Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh

<p>Abstract</p> <p>Background</p> <p>There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring's growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes.</p> <p>Methods</p> <p>In the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab), Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F) or MMS combined with either an early (immediately after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community) program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54 months, and 2735 children were available for analysis at 54 months.</p> <p>Results</p> <p>There were no differences in characteristics of mothers and households among the different intervention groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the proportion of stunting from early infancy up to 54 months for boys (p = 0.01), but not for girls (p = 0.31). MMS resulted in more stunting than standard Fe60F (p = 0.02). There was no interaction between the food and micronutrient supplementation on the growth outcome.</p> <p>Conclusions</p> <p>Early food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal growth suggest programming effects in early fetal life.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN16581394">ISRCTN16581394</a></p

Relevância epidemiológica da desnutrição e da obesidade em distintas classes sociais: métodos de estudo e aplicação à população brasileira Relevance of under and overnutrition in different social classes: methods and application to the Brazilian population

Buscou-se construir critérios de mesma especificidade no diagnóstico da desnutrição e da obesidade, de modo a produzir estimativas comparáveis para a prevalência desses eventos em distintos estratos socioeconômicos da população brasileira infantil e adulta. A fonte primária de dados é a Pesquisa Nacional sobre Saúde e Nutrição - PNSN, estudo do tipo transversal de base domiciliar, realizado no país em 1989. Foram considerados o conjunto das mulheres adultas estudadas pela PNSN, com idades entre 18 e 64 anos (n=15.669), o conjunto dos homens adultos com idades entre 20 e 64 anos (n=14.235) e o conjunto das crianças com idade entre 6 e 35 meses (n=3.641). Na avaliação do estado nutricional dos adultos empregou-se o Índice de Massa Corporal (kg/m²) e, na avaliação infantil, os índices peso/idade e peso/altura. Os percentis 5 e 95 da distribuição desses índices em uma população de referência foram utilizados como níveis críticos para o diagnóstico, respectivamente, da desnutrição e da obesidade. Os resultados obtidos evidenciam, entre outros aspectos, que a desnutrição infantil mostra-se controlada (prevalências muito baixas) mesmo em estratos da população com níveis muito modestos de renda familiar, enquanto a obesidade em mulheres adultas constitui problema de Saúde Pública (altas prevalências), mesmo para famílias situadas abaixo da linha da pobreza extrema. Tais evidências indicam a necessidade de se rever os modelos de causalidade tradicionalmente admitidos no país para a desnutrição e para a obesidade, ao mesmo tempo em que apontam a urgência de uma ampla revisão das prioridades e das estratégias de intervenção da Saúde Pública brasileira, no campo da nutrição.<br>The search for criteria of the same specificity in the diagnosis of both undernutrition and obesity is the main objective of this study. The selected criteria are applied to data collected by a nation-wide cross-sectional anthropometric survey undertaken in Brazil in 1989 as to produce comparable estimates for the prevalence of undernutrition and obesity in different socioeconomic strata. The study included 20-64 year-old male adults (n=14,235), 18-64 year-old female adults (n=15,669), and 6-35 month-old children (n=3.641). Body Mass Index (kg/m²) was employed to assess nutritional status of adults and weight-for-age and weight-for-height indices were used for children. The 5th and 95th centiles of the distribution of these indices in a reference population were used as limits for the diagnosis of undernutrition and obesity, respectively. These results challenge the common belief that undernutrition is a relevant problem for the poor population, and that obesity only affects affluent strata. The need for an urgent revision of national public health nutrition priorities and interventions is stressed