Low-dose weekly supplementation of iron and/or zinc does not affect growth among Bangladeshi infants

Walker, Christa L. Fischer; Baqui, Abdullah H; Ahmed, Saifuddin; Zaman, K.; Arifeen, Shams El; Begum, Nazma; Yunus, Muhammad; Black, Robert E.; Caulfield, Laura E.

doi:10.1038/sj.ejcn.1602905

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…In 13 papers on infants, children, and adolescents, there were two or more substudies: the intervention group was divided according to baseline iron status, according to two intervention groups, or according to gender and doses of supplemented iron . Furthermore, Dewey et al .…”

Section: Resultsmentioning

confidence: 99%

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Effect of iron intervention on growth during gestation, infancy, childhood, and adolescence: a systematic review with meta-analysis

et al. 2013

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To evaluate the effect of iron intervention on physical growth in fetuses, infants, children, and adolescents up to 18 years of age, a systematic review with meta-analysis of randomized controlled trials (RCTs) was conducted. Structured electronic searches were conducted to February 2010 using MEDLINE, Embase, and the Cochrane Library databases. RCTs that included iron-fortified foods, iron-fortified formula, or iron supplements and in which height, weight, mid-arm circumference (MAC), head circumference, birth weight, or length of gestation was evaluated were analyzed for inclusion. In total, 21 RCTs in infants, children, and adolescents and 7 studies in pregnant women met the inclusion criteria. The overall pooled result (random-effects model) showed no significant effects of iron intervention on any of the parameters measured. To accommodate wide heterogeneity, studies were stratified according to dose of iron, duration of intervention, age, and baseline iron status. However, only doses of 40-66 mg of supplemental iron and intervention in children ≥ 6 years of age showed a slight but significant association with weight and MAC.

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Section: Resultsmentioning

confidence: 99%

“…The key characteristics of the included RCTs assessing parameters of growth – height, weight, and mid‐arm circumference in the infants, children, and adolescents group, head circumference in infants, and outcomes of interest in pregnant women (length of gestation and birth weight) – are presented in Tables and …”

Section: Resultsmentioning

confidence: 99%

Effect of iron intervention on growth during gestation, infancy, childhood, and adolescence: a systematic review with meta-analysis

et al. 2013

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“…All the included studies were randomized controlled trials. In 25 studies zinc was supplemented alone while in 11 studies some of the study groups also received other micronutrients (iron, folic acid, vitamin A) [47,51,52,54,58,59,61-63,65,68]. Mean initial height for age Z score (HAZ) ranged from -2.91 [37] to -0.08 [33], and the mean initial age ranged from less than one month [50] to 55 months[40].…”

Section: Resultsmentioning

confidence: 99%

Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: a meta-analysis of studies for input to the lives saved tool

2011

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IntroductionZinc plays an important role in cellular growth, cellular differentiation and metabolism. The results of previous meta-analyses evaluating effect of zinc supplementation on linear growth are inconsistent. We have updated and evaluated the available evidence according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria and tried to explain the difference in results of the previous reviews.MethodsA literature search was done on PubMed, Cochrane Library, IZiNCG database and WHO regional data bases using different terms for zinc and linear growth (height). Data were abstracted in a standardized form. Data were analyzed in two ways i.e. weighted mean difference (effect size) and pooled mean difference for absolute increment in length in centimeters. Random effect models were used for these pooled estimates. We have given our recommendations for effectiveness of zinc supplementation in the form of absolute increment in length (cm) in zinc supplemented group compared to control for input to Live Saves Tool (LiST).ResultsThere were thirty six studies assessing the effect of zinc supplementation on linear growth in children < 5 years from developing countries. In eleven of these studies, zinc was given in combination with other micronutrients (iron, vitamin A, etc). The final effect size after pooling all the data sets (zinc ± iron etc) showed a significant positive effect of zinc supplementation on linear growth [Effect size: 0.13 (95% CI 0.04, 0.21), random model] in the developing countries. A subgroup analysis by excluding those data sets where zinc was supplemented in combination with iron showed a more pronounced effect of zinc supplementation on linear growth [Weighed mean difference 0.19 (95 % CI 0.08, 0.30), random model]. A subgroup analysis from studies that reported actual increase in length (cm) showed that a dose of 10 mg zinc/day for duration of 24 weeks led to a net a gain of 0.37 (±0.25) cm in zinc supplemented group compared to placebo. This estimate is recommended for inclusion in Lives Saved Tool (LiST) model.ConclusionsZinc supplementation has a significant positive effect on linear growth, especially when administered alone, and should be included in national strategies to reduce stunting in children < 5 years of age in developing countries.

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“…Sample size calculations for a cluster-randomized trial of non-inferiority were performed as per Blackwelder et al . 15 Based on available published data from similar non-intervened populations, 16 , 17 we estimated an endpoint LAZ in the control group of −1.70, with a standard deviation of 1.0. Existing data on intracluster correlation of 0.08 for LAZ at 6 months of age in our study population ( n = 2286) was used to estimate a maximum design effect of 1.5, which was applied to adjust the final calculated sample sizes.…”

Section: Methodsmentioning

confidence: 99%

Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial

Christian

Shaikh

Shamim³

et al. 2015

Int. J. Epidemiol.

128

126

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Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy’doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < −2), weight-for-length z-score (WLZ) and wasting (WLZ < −2) in children 6–18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02–0.04/month) in the Plumpy’doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy’doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5–6% (P ≤ 0.01) in those receiving Plumpy’doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 (all P < 0.05), respectively, in all four food groups relative to the control.Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.

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Low-dose weekly supplementation of iron and/or zinc does not affect growth among Bangladeshi infants

Cited by 16 publications

References 18 publications

Effect of iron intervention on growth during gestation, infancy, childhood, and adolescence: a systematic review with meta-analysis

Effect of iron intervention on growth during gestation, infancy, childhood, and adolescence: a systematic review with meta-analysis

Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: a meta-analysis of studies for input to the lives saved tool

Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial

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