Cardoso Marly A, Augusto Rosangela A, Bortolini Gisele A, Oliveira Cristieli S M, Tietzman Daniela C, Sequeira Leopoldina A S, Hadler Maria Claret C M, Peixoto Maria do Rosario G, Muniz Pascoal T, Vitolo Márcia R, Lira Pedro I C, Jaime Patrícia C
Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
Coordenação Geral de Alimentação e Nutrição (CGAN), Ministry of Health, Brasília, Brazil.
PLoS One. 2016 Mar 14;11(3):e0151097. doi: 10.1371/journal.pone.0151097. eCollection 2016.
Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce.
A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment.
In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children.
MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children.
Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b.
世界卫生组织推荐使用多种微量营养素粉（MNP）预防幼儿贫血。然而，关于其在不同人群中的有效性以及对其他结局（如线性生长和维生素A缺乏）改善情况的证据却很稀少。
在基层医疗中心开展了一项多中心实用对照试验。在研究基线时，招募了10至14个月大的儿童作为对照组（CG，n = 521），通过常规医疗保健评估其贫血、人体测量和微量营养素状况。与此同时，招募了6至8个月大的婴儿作为干预组（IG，n = 462），在60天的辅食喂养期间每天接受MNP。当IG组婴儿达到CG组儿童入组时的年龄时，对两组进行比较。
在CG组中，贫血（血红蛋白（Hb）<110 g/L）、缺铁（ID，血浆铁蛋白<12 μg/L或转铁蛋白受体>8.3 mg/L）和维生素A缺乏（VAD，血清视黄醇<0.70μmol/L）的患病率分别为23.1%、37.4%和17.4%。入组4至6个月后，当IG组参与者在测试时与对照组年龄相同时，IG组贫血、ID和VAD的患病率分别为14.3%、30.1%和7.9%。在对城市、医疗中心、母亲教育程度和年龄进行调整后，与CG组儿童相比，IG组儿童患贫血和VAD的可能性更低[患病率比值（95%置信区间）分别为0.63（0.45，0.88）和0.45（0.29，0.69）]。与CG组儿童相比，IG组儿童血红蛋白和年龄别身长Z评分的调整后平均分布提高了2个标准差。
MNP有效降低了巴西幼儿的贫血患病率，并改善了其生长和微量营养素状况。
巴西临床试验注册中心RBR-5ktv6b。
