脂类营养素补充剂预防儿童营养不良：少即是多。

Lipid-based nutrient supplements for prevention of child undernutrition: when less may be more.

机构信息

Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States.

出版信息

Am J Clin Nutr. 2023 Dec;118(6):1133-1144. doi: 10.1016/j.ajcnut.2023.09.007. Epub 2023 Sep 23.

DOI:10.1016/j.ajcnut.2023.09.007

PMID:37742931

Abstract

BACKGROUND

Both small-quantity and medium-quantity lipid-based nutrient supplements (LNS) have been used for the prevention of child undernutrition. A meta-analysis of 14 trials of small-quantity lipid-based nutrient supplements (SQ-LNS) - no LNS showed effects on length-for-age z-score {LAZ, +0.14 [95% confidence interval (CI): 0.11, 0.16]} and weight-for-length z-score [WLZ, +0.08 (0.06, 0.10)] z-scores, as well as prevalence ratios (95% CI) for stunting [LAZ < -2, 0.88 (0.85, 0.91)] and wasting [WLZ < -2, 0.86 (0.80, 0.93)]. However, little is known about the effects of medium-quantity lipid-based nutrient supplements (MQ-LNS) on growth.

OBJECTIVES

We aimed to examine the effects of preventive MQ-LNS (∼250-499 kcal/d) provided at ∼6-23 mo of age on growth outcomes - no LNS or provision of SQ-LNS.

METHODS

We conducted a systematic review of studies of MQ-LNS for prevention, and categorized them as providing <6 mo - ≥6 mo of supplementation; for the latter category, we conducted a meta-analysis, with the main outcomes being change in WLZ and LAZ, and prevalence of wasting and stunting.

RESULTS

Three studies provided MQ-LNS for 3-5 mo (seasonal) for children 6-36 mo of age, and did not show consistent effects on growth outcomes. Eight studies provided MQ-LNS for 6-18 mo, generally starting at 6 mo of age; in the meta-analysis (max total n = 13,954), MQ-LNS increased WLZ [+0.09 (95% CI: 0.05, 0.13)] and reduced wasting [0.89 (0.81, 0.97)], but had no effect on LAZ [+0.04 (-0.02, 0.11)] or stunting [0.97 (0.92, 1.02)] - no LNS. Two studies directly compared SQ-LNS and MQ-LNS and showed no significant differences in growth outcomes.

CONCLUSIONS

The current evidence suggests that MQ-LNS offer no added benefits over SQ-LNS, although further studies directly comparing MQ-LNS with SQ-LNS would be useful. One possible explanation is incomplete consumption of the MQ-LNS ration and thus lower than desirable intake of certain nutrients.

TRIAL REGISTRATION NUMBER

Registry and registry number for systematic reviews or meta-analyses: Registered with PROSPERO as CRD42022382448 on December 18, 2022: =https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022382448.

摘要

背景

小剂量和中剂量的基于脂质的营养补充剂（LNS）都被用于预防儿童营养不良。对 14 项小剂量基于脂质的营养补充剂（SQ-LNS）试验的荟萃分析——无 LNS 显示对年龄别身长 Z 评分（LAZ，+0.14[95%置信区间（CI）：0.11，0.16]）和身长别体重 Z 评分（WLZ，+0.08[0.06，0.10]）的影响，以及发育迟缓（LAZ<-2）和消瘦（WLZ<-2）的患病率比值（95%CI）[LAZ < -2，0.88（0.85，0.91）]和消瘦（WLZ < -2，0.86（0.80，0.93））。然而，对于中剂量基于脂质的营养补充剂（MQ-LNS）对生长的影响知之甚少。

目的

我们旨在研究预防性 MQ-LNS（约 250-499 千卡/天）在 6-23 月龄时提供对生长结果的影响-无 LNS 或提供 SQ-LNS。

方法

我们对 MQ-LNS 预防的研究进行了系统评价，并将其分为提供<6 个月-≥6 个月的补充；对于后者，我们进行了荟萃分析，主要结果是 WLZ 和 LAZ 的变化，以及消瘦和发育迟缓的患病率。

结果

三项研究提供了 3-5 个月（季节性）的 MQ-LNS，用于 6-36 月龄的儿童，对生长结果没有一致的影响。八项研究提供了 6-18 个月的 MQ-LNS，通常从 6 个月开始；在荟萃分析（最大总 n=13954）中，MQ-LNS 增加了 WLZ[+0.09（95%CI：0.05，0.13）]和减少了消瘦[0.89（0.81，0.97）]，但对 LAZ 没有影响[+0.04（-0.02，0.11）]或发育迟缓[0.97（0.92，1.02）]-无 LNS。两项研究直接比较了 SQ-LNS 和 MQ-LNS，发现生长结果没有显著差异。