Park Jay J H, Harari Ofir, Siden Ellie, Dron Louis, Zannat Noor-E, Singer Joel, Lester Richard T, Thorlund Kristian, Mills Edward J
Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
MTEK Sciences, Vancouver, BC, V5Z1J5, Canada.
Gates Open Res. 2020 Sep 24;3:1660. doi: 10.12688/gatesopenres.13083.2. eCollection 2019.
Optimizing linear growth in children during complementary feeding period (CFP) (6-24 months) is critical for their development. Several interventions, such as micronutrient and food supplements, deworming, maternal education, and water, sanitation and hygiene (WASH), could potentially be provided to prevent stunting, but their comparative effectiveness are currently unclear. In this study, we evaluated comparative effectiveness of interventions under these domains on child linear growth outcomes of height-for-age z-score (HAZ) and stunting (HAZ <-2SD) For this study, we searched for low- and middle-income country (LMIC)-based randomized clinical trials (RCTs) of aforementioned interventions provided to children during CFP. We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We performed random-effects network meta-analysis (NMA) for HAZ and stunting. The evidence base for our NMA was based on 79 RCTs (96 papers) involving 81,786 children. Among the micronutrients, compared to standard-of-care, iron + folic acid (IFA) (mean difference =0.08; 95% credible interval [CrI]: 0.01, 0.15) and multiple micronutrients (MMN) (mean difference =0.06; 95%CrI: 0.01, 0.11) showed improvements for HAZ; MMN also reduced the risks for stunting (RR=0.86; 95%Crl: 0.73, 0.98), whereas IFA did not (RR=0.92; 95%Crl: 0.64, 1.23). For food supplements, flour in the caloric range of 270-340 kcal (RR=0.73; 95%Crl: 0.51, 1.00) and fortified lipid-based nutrient supplements (LNS) containing 220-285 kcal (RR=0.80; 95%Crl: 0.66, 0.97) decreased the risk of stunting compared to standard-of-care, but these interventions and other food supplements did not show improvements for HAZ. Deworming, maternal education, and WASH interventions did not show improvements for HAZ nor stunting. While we found micronutrient and food supplements to be effective for HAZ and/or stunting, the evidence base for other domains in this life stage was limited, highlighting the need for more investigation. PROSPERO CRD42018110449; registered on 17 October 2018.
在辅食喂养期（6 - 24个月）优化儿童的线性生长对其发育至关重要。可以采取多种干预措施，如微量营养素和食物补充剂、驱虫、孕产妇教育以及水、环境卫生和个人卫生（WASH），这些措施可能有助于预防发育迟缓，但目前它们的相对有效性尚不清楚。在本研究中，我们评估了这些领域的干预措施对儿童线性生长指标年龄别身高Z评分（HAZ）和发育迟缓（HAZ < -2SD）的相对有效性。在本研究中，我们检索了基于低收入和中等收入国家（LMIC）的随机临床试验（RCT），这些试验是关于在辅食喂养期向儿童提供上述干预措施的。我们检索了截至2019年9月17日发表的报告，并人工检索了现有综述的参考文献。我们对HAZ和发育迟缓进行了随机效应网络荟萃分析（NMA）。我们NMA的证据基础基于79项RCT（96篇论文），涉及81786名儿童。在微量营养素中，与标准护理相比，铁 + 叶酸（IFA）（平均差异 = 0.08；95%可信区间[CrI]：0.01，0.15）和多种微量营养素（MMN）（平均差异 = 0.06；95%CrI：0.01，0.11）对HAZ有改善作用；MMN也降低了发育迟缓的风险（RR = 0.86；95%Crl：0.73，0.98），而IFA没有（RR = 0.9.92；95%Crl：0.64，1.23）。对于食物补充剂，热量在270 - 340千卡范围内的面粉（RR = 0.73；95%Crl：0.51，1.00）和含有220 - 285千卡的强化脂质基营养补充剂（LNS）与标准护理相比降低了发育迟缓的风险，但这些干预措施和其他食物补充剂对HAZ没有改善作用。驱虫、孕产妇教育和WASH干预措施对HAZ和发育迟缓均无改善作用。虽然我们发现微量营养素和食物补充剂对HAZ和/或发育迟缓有效，但这一生命阶段其他领域的证据基础有限，突出了需要更多研究的必要性。PROSPERO CRD号码：CRD42018110449；于2018年10月17日注册。
