微量营养素充足程度较差,但与 12-24 个月龄儿童的发育迟缓无关:来自孟加拉贫民窟地区的队列研究结果。

Micronutrient adequacy is poor, but not associated with stunting between 12-24 months of age: A cohort study findings from a slum area of Bangladesh.

机构信息

Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

Renal Unit, Menzies School of Health Research, Darwin, Australia.

出版信息

PLoS One. 2018 Mar 29;13(3):e0195072. doi: 10.1371/journal.pone.0195072. eCollection 2018.

Abstract

The prevalence of stunting among children below 5 years of age is higher in the slum-dwelling population of Bangladesh compared to that in both urban and rural areas. Studies have reported that several factors such as inadequate nutrition, low socio-economic status, poor hygiene and sanitation and lack of maternal education are the substantial predictors of childhood stunting. Almost all these factors are universally present in the slum-dwelling population of Bangladesh. However, few studies have prospectively examined such determinants of stunting among slum populations. In this paper, we reveal the findings of a cohort study with an aim to explore the status of micronutrient adequacy among such vulnerable children and establish its association with stunting along with other determinants. Two-hundred-sixty-five children were enrolled and followed since birth until 24 months of age. We collected anthropometric, morbidity and dietary intake data monthly. We used the 24-hour multiple-pass recall approach to collect dietary intake data from the age of 9 months onward. Micronutrient adequacy of the diet was determined by the mean adequacy ratio (MAR) which was constructed from the average intake of 9 vitamins and 4 minerals considered for the analysis. We used generalized estimating equation (GEE) regression models to establish the determinants of stunting between 12-24 months of age in our study population. The prevalence of low-birth-weight (LBW) was about 28.7% and approximately half of the children were stunted by the age of 24 months. The average micronutrient intake was considerably lower than the recommended dietary allowance and the MAR was only 0.48 at 24 months of age compared to the optimum value of 1. However, the MAR was not associated with stunting between 12-24 months of age. Rather, LBW was the significant determinant (AOR = 3.03, 95% CI: 1.69-5.44) after adjusting for other factors such as age (AOR = 2.12, 95% CI: 1.45-3.11 at 24 months and AOR = 1.97, 95% CI: 1.49-2.59 at 18 months, ref: 12 months) and sex (AOR = 1.98, 95% CI: 1.17-3.33, ref: female). Improving the nutritional quality of complementary food in terms of adequacy of micronutrients is imperative for optimum growth but may not be adequate to mitigate under-nutrition in this setting. Further research should focus on identifying multiple strategies that can work synergistically to diminish the burden of stunting in resource-poor settings.

摘要

孟加拉国贫民窟居民中,5 岁以下儿童发育迟缓的患病率高于城市和农村地区。研究报告称,营养不良、社会经济地位低、卫生条件差和缺乏母亲教育等多种因素是导致儿童发育迟缓的主要预测因素。几乎所有这些因素在孟加拉国贫民窟居民中普遍存在。然而,很少有研究前瞻性地检查贫民窟人口中发育迟缓的这些决定因素。在本文中,我们揭示了一项队列研究的结果,旨在探索此类弱势儿童的微量营养素充足情况,并确定其与发育迟缓以及其他决定因素的关系。我们招募了 265 名儿童,从出生开始一直随访到 24 个月。我们每月收集人体测量学、发病率和饮食摄入数据。我们使用 24 小时多次通过回忆法从 9 个月大开始收集饮食摄入数据。通过平均充足率 (MAR) 确定饮食中微量营养素的充足程度,MAR 是根据分析中考虑的 9 种维生素和 4 种矿物质的平均摄入量构建的。我们使用广义估计方程 (GEE) 回归模型来确定我们研究人群中 12-24 个月时发育迟缓的决定因素。低出生体重 (LBW) 的患病率约为 28.7%,大约一半的儿童在 24 个月时发育迟缓。平均微量营养素摄入量明显低于膳食参考摄入量,24 个月时 MAR 仅为 0.48,而最佳值为 1。然而,MAR 与 12-24 个月时的发育迟缓无关。相反,LBW 是调整其他因素(如年龄(24 个月时 AOR=2.12,95%CI:1.45-3.11;18 个月时 AOR=1.97,95%CI:1.49-2.59,参考:12 个月)和性别(AOR=1.98,95%CI:1.17-3.33,参考:女性)后的重要决定因素(AOR=3.03,95%CI:1.69-5.44)。改善补充食品中微量营养素的营养质量对于最佳生长至关重要,但在这种情况下,可能不足以减轻营养不良。进一步的研究应侧重于确定可以协同作用以减轻资源匮乏环境中发育迟缓负担的多种策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7daf/5875860/dd36614216a0/pone.0195072.g001.jpg

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