各种家庭强化方法对 5 岁以下儿童的有效性：有效和无效的地方。系统评价和荟萃分析。

Effectiveness of various methods of home fortification in under-5 children: where they work, where they do not. A systematic review and meta-analysis.

机构信息

Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

Nutr Rev. 2021 Mar 9;79(4):445-461. doi: 10.1093/nutrit/nuaa087.

DOI:10.1093/nutrit/nuaa087

PMID:33011799

Abstract

CONTEXT

The common approaches of home fortification (HF) for prevention and/or treatment of micronutrient deficiencies are micronutrient powders (MNPs), foodlets, and lipid-based nutrient supplements (LNSs). There are mixed results for the impact of HF on growth and nutritional status of young children.

OBJECTIVE

This systematic review was prepared in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate current evidence from randomized controlled trials including children younger than 5 years to assess the effect of strategies of HF on growth and micronutrient status.

METHODS

The MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar databases were searched to July 2018. A total of 1301 studies were found in a preliminary search. After screening of titles and abstracts, 30 studies were selected.

RESULTS

Treatment with MNPs, foodlets, and LNSs effectively increased hemoglobin concentrations by at least 2.52 g/L, 4.59 g/L, and 4.4 g/dL, respectively, as compared with a control. There was a significant decrease in risk of anemia development after foodlet intervention compared with a control or iron drops (odds ratio, 0.27; 95%CI, 0.10-0.74; P = 0.01). However, these interventions did not result in any significant improvement in z-scores for changes of height for age, weight for age, and weight for height. The results indicated that MNP (7.16; 95%CI, 0.31-14.01; P = 0.04) and foodlet treatment (4.92; 95%CI, 0.28-9.57; P = 0.04) could increase serum zinc levels. However, none of the home fortification methods improved vitamin A status in the target group.

CONCLUSION

Home fortification can be used as an effective method to improve hemoglobin, iron, and zinc status, although in this study it had no effect on vitamin A or anthropometric indicators of the target population. More investigations are warranted for newer approaches of HF to improve a broader range of micronutrients as well as child growth indices and for evaluation of the coverage, compliance, and consistency of such interventions at the population level.

PROSPERO REGISTRATION NO

CRD42018109279.

摘要

背景

家庭强化（HF）是预防和/或治疗微量营养素缺乏的常用方法，包括微量营养素粉（MNP）、食物片和脂基营养素补充剂（LNS）。HF 对幼儿生长和营养状况的影响结果不一。

目的

本系统评价按照系统评价和荟萃分析的首选报告项目进行准备，旨在评估包括 5 岁以下儿童在内的随机对照试验的现有证据，以评估 HF 策略对生长和微量营养素状况的影响。

方法

初步检索共检索到 1301 项研究，通过 MEDLINE、PubMed、Embase、Cochrane 图书馆和 Google Scholar 数据库检索至 2018 年 7 月。在筛选标题和摘要后，选择了 30 项研究。

结果

与对照组相比，MNP、食物片和 LNS 的治疗分别有效增加血红蛋白浓度至少 2.52 g/L、4.59 g/L 和 4.4 g/dL。与对照组或铁滴剂相比，食物片干预后贫血发展的风险显著降低（比值比，0.27；95%CI，0.10-0.74；P=0.01）。然而，这些干预措施并未导致身高年龄、体重年龄和体重身高的 z 评分有任何显著改善。结果表明，MNP（7.16；95%CI，0.31-14.01；P=0.04）和食物片治疗（4.92；95%CI，0.28-9.57；P=0.04）可以增加血清锌水平。然而，家庭强化方法均未改善目标人群的维生素 A 状况。