脂质营养素补充剂对发育迟缓儿童微量营养素状况和血红蛋白的影响：乌干达一项随机对照试验的二次分析。

Effect of lipid-based nutrient supplements on micronutrient status and hemoglobin among children with stunting: secondary analysis of a randomized controlled trial in Uganda.

机构信息

Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.

Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.

出版信息

Am J Clin Nutr. 2024 Mar;119(3):829-837. doi: 10.1016/j.ajcnut.2024.01.018. Epub 2024 Jan 24.

DOI:10.1016/j.ajcnut.2024.01.018

PMID:38278366

Abstract

BACKGROUND

Micronutrient deficiencies and anemia are widespread among children with stunting.

OBJECTIVES

We assessed the effects of lipid-based nutrient supplements (LNS) containing milk protein (MP) and/or whey permeate (WP) on micronutrient status and hemoglobin (Hb) among children with stunting.

METHODS

This was a secondary analysis of a randomized controlled trial. Children aged 12-59 mo with stunting were randomly assigned to LNS (100 g/d) with milk or soy protein and WP or maltodextrin for 12 wk, or no supplement. Hb, serum ferritin (S-FE), serum soluble transferrin receptor (S-TfR), plasma cobalamin (P-Cob), plasma methylmalonic acid (P-MMA), plasma folate (P-Fol), and serum retinol-binding protein (S-RBP) were measured at inclusion and at 12 wk. Data were analyzed using linear and logistic mixed-effects models.

RESULTS

Among 750 children, with mean age ± SD of 32 ± 11.7 mo, 45% (n = 338) were female and 98% (n = 736) completed follow-up. LNS, compared with no supplementation, resulted in 43% [95% confidence interval (CI): 28, 60] greater increase in S-FE corrected for inflammation (S-FEci), 2.4 (95% CI: 1.2, 3.5) mg/L greater decline in S-TfR, 138 (95% CI: 111, 164) pmol/L greater increase in P-Cob, 33% (95% CI: 27, 39) reduction in P-MMA, and 8.5 (95% CI: 6.6, 10.3) nmol/L greater increase in P-Fol. There was no effect of LNS on S-RBP. Lactation modified the effect of LNS on markers of cobalamin status, reflecting improved status among nonbreastfed and no effects among breastfed children. LNS increased Hb by 3.8 (95% CI: 1.7, 6.0) g/L and reduced the odds of anemia by 55% (odds ratio: 0.45, 95% CI: 0.29, 0.70). MP compared with soy protein increased S-FEci by 14% (95% CI: 3, 26).

CONCLUSIONS

LNS supplementation increases Hb and improves iron, cobalamin, and folate status, but not vitamin A status among children with stunting. LNS should be considered for children with stunting. This trial was registered at ISRCTN as 13093195.

摘要

背景

微量营养素缺乏和贫血在发育迟缓的儿童中普遍存在。

目的

我们评估了含有牛奶蛋白（MP）和/或乳清渗透物（WP）的脂质营养素补充剂（LNS）对发育迟缓儿童的微量营养素状况和血红蛋白（Hb）的影响。

方法

这是一项随机对照试验的二次分析。12-59 月龄的发育迟缓儿童被随机分配至 LNS（100 g/d），其中含有牛奶或大豆蛋白和 WP 或麦芽糊精，或不补充，共 12 周。在纳入时和 12 周时测量 Hb、血清铁蛋白（S-FE）、血清可溶性转铁蛋白受体（S-TfR）、血浆钴胺素（P-Cob）、血浆甲基丙二酸（P-MMA）、血浆叶酸（P-Fol）和血清视黄醇结合蛋白（S-RBP）。使用线性和逻辑混合效应模型进行数据分析。

结果

在 750 名儿童中，平均年龄 ± SD 为 32 ± 11.7 个月，45%（n = 338）为女性，98%（n = 736）完成了随访。与不补充相比，LNS 导致 S-FEci 增加 43%[95%置信区间（CI）：28，60]，S-TfR 降低 2.4（95% CI：1.2，3.5）mg/L，P-Cob 增加 138（95% CI：111，164）pmol/L，P-MMA 降低 33%（95% CI：27，39），P-Fol 增加 8.5（95% CI：6.6，10.3）nmol/L。LNS 对 S-RBP 没有影响。哺乳方式改变了 LNS 对钴胺素状态标志物的影响，反映了非母乳喂养儿童的状态改善，而母乳喂养儿童则没有影响。LNS 使 Hb 增加了 3.8（95% CI：1.7，6.0）g/L，使贫血的几率降低了 55%（比值比：0.45，95% CI：0.29，0.70）。与大豆蛋白相比，MP 使 S-FEci 增加了 14%（95% CI：3，26）。