067, 0.27), multiple micronutrients 0.082 (-0.012, 0.18) and single micronutrients 0.058 (-0.0015, 0.12). Motor development, but not growth status, effect sizes were significantly associated with mental development in postnatal interventions. In summary, nutrition interventions had small effects on mental development. Future studies might have greater effect if they addressed macronutrient deficiencies combined with child stimulation and hygiene and sanitation interventions.
改善低收入和中等收入国家（LMIC）幼儿营养状况的干预措施可能会带来改善其心理和运动发育的额外益处。这项荟萃分析通过回答两个重要问题对先前的研究进行了更新和拓展：（1）产前和产后营养投入是否能改善心理发育？（2）对心理发育的影响是否与两个理论上有趣的中介因素相关，即身体生长和运动发育？对Medline、PsycINFO、Global Health和Embase上文章的荟萃分析仅限于LMICs的随机试验，以出生至两岁儿童的心理发育作为结果。最初的2689项研究筛选后减少至33项；12项获得了较高的整体质量评级。在10项产前和23项产后营养干预措施中，大多数使用锌、铁/叶酸、维生素A或多种微量营养素，少数评估常量营养素。产前和产后营养干预对心理发育的加权平均效应量，科恩d值（95%置信区间）分别为0.042（-0.0084，0.092）和0.076（0.019，0.13）。由常量营养素组成的产后补充剂产生的效应量d（95%置信区间）为0.14（0.0067，0.27），多种微量营养素为0.082（-0.012，0.18），单一微量营养素为0.058（-0.0015，0.12）。在产后干预中，运动发育而非生长状况的效应量与心理发育显著相关。总之，营养干预对心理发育的影响较小。如果未来的研究能够解决常量营养素缺乏问题，并结合儿童刺激以及卫生和环境卫生干预措施，可能会产生更大的效果。
