Wang Jie, Chang Suying, Zhao Liyun, Yu Wentao, Zhang Jian, Man Qingqing, He Li, Duan Yifan, Wang Hui, Scherpbier Robert, Yin Shi-An
Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children's Fund, Beijing, China.
PLoS One. 2017 Mar 20;12(3):e0174302. doi: 10.1371/journal.pone.0174302. eCollection 2017.
Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation.
Baseline and follow-up cross-sectional surveys were conducted before and after a nutrition intervention program in 3 national poverty counties in China. Soybean-based complementary food supplements called Yingyangbao (YYB) in Chinese and training materials on child feeding were distributed to households with children aged 6-23 months for 18 months. Representative children were selected by probability proportional to size sampling methods to assess compliance of YYB and the intervention efficacy. A questionnaire was designed to collect data on basic characteristics of children, breastfeeding, 24-hour dietary intake, and consumption and appetite of YYB. Anthropometrics and hemoglobin were measured in the field, and anemia prevalence was evaluated. Venous blood was drawn from children aged 12-35 months to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia.
Of the children involved in the follow-up survey (n = 693), the P50 (P25, P75) intake of YYB was 6.7 (3.5, 7.0) sachets weekly, and 54.7% of the children liked the taste of YYB. Compared with the baseline situation (n = 823), the proportion of children fed a diverse diet and foods rich in iron or vitamin A increased (P < 0.01) in the follow-up study. The prevalence of stunting and underweight decreased (P < 0.05), the prevalence of anemia decreased from 28.0% to 19.9% (P < 0.01), and the prevalence of vitamin B12 deficiency decreased from 26.8% to 15.4% (P < 0.01). For children aged 12-23 months, those who liked YYB and consumed 6 or more sachets of YYB weekly were at lower risk for anemia (OR = 0.34, 95% CI 0.13-0.90, P < 0.05), but the risk of stunting was associated with a non-diverse diet (OR = 1.48, 95% CI 1.06-2.07, P < 0.05).
The quality of diet and nutritional status of children aged 6-23 months are significantly improved by the intervention of YYB and nutrition education, and good compliance to YYB contributes to a low risk for anemia.
Chinese Clinical Trial Registry ChiCTR-OOC-16008846.
生长发育不良和微量营养素缺乏主要影响大龄婴儿和幼儿。一些国家已采取临床有效措施来应对营养不良问题，但国家项目中干预措施的依从性和效果改善情况需要评估。
在中国3个国家级贫困县开展了一项营养干预项目，在项目前后分别进行了基线和随访横断面调查。向有6至23个月大孩子的家庭发放了名为“营养包”（YYB）的大豆基辅食补充剂和儿童喂养培训材料，为期18个月。通过与规模大小成比例的概率抽样方法选取代表性儿童，以评估YYB的依从性和干预效果。设计了一份问卷，收集有关儿童基本特征、母乳喂养情况、24小时饮食摄入量以及YYB的食用量和食欲的数据。在现场测量人体测量指标和血红蛋白，并评估贫血患病率。采集12至35个月大儿童的静脉血以评估微量营养素状况。采用逻辑回归分析确定儿童贫血的危险因素。
在参与随访调查的儿童中（n = 693），YYB的P50（P25，P75）摄入量为每周6.7（3.5，7.0）袋，54.7%的儿童喜欢YYB的味道。与基线情况（n = 823）相比，在随访研究中，喂养多样化饮食以及富含铁或维生素A食物的儿童比例有所增加（P < 0.01）。发育迟缓与体重不足的患病率下降（P < 0.05），贫血患病率从28.0%降至19.9%（P < 0.01），维生素B12缺乏患病率从26.8%降至15.4%（P < 0.01）。对于12至23个月大的儿童，喜欢YYB且每周食用6袋及以上YYB的儿童患贫血的风险较低（OR = 0.34，95%CI 0.13 - 0.90，P < 0.05），但发育迟缓的风险与饮食单一有关（OR = 1.48，95%CI 1.06 - 2.07，P < 0.05）。
通过YYB干预和营养教育，6至23个月大儿童的饮食质量和营养状况得到显著改善，对YYB的良好依从性有助于降低贫血风险。
中国临床试验注册中心ChiCTR - OOC - 16008846。
