Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
Nestlé Research Center, Public Health Department, Lausanne, Switzerland.
PLoS One. 2019 Jan 23;14(1):e0210899. doi: 10.1371/journal.pone.0210899. eCollection 2019.
Micronutrient (MN) deficiencies cause a considerable burden of disease for children in many countries. Dairy products or cereals are an important food component during adolescence. Fortification of dairy products or cereals with MN may be an effective strategy to overcome MN deficiencies, but their specific impact on health in this age group is poorly documented.
We performed a systematic review and meta-analysis (registration number CRD42016039554) to assess the impact of MN fortified dairy products and cereal food on the health of children and adolescents (aged 5-15 years) compared with non-fortified food. We reviewed randomised controlled trials (RCT) using electronic databases (MEDLINE, EMBASE, Cochrane library; latest search: January 2018), reference list screening and citation searches. Three pairs of reviewers assessed 2048 studies for eligibility and extracted data. We assessed the risk of bias and applied GRADE to rate quality of evidence.
We included 24 RCT (often multi MN fortification) with 30 pair-wise comparisons mainly from low- and middle income countries. A very small and non-significant increase of haemoglobin values emerged (0.09 g/dl [95%-CI: -0.01 to 0.18]; 13 RCT with iron fortification; very low quality of evidence). No significant difference was found on anaemia risk (risk ratio 0.87 [95%-CI: 0.76 to 1.01]; 12 RCT; very low quality), but a significant difference in iron deficiency anaemia favouring fortified food was found (risk ratio 0.38 [95%-CI: 0.18 to 0.81]; 5 RCT; very low quality). Similar effects were seen for fortified dairy products and cereals and different fortification strategies (mono- vs. dual- vs. multi-MN). Follow-up periods were often short and the impact on anthropometric measures was weak (low quality of evidence) Very low quality of evidence emerged for the improvement of cognitive performance, functional measures and morbidity.
Fortification of dairy products and cereal food had only marginal health effects in our sample population from 5-15 years. Further evidence is needed to better understand the health impact of fortified dairy products and cereals in this age group.
The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 26 May 2016 (registration number CRD42016039554).
在许多国家，微量营养素（MN）缺乏症给儿童带来了相当大的疾病负担。乳制品或谷物是青春期的重要食物组成部分。用 MN 强化乳制品或谷物可能是克服 MN 缺乏症的有效策略，但它们对该年龄段健康的具体影响记录甚少。
我们进行了系统评价和荟萃分析（注册号 CRD42016039554），以评估与非强化食品相比，MN 强化乳制品和谷物食品对儿童和青少年（5-15 岁）健康的影响。我们使用电子数据库（MEDLINE、EMBASE、Cochrane 图书馆；最新搜索：2018 年 1 月）、参考文献筛选和引文搜索审查了随机对照试验（RCT）。三对评审员对 2048 项研究进行了资格评估并提取了数据。我们评估了偏倚风险，并应用 GRADE 对证据质量进行评级。
我们纳入了 24 项 RCT（通常是多种 MN 强化），涉及来自中低收入国家的 30 对比较。血红蛋白值略有但无统计学意义的增加（0.09 g/dl [95%-CI：-0.01 至 0.18]；13 项铁强化 RCT；极低质量证据）。贫血风险无显著差异（风险比 0.87 [95%-CI：0.76 至 1.01]；12 项 RCT；极低质量），但强化食品对缺铁性贫血的影响有显著差异（风险比 0.38 [95%-CI：0.18 至 0.81]；5 项 RCT；极低质量）。强化乳制品和谷物均有类似效果，且不同强化策略（单 MN 强化 vs. 双 MN 强化 vs. 多 MN 强化）也有类似效果。随访期通常较短，对人体测量指标的影响较弱（证据质量低），认知表现、功能测量和发病率的改善也仅有低质量证据。
在我们的 5-15 岁样本人群中，乳制品和谷物的强化仅对健康产生了微不足道的影响。需要进一步的证据来更好地了解强化乳制品和谷物在该年龄段的健康影响。
该研究方案于 2016 年 5 月 26 日在国际前瞻性系统评价登记处（PROSPERO）注册（注册号 CRD42016039554）。
