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

Khan, Ashraful Islam; Kabir, Iqbal; Ekström, Eva‐Charlotte; Åsling-Monemi, Kajsa; Alam, Dewan S.; Frongillo, Edward A.; Yunus, Muhammad; Arifeen, Shams El; Persson, Lars‐Åke

doi:10.1186/1475-2891-10-134

Cited by 70 publications

(103 citation statements)

References 31 publications

(35 reference statements)

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“…In Bangladesh, food rations combined with micronutrients tablets given in early gestation resulted in a reduced proportion of stunting from early infancy up to 54 months for boys and a higher infant mortality. 14 We previously reported that providing pregnant women with lipid-based nutrient supplementation (LNS) increased birth length by 4.6 mm (P = .001) and weight by 31 g (P = .197). 15 In the current study, we assessed the effect of prenatal LNS compared with MMNs on postnatal growth and nutritional status during the first year of life.…”

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confidence: 98%

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Prenatal lipid-based nutrient supplementation has been demonstrated to increase birth length. However, the impact of this intervention on infant growth and morbidity is unknown. WHAT THIS STUDY ADDS:Infants from mothers who were given prenatal lipid-based nutrient supplements showed decelerated linear growth. The gain in length at birth related to prenatal lipidbased nutrient supplementation was not sustained during infancy. abstract BACKGROUND AND OBJECTIVES: Prenatal lipid-based nutrient supplements (LNS) have been shown to improve birth anthropometry. However, little is known about the effects of such supplements on infant health. We hypothesized that prenatal LNS compared with multiple micronutrient supplement for pregnant and lactating women would improve survival, growth, and morbidity during infancy. METHODS:Infants' weight, length, head, chest, and mid-upper arm circumferences were measured during monthly home visits from birth to 12 months of age in the Micronutriments et Santé de la Mère et de l'Enfant-2 trial. Differences in stunting and wasting episodes between study arms were assessed by Cox regression for recurrent event models. Morbidity signs during the 2 weeks before the visits and death cases were also assessed by multilevel analysis accounting for repeated individual measurements.RESULTS: Infant length-for-age growth (-0.033 z score/month; 95% confidence interval: -0.601 to -0.006; P = .018) for the LNS group was inferior to that of the control group. We did not find evidence of significant difference in mortality or morbidity between groups. CONCLUSIONS:The previously reported positive effect of prenatal LNS on birth length was not sustained during the postnatal phase. Prenatal LNS does not appear to make a long-lasting difference in child linear growth. Pediatrics 2014;133:e1001-e1008 Size at birth and growth in early infancy are important indicators of early childhood survival and health. Newborns with small birth size, reflecting poor intrauterine nutrition and/or prematurity, have an increased riskofinfant mortality and morbidity, 1 impaired child cognitive development, 2 and adverse health outcomes in adulthood. 3 Poor infant growth is associated with higher mortality and neurocognitive delays. 4,5 Stunted growth during the first 2 years is also associated with shorter adult height, reduced economic productivity, and decreased reproductive performance. 5 In 2011, an estimated 165 million children aged ,5 years worldwide had stunted growth, with the majority residing in Asia and sub-Saharan Africa. 6 Prenatal multiple micronutrient (MMN) 7 and balanced energy and protein 8 supplementation result in a significant reduction in small-for-gestational age births (9% and 31%, respectively). However, the results of such interventions on postnatal growth yielded more dispersed results. In 2 prenatal multiple MMN trials in Burkina Faso and Vietnam, the rate of stunting was reduced during infancy 9 and at 2 years, 10 although no difference was seen at 2.5 years in the ...

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confidence: 98%

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

et al. 2014

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“…Nevertheless, we have identified studies, both from Guatemala and in the international literature, with which to compare the present findings. Birth length is often part of protocols in long-term cohort studies bridging from birth through childhood and towards adulthood (40)(41)(42)(43)(44)(45) or short-term, longitudinal observational studies seeking to find correlates of early growth or health (46)(47)(48)(49)(50)(51)(52)(53) . More recently, length is measured at birth as part of studies evaluating inter-pregnancy interventions in (4) .…”

Section: Discussionmentioning

confidence: 99%

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

Solomons¹,

Vossenaar²,

Chomat

et al. 2014

Public Health Nutr.

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Objective: Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical 'under-5' stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49·8 %), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1·5 months of life among Guatemalan infants. Design: As part of a cross-sectional observational study, supine length was measured in young infants. Mothers' height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ < − 2 using WHO growth standards. Setting: Eight rural, indigenous Mam-Mayan villages (n 200, 100 % of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27 % of Mayan indigenous origin), Guatemala. Subjects: Three hundred and six newborns with a median age of 19 d. Results: The median rural HAZ was − 1·56 and prevalence of stunting was 38 %; the respective urban values were − 1·41 and 25 %. Linear regression revealed no relationship between infant age and HAZ (r = 0·101, r 2 = 0·010, P = 0·077). Maternal height explained 3 % of the variability in HAZ (r = 0·171, r 2 = 0·029, P = 0·003). Conclusions: Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.

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“…Early nutrition-specific interventions like prenatal multiple micronutrient supplements reduce the risk of SGA and LBW babies [32] and reduce postnatal stunting [14, 32, 33]. Interventions that focused on multiple micronutrients along with balanced energy and protein during pregnancy have even greater results on SGA [14, 32, 34].…”

Section: Linear Growth From Preconception To Beyond the First 1000 Dmentioning

confidence: 99%

World Perspective on the Epidemiology of Stunting between 1990 and 2015

2017

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Background: Stunting is the most prevalent form of child undernutrition with current worldwide estimates at 156 million. The majority of these children reside in low- and middle-income countries. When stunting prevails to adulthood, optimal growth potential and economic productivity are minimized. Results: In 2015 there were 98.5 million fewer stunted children under 5 years of age than in 1990. In East Asia and Pacific and South Asia, the stunting prevalence decreased by 24.8 and 25%, respectively. Minimal declines were observed in Latin America and the Caribbean at 12.6%, in the Middle East and North Africa at 12.9%, and in sub-Saharan Africa at 13.4%. But because large populations of children under 5 years of age are distributed disproportionately, decreases in prevalence do not translate to fewer numbers of stunted children globally. In sub-Saharan Africa, the number of stunted children increased by 12.4 million between 1990 and 2015. Conclusions: Adult height is dependent on nutrition-specific or nutrition-sensitive factors. Nutrition-specific factors can be targeted according to their impact at critical points of development and therefore offer multiple windows of opportunity for interventions. To date, many interventions focus on the first 1,000 days, but opportunities may extend into later childhood and adolescence.

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

Cited by 70 publications

References 31 publications

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

World Perspective on the Epidemiology of Stunting between 1990 and 2015

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