Khan Aslam, Ul-Haq Zia, Fazid Sheraz, Fatima Sadia, Muhammad Nawshad, Ahmed Jawad, Manoharadas Salim, Safi Sher Zaman, Habib Ijaz, Garzon Cecilia, Ihtesham Yasir, Zahid Fareeda, Dad Fazal, Mahamadou Tanimoune, Lowe Nicola M
Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Front Nutr. 2023 Jul 27;10:1176778. doi: 10.3389/fnut.2023.1176778. eCollection 2023.
Micronutrient deficiencies including vitamin A, vitamin D, and zinc are highly prevalent in children below 5 years of age in low and -middle-income countries. We aimed to evaluate the effectiveness of ready-to-use Lipid-based Nutrient Supplement-Medium Quantity (LNS-MQ) local name "Wawa-mum" on plasma micronutrient status, hemoglobin concentration and anthropometric measurements.
A community-based non-randomized trial was conducted in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019. A total of 110 children aged 6 to 23 months old were recruited and allocated to the intervention and control arm of the study. A total of 57 children in the intervention arm received a daily ration of 50 g of Wawa-mum, for one year. To assess the impact of the intervention on primary outcome measures, i.e., serum vitamin A, D concentration, plasma zinc, and hemoglobin concentration. Blood samples were collected at baseline and after one year following the intervention. The vitamins concentration in serum were assessed using Enzyme-Linked Immunosorbent Assay (ELISA) and plasma zinc by atomic absorption spectrometry. The hemoglobin concentration was measured by an automated hematology analyzer. A 24-h dietary recall interview was used to assess the nutrient intake adequacy. Multivariate Linear regression models were used to analyze the outcomes while controlling for potential confounders.
In the intervention arm, children had on average 6.2 μg/dL (95% CI 3.0-9.3, value of <0.001) increase in the serum vitamin A concentration, 8.1 ng/mL (95% CI 1.3-14.9, value of 0.02) increase in serum vitamin D concentration and 49.0 μg/dL (95% CI 33.5-64.5, value of <0.001) increase in the plasma zinc concentration, and 2.7 g/dL (95% CI 2.0-3.3, value of <0.001) increase in hemoglobin concentration while adjusted for covariates. An addition, length-for-age -score (LAZ), weight-for-length -score (WLZ), weight-for-age -score (WAZ), and prevalence of undernutrition including stunting, wasting, and underweight were calculated as a secondary outcome to investigate the impact of micronutrients on growth parameters, that has been improved significantly after receiving the Wawa-mum.
Wawa-mum (LNS-MQ) is an effective intervention to improve the micronutrient status, hemoglobin concentration, and growth parameters in 6 to 23 months children, which can be scaled up in the existing health system to address the alarming rates of under nutrition in Pakistan and other developing countries.
https://doi.org/10.1186/ISRCTN94319790, ISRCTN94319790.
在低收入和中等收入国家，包括维生素A、维生素D和锌在内的微量营养素缺乏在5岁以下儿童中极为普遍。我们旨在评估即食型中等剂量脂质基营养补充剂（当地名称为“瓦瓦妈妈”）对血浆微量营养素状况、血红蛋白浓度和人体测量指标的有效性。
2018年1月至2019年6月在开伯尔-普赫图赫瓦省库拉姆地区进行了一项基于社区的非随机试验。共招募了110名6至23个月大的儿童，并将其分配到研究的干预组和对照组。干预组的57名儿童每天食用50克瓦瓦妈妈，持续一年。为评估干预对主要结局指标（即血清维生素A、D浓度、血浆锌和血红蛋白浓度）的影响，在基线和干预一年后采集血样。血清中维生素浓度采用酶联免疫吸附测定（ELISA）法评估，血浆锌采用原子吸收光谱法评估。血红蛋白浓度通过自动血液分析仪测量。采用24小时饮食回顾访谈评估营养摄入充足情况。在控制潜在混杂因素的同时，使用多元线性回归模型分析结果。
在干预组中，调整协变量后，儿童血清维生素A浓度平均增加6.2微克/分升（95%置信区间3.0 - 9.3，P值<0.001），血清维生素D浓度增加8.1纳克/毫升（95%置信区间1.3 - 14.9，P值0.02），血浆锌浓度增加49.0微克/分升（95%置信区间33.5 - 64.5，P值<0.001），血红蛋白浓度增加2.7克/分升（95%置信区间2.0 - 3.3，P值<0.001）。此外，计算年龄别身长标准差（LAZ）、身长别体重标准差（WLZ）、年龄别体重标准差（WAZ）以及包括发育迟缓、消瘦和体重不足在内的营养不良患病率作为次要结局，以研究微量营养素对生长参数的影响，结果显示在食用瓦瓦妈妈后有显著改善。
瓦瓦妈妈（即食型中等剂量脂质基营养补充剂）是改善6至23个月儿童微量营养素状况、血红蛋白浓度和生长参数的有效干预措施，可在现有卫生系统中扩大规模，以应对巴基斯坦和其他发展中国家令人担忧的营养不良率。
