International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
The Liggins Institute, The University of Auckland, Auckland, New Zealand.
PLoS One. 2024 Mar 15;19(3):e0296529. doi: 10.1371/journal.pone.0296529. eCollection 2024.
Reversing malnutrition-induced impairment of cognition and emotional regulation is a critical global gap. We hypothesize that brain-targeted micronutrient supplemented nutritional rehabilitation in children with moderate acute malnutrition, followed by 2 years micronutrient supplementation will impact on the cognition and emotion regulation of these children.
The primary outcome of this prospective, randomized controlled trial is to study the development of executive functions (EFs) and emotion regulation (ER) in this cohort. Moderate acute malnourished (MAM; WLZ/WHZ <-2 and ≥-3 z-score, and/or 11.5 cm ≤ MUAC < 12.5cm; n = 140)children aged around one year (11m-13m) in Mirpur, Dhaka, Bangladesh will be randomized (1:1) to receive either locally produced Ready to Use Supplementary Food (RUSF) or Enhanced Ready to Use Supplementary Food (E-RUSF) until anthropometric recovery (WLZ/WHZ > -1SD), or for 3 months after enrollment (whichever is earlier). The randomized MAMs groups will be given either Small Quantity Lipid Based Nutrient Supplement (SQLNS) or Enhanced Small Quantity Lipid Based Nutrient Supplement (E-SQLNS), respectively until the end of the 2-year follow up period. Standard psychosocial stimulation will be provided to the MAMs intervention groups. Biological samples will be collected, anthropometric and neurocognitive assessments will be performed at 2 (22m-26m) and 3 (34m-38m) years of age. Two control groups will be recruited: 1), non-malnourished one-year (11m-13m) old children (WLZ/WHZ score>-1SD; n = 70); and 2) three-year (34m-38m) old children (n = 70) with untreated MAM (WHZ <-2 and ≥-3 z-score, and/or 11.5≤MUAC<12.5 cm). The 3-year-old MAM reference group will be assessed once and provided with 2 months of nutritional rehabilitation support (RUSF Nutriset's Plumpy'Sup™).
纠正营养不良导致的认知和情绪调节损伤是一个全球性的关键空白。我们假设，对中度急性营养不良儿童进行以大脑为靶向的微量营养素补充型营养康复治疗，随后再进行 2 年的微量营养素补充，将对这些儿童的认知和情绪调节产生影响。
本前瞻性随机对照试验的主要结局是研究该队列中执行功能（EF）和情绪调节（ER）的发展情况。将孟加拉国达卡米尔普尔年龄在 11 个月至 13 个月（11m-13m）之间的中度急性营养不良（MAM；WLZ/WHZ <-2 且≥-3 z 评分，和/或 11.5cm ≤ MUAC < 12.5cm；n = 140）儿童随机（1:1）分为两组，分别接受当地生产的即食补充食品（RUSF）或强化即食补充食品（E-RUSF），直至达到人体测量学恢复（WLZ/WHZ > -1SD），或在入组后 3 个月（以较早者为准）。随机 MAMs 组将分别接受小剂量脂质基础营养补充剂（SQLNS）或强化小剂量脂质基础营养补充剂（E-SQLNS），直至 2 年随访期结束。MAMs 干预组将接受标准社会心理刺激。将在 2 岁（22m-26m）和 3 岁（34m-38m）时采集生物样本、进行人体测量和神经认知评估。将招募两个对照组：1）无营养不良的 1 岁（11m-13m）儿童（WLZ/WHZ 评分>-1SD；n = 70）；和 2）未经治疗的 MAM 3 岁（34m-38m）儿童（WHZ <-2 且≥-3 z 评分，和/或 11.5cm ≤ MUAC < 12.5cm；n = 70）。3 岁的 MAM 参考组将进行一次评估，并提供 2 个月的营养康复支持（RUSF Nutriset 的 Plumpy'Sup™）。
