Hoffmann Vivian, Jones Kelly, Leroy Jef L
Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA.
Economics Department, American University, Washington, DC, USA.
BMJ Glob Health. 2018 Dec 1;3(6):e000983. doi: 10.1136/bmjgh-2018-000983. eCollection 2018.
Observational studies have documented an association between aflatoxin (AF) exposure and reduced linear growth in infants and young children. Our objective was to assess the effectiveness of reducing AF exposure on child linear growth and serum AF levels in rural areas in Eastern Kenya.
A cluster randomised controlled design was used (28 intervention and 28 control clusters). The intervention arm received a swapping (contaminated maize was replaced with safe maize) and a stockist intervention (households were encouraged to purchase from a stockist supplied with clean maize). Women in the fifth to final month of pregnancy were invited to enrol in the study. Outcomes were child length-for-age Z-score (LAZ), the prevalence of stunting and child serum AFB-lysine adduct level 24 (endline, primary outcomes) and 11 to 19 months (midline, secondary outcomes) after trial commencement, respectively. The trial was registered with socialscienceregistry.org.
Of the 1230 unborn children enrolled in the study, 881 (72%) were included in the LAZ and 798 (65%) in the serum AFB analysis. The intervention significantly reduced endline ln serum AFB-lysine adduct levels (intervention effect-0.273, 95% CI -0.547 to 0.001; one-sided p=0.025), but had no effect on endline LAZ or stunting (mean LAZ at endline was -1.64). At midline, the intervention increased LAZ by 0.16 (95% CI -0.009 to 0.33; one-sided p=0.032) and reduced stunting by seven percentage points (95% CI -0.125 to -0.007; one-sided p=0.015), but had no impact on serum AFB levels.
Improving access to AF-free maize substantially reduced endline serum AF, but had no effect on child linear growth. The midline analysis suggests that AF may affect linear growth at younger ages.
AEARCTR-0000105.
观察性研究已记录到黄曲霉毒素（AF）暴露与婴幼儿线性生长减缓之间存在关联。我们的目标是评估在肯尼亚东部农村地区减少AF暴露对儿童线性生长和血清AF水平的有效性。
采用整群随机对照设计（28个干预组和28个对照组）。干预组接受了一项交换措施（用安全玉米替代受污染玉米）和一项经销商干预措施（鼓励家庭从供应清洁玉米的经销商处购买）。邀请处于妊娠第五个月至最后一个月的妇女参与研究。结局指标分别为试验开始后儿童年龄别身长Z评分（LAZ）、发育迟缓患病率以及儿童血清AFB-赖氨酸加合物水平（终末点，主要结局指标）和11至19个月时（中点，次要结局指标）。该试验已在socialscienceregistry.org注册。
在参与研究的1230名未出生儿童中，881名（72%）纳入了LAZ分析，798名（65%）纳入了血清AFB分析。干预措施显著降低了终末点血清AFB-赖氨酸加合物水平（干预效应为-0.273，95%置信区间为-0.547至0.001；单侧p=0.025），但对终末点LAZ或发育迟缓无影响（终末点时平均LAZ为-1.64）。在中点时，干预措施使LAZ增加了0.16（95%置信区间为-0.009至0.33；单侧p=0.032），并使发育迟缓率降低了7个百分点（95%置信区间为-0.125至-0.007；单侧p=0.015），但对血清AFB水平无影响。
改善无AF玉米的可及性可大幅降低终末点血清AF，但对儿童线性生长无影响。中点分析表明，AF可能在儿童较小时影响线性生长。
AEARCTR-0000105。
