1Nutrition and Health Sciences Program,Laney Graduate School,Emory University,Atlanta,GA 30322,USA.
3Department of Psychology,Emory University,Atlanta,GA 30322,USA.
Br J Nutr. 2018 Jul;120(2):176-187. doi: 10.1017/S000711451800140X.
Research demonstrates the importance of nutrition for early brain development. Few studies have examined the effectiveness of multiple micronutrient powders (MNP) on child development. This study examined the impacts of home fortification with MNP on motor and mental development, executive function and memory of children living in Bihar. This two-arm cluster-randomised effectiveness trial selected seventy health sub-centres to receive either MNP and nutrition counselling (intervention) or nutrition counselling alone (control) for 12 months. Front-line health workers delivered the intervention to all households in study communities with a child aged 6-18 months. Data were collected using cross-sectional surveys at baseline and endline by selecting households from intervention (baseline, n 2184; endline, n 2170) and control (baseline, n 2176; endline, n 2122) communities using a two-stage cluster-randomised sampling strategy. Children in the intervention group had a significantly larger improvement from baseline to endline compared with those in the control group on scores for motor and mental development (Cohen's d, motor=0·12; 95 % CI 0·03, 0·22; mental=0·15; 95 % CI 0·06, 0·25). Greater impacts of MNP on motor and mental development were observed in children from households with higher stimulation scores at baseline compared with those with lower stimulation (Cohen's d, motor=0·20 v. 0·09; mental=0·22 v. 0·14; P interaction<0·05). No significant treatment differences were seen for executive function or memory. Home fortification with MNP through the existing health infrastructure in Bihar was effective in improving motor and mental development and should be considered in combination with other child development interventions such as stimulation.
研究表明营养对大脑早期发育的重要性。很少有研究调查多种微量营养素粉（MNP）对儿童发育的影响。本研究考察了在家中强化 MNP 对居住在比哈尔邦的儿童运动和精神发育、执行功能和记忆的影响。这项双臂、集群随机有效性试验选择了 70 个卫生分中心，这些分中心在 12 个月的时间里接受 MNP 和营养咨询（干预组）或仅接受营养咨询（对照组）。一线卫生工作者向研究社区中所有有 6-18 个月大孩子的家庭提供干预措施。通过采用两阶段集群随机抽样策略，从干预组（基线 n=2184；终点 n=2170）和对照组（基线 n=2176；终点 n=2122）社区中抽取家庭进行横断面调查，在基线和终点收集数据。与对照组相比，干预组儿童在运动和精神发育评分方面的改善更为显著（Cohen's d，运动=0.12；95%CI 0.03，0.22；精神=0.15；95%CI 0.06，0.25）。与基线刺激评分较低的家庭相比，基线刺激评分较高的家庭中 MNP 对运动和精神发育的影响更大（Cohen's d，运动=0.20 比 0.09；精神=0.22 比 0.14；P 交互<0.05）。在执行功能或记忆方面，未观察到治疗的显著差异。在比哈尔邦现有的卫生基础设施中，通过家庭强化 MNP 可以有效改善运动和精神发育，应将其与其他儿童发展干预措施（如刺激）结合考虑。
