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.
Am J Clin Nutr. 2024 Mar;119(3):829-837. doi: 10.1016/j.ajcnut.2024.01.018. Epub 2024 Jan 24.
Micronutrient deficiencies and anemia are widespread among children with stunting.
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.
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.
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).
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.
微量营养素缺乏和贫血在发育迟缓的儿童中普遍存在。
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。
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。
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）。
LNS 补充剂可提高发育迟缓儿童的 Hb 水平，并改善铁、钴胺素和叶酸状况，但不能改善维生素 A 状况。LNS 应考虑用于发育迟缓的儿童。该试验在 ISRCTN 注册为 13093195。
