Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA.
Department of Nutrition and Food Science, University of Ghana, Legon, Ghana.
Am J Clin Nutr. 2019 Feb 1;109(2):322-334. doi: 10.1093/ajcn/nqy303.
Adequate nutrition is necessary for brain development during pregnancy and infancy. Few randomized controlled trials of supplementation during these periods have measured later developmental outcomes.
Our objective was to investigate the effects of provision of prenatal and postnatal lipid-based nutrient supplements (LNS) on child development at preschool age.
We conducted a follow-up study of 966 children aged 4-6 y in 2016, born to women who participated in the International Lipid-Based Nutrient Supplements-DYAD trial conducted in Ghana in 2009-2014, representing 79% of eligible children. Women ≤20 weeks of gestation were randomized to daily LNS or multiple micronutrient (MMN) capsules during pregnancy through 6 mo postpartum or iron and folic acid (IFA) capsules during pregnancy and calcium placebo capsules during 6 mo postpartum. Children in the LNS group received LNS from 6 to 18 mo. Primary outcomes of this follow-up study were (1) a cognitive factor score based on a test battery adapted from several standard tests, 2) fine motor score (9-hole pegboard test), and (3) social-emotional difficulties (Strengths and Difficulties Questionnaire; SDQ). Eight secondary outcomes were calculated in specific domains (e.g., language, SDQ prosocial). Analysis was by a complete case intention to treat in a 2-group comparison: LNS compared with non-LNS (MMN + IFA).
Children in the LNS group had significantly lower social-emotional difficulties z-scores than children in the non-LNS group (adjusted for child age β = -0.12, 95% CI: -0.25, 0.02, P = 0.087; fully adjusted β = -0.16, 95% CI: -0.29, -0.03, P = 0.013). The effect of LNS on social-emotional difficulties score was larger among children living in households with lower home environment scores (P-interaction = 0.081). No other outcomes differed between the 2 intervention groups.
Provision of LNS during the first 1000 d of development improved behavioral function, particularly for children from low nurturing and stimulation households, but did not affect cognition at preschool age in this setting. Trial Registration: clinicaltrials.gov, Identifier NCT00970866.
怀孕期间和婴儿期的大脑发育需要充足的营养。在这些时期进行的少数随机对照试验中，很少有测量后期发育结果的试验。
我们的目的是研究在学前年龄提供产前和产后脂质营养素补充剂（LNS）对儿童发育的影响。
我们对 2016 年 966 名 4-6 岁的儿童进行了随访研究，这些儿童的母亲参加了 2009-2014 年在加纳进行的国际脂质营养素补充剂-DYAD 试验，占符合条件的儿童的 79%。妊娠<20 周的妇女被随机分配在妊娠期间每天服用 LNS 或多种微量营养素（MMN）胶囊至产后 6 个月，或在妊娠期间服用铁和叶酸（IFA）胶囊，在产后 6 个月服用钙安慰剂胶囊。LNS 组的儿童在 6 至 18 个月期间接受 LNS。本随访研究的主要结局为：（1）基于几项标准测试改编的测试组合的认知因子评分，2）精细运动评分（9 孔钉板测试），3）社会情感困难（优势与困难问卷；SDQ）。在特定领域计算了 8 个次要结局（例如，语言，SDQ 亲社会）。分析为 2 组比较的完全病例意向治疗：LNS 与非 LNS（MMN+IFA）。
与非 LNS 组相比，LNS 组儿童的社会情感困难 Z 分数显著降低（按儿童年龄调整β=-0.12，95%CI：-0.25，0.02，P=0.087；完全调整β=-0.16，95%CI：-0.29，-0.03，P=0.013）。LNS 对社会情感困难评分的影响在家庭环境评分较低的家庭中更大（P 交互=0.081）。两组干预措施之间没有其他结果差异。
在生命最初 1000 天提供 LNS 可改善行为功能，特别是对于来自低养育和刺激家庭的儿童，但在这种环境下，对学前年龄的认知没有影响。试验注册：clinicaltrials.gov，标识符 NCT00970866。
