Division of Pediatric Emergency Medicine and the Institute for Human Nutrition, Columbia and the Institute for Human Nutrition, Columbia, Columbia University Medical Center, New York, NY, USA.
Department of Nutrition, UNICEF, New York, NY, USA.
Eur J Clin Nutr. 2018 Jan;72(1):130-135. doi: 10.1038/ejcn.2017.138. Epub 2017 Sep 6.
BACKGROUND/OBJECTIVES: Zinc (Zn) supplementation adversely affects iron status in animal and adult human studies, but few trials have included young infants. The objective of this study was to determine the effects of Zn and multivitamin (MV) supplementation on infant hematologic and iron status.
SUBJECTS/METHODS: In a double-blind RCT, Tanzanian infants were randomized to daily, oral Zn, MV, Zn and MV or placebo treatment arms at the age of 6 weeks of life. Hemoglobin concentration (Hb) and red blood cell indices were measured at baseline and at 6, 12 and 18 months of age. Plasma samples from 589 infants were examined for iron deficiency (ID) at 6 months.
In logistic regression models, Zn treatment was associated with greater odds of ID (odds ratio (OR) 1.8 (95% confidence interval (CI) 1.0-3.3)) and MV treatment was associated with lower odds (OR 0.49 (95% CI 0.3-0.9)). In Cox models, MV was associated with a 28% reduction in risk of severe anemia (hazard ratio (HR)=0.72 (95% CI 0.56-0.94)) and a 26% reduction in the risk of severe microcytic anemia (HR=0.74 (0.56-0.96)) through 18 months. No effects of Zn on risk of anemia were seen. Infants treated with MV alone had higher mean Hb (9.9 g/dl (95% CI 9.7-10.1)) than those given placebo (9.6 g/dl (9.4-9.8)) or Zn alone (9.6 g/dl (9.4-9.7)).
MV treatment improved iron status in infancy, whereas Zn worsened iron status but without an associated increase in risk for anemia. Infants in long-term Zn supplementation programs at risk for ID may benefit from screening and/or the addition of a MV supplement.
背景/目的：锌（Zn）补充在动物和成人的研究中会对铁的状态产生不利影响，但很少有试验包括婴幼儿。本研究的目的是确定 Zn 和多种维生素（MV）补充对婴儿血液学和铁状态的影响。
受试者/方法：在一项双盲 RCT 中，坦桑尼亚婴儿在出生后 6 周时被随机分配至每日口服 Zn、MV、Zn 和 MV 或安慰剂治疗组。在基线和 6、12 和 18 个月时测量血红蛋白浓度（Hb）和红细胞指数。在 6 个月时对 589 名婴儿的血浆样本进行缺铁（ID）检查。
在逻辑回归模型中，Zn 治疗与更高的 ID 几率相关（比值比（OR）1.8（95%置信区间（CI）1.0-3.3）），MV 治疗与更低的几率相关（OR 0.49（95% CI 0.3-0.9））。在 Cox 模型中，MV 与严重贫血风险降低 28%相关（风险比（HR）=0.72（95% CI 0.56-0.94）），严重小细胞性贫血风险降低 26%相关（HR=0.74（0.56-0.96））至 18 个月。未观察到 Zn 对贫血风险的影响。单独接受 MV 治疗的婴儿平均 Hb 较高（9.9 g/dl（95% CI 9.7-10.1）），高于接受安慰剂（9.6 g/dl（9.4-9.8））或单独接受 Zn（9.6 g/dl（9.4-9.7））的婴儿。
MV 治疗改善了婴儿期的铁状态，而 Zn 则恶化了铁状态，但与贫血风险增加无关。在长期 Zn 补充计划中存在 ID 风险的婴儿可能受益于筛查和/或添加 MV 补充剂。
