Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Am J Clin Nutr. 2022 Mar 4;115(3):738-748. doi: 10.1093/ajcn/nqab404.
Prenatal multiple micronutrient supplementation (MMS) and lipid-based nutrient supplementation (LNS) can improve birth outcomes relative to iron-folic acid supplementation (IFA); however, effects on child postnatal growth remain unclear.
The aim was to compare the effect of prenatal MMS, medium-quantity LNS (MQ-LNS), and IFA on child growth up to 2 y of age.
We conducted a cluster randomized controlled trial of prenatal nutritional supplementation in Madarounfa, Niger. Villages were randomly assigned for pregnant women to receive IFA (17 villages, 1105 women), MMS (18 villages, 1083 women) or MQ-LNS (18 villages, 1144 women). Pregnant women received nutritional supplements weekly until delivery, and children were followed up monthly from 6-8 wk to 24 mo of age. We assessed the effect of prenatal MMS and MQ-LNS compared with IFA and the effect of prenatal MMS compared with MQ-LNS on child length-for-age z scores (LAZ), weight-for-age z scores (WAZ), and weight-for-length z scores (WLZ) at 24 mo of age using generalized linear models. In secondary analyses, we used mixed-effects models to assess the trajectories of anthropometric z scores longitudinally from 6-8 wk to 24 mo.
Compared with IFA, MMS and MQ-LNS had no effect on child LAZ, WAZ, or WLZ at 24 mo of age (P > 0.05). Children in the MQ-LNS arm had significantly higher mid-upper arm circumference at 24 mo than children in the MMS arm: mean difference 0.50 cm (95% CI 0.10, 0.91 cm). WAZ and WLZ trajectories were more negative in the MQ-LNS arm compared with IFA and MMS, with lower z scores from 14 to 20 mo of age. However, WAZ and WLZ trajectories converged after 20 mo of age, and there were no differences by 24 mo of age.
Prenatal MMS and MQ-LNS had limited effect on anthropometric measures of child growth up to 24 mo of age as compared with IFA in rural Niger.
与铁叶酸补充剂（IFA）相比，产前多种微量营养素补充（MMS）和基于脂质的营养素补充（LNS）可改善出生结局；然而，其对儿童产后生长的影响尚不清楚。
本研究旨在比较产前 MMS、中剂量 LNS（MQ-LNS）和 IFA 对 2 岁以下儿童生长的影响。
我们在尼日尔的马杜罗纳法进行了一项关于产前营养补充的整群随机对照试验。村庄被随机分配给孕妇接受 IFA（17 个村庄，1105 名妇女）、MMS（18 个村庄，1083 名妇女）或 MQ-LNS（18 个村庄，1144 名妇女）。孕妇每周接受营养补充剂，直至分娩，儿童从 6-8 周龄到 24 月龄每月接受一次随访。我们使用广义线性模型评估了产前 MMS 和 MQ-LNS 与 IFA 相比以及产前 MMS 与 MQ-LNS 相比对 24 月龄儿童的身长年龄 z 评分（LAZ）、体重年龄 z 评分（WAZ）和体重身长 z 评分（WLZ）的影响。在次要分析中，我们使用混合效应模型从 6-8 周龄到 24 月龄对人体测量 z 评分的纵向轨迹进行了评估。
与 IFA 相比，MMS 和 MQ-LNS 对 24 月龄儿童的 LAZ、WAZ 或 WLZ 没有影响（P>0.05）。MQ-LNS 组儿童的中上臂围在 24 月龄时明显高于 MMS 组：平均差值 0.50cm（95%CI 0.10，0.91cm）。与 IFA 和 MMS 相比，MQ-LNS 组儿童的 WAZ 和 WLZ 轨迹更负，从 14 月龄到 20 月龄的 z 评分较低。然而，WAZ 和 WLZ 轨迹在 20 月龄后趋同，到 24 月龄时没有差异。
与 IFA 相比，在尼日尔农村，产前 MMS 和 MQ-LNS 对 24 月龄以下儿童生长的人体测量指标的影响有限。
