Ren Ting, Lu Yuqiong, Dai Zhanjing, Yang Jing, Wu Yuhang, Chang Feng, Wang Sida, Wang Linyun, Lu Yun
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.
J Acad Nutr Diet. 2025 Jan 9. doi: 10.1016/j.jand.2025.01.002.
Anemia is a prevalent health issue among children and adolescents worldwide, with malnutrition being among the most common causes. Nutrition-related anemia can be prevented or controlled through targeted interventions.
This study aimed to evaluate the effects of nutrition interventions on ferritin concentration, hemoglobin concentration, anemia prevalence, and nutrition-related anemia prevalence in infants, children, and adolescents-and to compare outcomes by intervention and age group using network meta-analysis of randomized controlled trials.
Web of Science, PubMed, Scopus, EBSCO, the Cochrane Library, China National Knowledge Infrastructure Database, Weipu Database, and Wanfang Database were comprehensively searched to identify randomized controlled trials on the effects of nutrition interventions (micronutrient supplementation, macronutrient supplementation, and nutrition education) until September 30, 2023. Two groups of researchers screened the literature and extracted data based on set inclusion and exclusion criteria. Reviewers used the Cochrane tool for assessing risk-of-bias in randomized controlled trials and used the Grading of Recommendations, Assessment, Development, and Evaluation for evaluating the strength of evidence for inclusion in network meta-analysis. The study population was categorized into infants and preschool-aged children (aged 6 to 59 months), school-aged children (aged 6 to 11 years), and adolescents (aged 12 to 18 years). The study evaluated the mean difference, risk ratio, and 95% credible interval of outcomes for each intervention across different age groups using network meta-analysis.
Sixty-one randomized controlled trials were included in this analysis. In network meta-analysis, micronutrient supplementation, macronutrient supplementation, and nutrition education were found to have significant effects on hemoglobin concentrations in infants and preschool-aged children. Lipid-based nutrient supplementation resulted in the highest increase in hemoglobin concentration, whereas multiple micronutrient supplementation resulted in the largest reduction in risk of anemia and iron deficiency anemia. In school-aged children, iron supplementation increased hemoglobin concentration, whereas micronutrient supplementation also increased hemoglobin concentration and reduced anemia risk. In adolescents, iron supplementation improved hemoglobin concentration and lowered anemia risk.
The effectiveness of nutrition interventions in improving nutrition-related anemia varies across intervention types and age groups. Micronutrient and iron supplementation consistently improved hemoglobin levels and related indicators, with evidence quality ranging from low to moderate. MMN and LNS had positive effects on hemoglobin concentrations and anemia in infants and preschool-aged children, which is supported by low-to-moderate quality evidence. For adolescents, although micronutrient and iron supplementation showed positive effects, the overall evidence quality was generally low, highlighting the need for further high-quality clinical research to validate these findings.
贫血是全球儿童和青少年中普遍存在的健康问题，营养不良是最常见的原因之一。与营养相关的贫血可通过有针对性的干预措施加以预防或控制。
本研究旨在评估营养干预对婴儿、儿童和青少年铁蛋白浓度、血红蛋白浓度、贫血患病率以及与营养相关的贫血患病率的影响，并通过对随机对照试验的网络荟萃分析，按干预措施和年龄组比较结果。
全面检索了Web of Science、PubMed、Scopus、EBSCO、Cochrane图书馆、中国知网数据库、维普数据库和万方数据库，以识别截至2023年9月30日关于营养干预（微量营养素补充、宏量营养素补充和营养教育）效果的随机对照试验。两组研究人员根据设定的纳入和排除标准筛选文献并提取数据。评审人员使用Cochrane工具评估随机对照试验中的偏倚风险，并使用推荐分级、评估、制定和评价系统来评估纳入网络荟萃分析的证据强度。研究人群分为婴儿和学龄前儿童（6至59个月）、学龄儿童（6至11岁）和青少年（12至18岁）。该研究使用网络荟萃分析评估了不同年龄组中每种干预措施的结局的平均差异、风险比和95%可信区间。
本分析纳入了61项随机对照试验。在网络荟萃分析中，发现微量营养素补充、宏量营养素补充和营养教育对婴儿和学龄前儿童的血红蛋白浓度有显著影响。基于脂质的营养补充导致血红蛋白浓度升高幅度最大，而多种微量营养素补充导致贫血和缺铁性贫血风险降低幅度最大。在学龄儿童中，补充铁剂可提高血红蛋白浓度，而微量营养素补充也可提高血红蛋白浓度并降低贫血风险。在青少年中，补充铁剂可改善血红蛋白浓度并降低贫血风险。
营养干预在改善与营养相关贫血方面的有效性因干预类型和年龄组而异。微量营养素和铁剂补充持续改善血红蛋白水平及相关指标，证据质量从低到中等。MMN和LNS对婴儿和学龄前儿童的血红蛋白浓度和贫血有积极影响，并得到低到中等质量证据的支持。对于青少年，虽然微量营养素和铁剂补充显示出积极效果，但总体证据质量普遍较低，这突出表明需要进一步开展高质量临床研究来验证这些发现。
