每周补充铁和叶酸对撒哈拉以南非洲儿童和青少年铁营养状况、心理健康和学业成绩的影响：系统评价和荟萃分析。

Weekly iron-folic acid supplementation and its impact on children and adolescents iron status, mental health and school performance: a systematic review and meta-analysis in sub-Saharan Africa.

机构信息

Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia

Department of Public Health, College of Medicine and Health Science, Werabe University, Werabe Ethiopia.

出版信息

BMJ Open. 2024 Jun 11;14(6):e084033. doi: 10.1136/bmjopen-2024-084033.

DOI:10.1136/bmjopen-2024-084033

PMID:38862227

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11168171/

Abstract

OBJECTIVE

This systematic review and meta-analysis aimed to comprehensively assess the impact of weekly iron-folic acid supplementation (WIFAS) on the nutrition, health and educational outcomes of children and adolescents in sub-Saharan Africa.

DESIGN

A systematic review and meta-analysis was used.

DATA SOURCES

Five databases, namely, MEDLINE, Scopus, Web of Science, Cochrane Library and Google Scholar, were systematically searched for relevant articles up to 23 August 2023.

ELIGIBILITY CRITERIA

It was focused on randomised controlled trials involving children and adolescents in sub-Saharan Africa, exploring the effects of iron supplementation on various outcomes, such as serum ferritin and haemoglobin levels, anaemia, mental health and school performance.

DATA EXTRACTION AND SYNTHESIS

The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with two independent reviewers thoroughly evaluating each paper. Using the Cochrane risk of bias tool, we evaluated the certainty of evidence such as the risk of bias, inconsistency, indirectness, imprecision and publication bias.

RESULTS

A systematic review of 10 articles revealed that WIFAS significantly increased serum ferritin levels in adolescent girls (Hedge's g=0.53, 95% CI 0.28 to 0.78; heterogeneity I=41.21%, p<0.001) and haemoglobin levels in school-aged children (Hedge's g=0.37, 95% CI 0.01 to 0.73; heterogeneity I=91.62%, p<0.001). The analysis further demonstrated a substantial reduction in the risk of anaemia by 20% (risk ratio=0.8, 95% CI 0.69 to 0.93; heterogeneity I=28.12%, p<0.001).

CONCLUSION

WIFAS proved effective in enhancing serum ferritin and haemoglobin concentrations and lowering the risk of anaemia in school-aged children and adolescents compared with a placebo. Similarly, there are not enough studies to examine the effects of WIFAS on school performance. However, information regarding mental health problems, mortality and potential side effects remains insufficient.

PROSPERO REGISTRATION NUMBER

CRD42023397898.

摘要

目的

本系统评价和荟萃分析旨在全面评估每周补充铁叶酸（WIFAS）对撒哈拉以南非洲儿童和青少年的营养、健康和教育结果的影响。

设计

系统评价和荟萃分析。

资料来源

截至 2023 年 8 月 23 日，我们系统地检索了 5 个数据库，包括 MEDLINE、Scopus、Web of Science、Cochrane 图书馆和 Google Scholar，以查找相关文章。

纳入标准

研究对象为撒哈拉以南非洲的儿童和青少年，随机对照试验，探讨铁补充对血清铁蛋白和血红蛋白水平、贫血、心理健康和学业成绩等各种结局的影响。

数据提取与综合

采用 Joanna Briggs 研究所的批判性评估工具进行质量评估，由两名独立评审员对每篇论文进行全面评估。使用 Cochrane 偏倚风险工具评估证据的确定性，如偏倚风险、不一致性、间接性、不精确性和发表偏倚。

结果

对 10 篇文章进行系统评价后发现，WIFAS 显著提高了青春期少女的血清铁蛋白水平（Hedge's g=0.53，95%置信区间 0.28 至 0.78；异质性 I=41.21%，p<0.001）和学龄儿童的血红蛋白水平（Hedge's g=0.37，95%置信区间 0.01 至 0.73；异质性 I=91.62%，p<0.001）。分析还表明，贫血风险降低了 20%（风险比=0.8，95%置信区间 0.69 至 0.93；异质性 I=28.12%，p<0.001）。