Combined Iron and Folic Acid Supplementation with or without Zinc Reduces Time to Walking Unassisted among Zanzibari Infants 5- to 11-mo old

Abstract

Iron and zinc deficiencies have been associated with delayed motor development in nutritionally at-risk children, albeit inconsistently. In this community-based, randomized double-blind trial, iron+folic acid (FeFA) (12.5 mg Fe + 50 mug folic acid), zinc (Zn) (10 mg), and iron+folic acid+zinc (FeFA+Zn) supplements or a placebo were given daily for 1 y to nutritionally at-risk children in Pemba, Zanzibar. The effects of these treatments on attaining unassisted walking were evaluated using survival analysis for 354 children aged 5-11 mo at the start of supplementation. Treatment effects on changes in hemoglobin (Hb) and zinc protoporphyrin (ZPP) and height-for-age (HAZ) and weight-for-age (WAZ) Z scores were evaluated using linear regression. Attained motor milestone was recorded every 2 wk for 1 y. Hb, ZPP, HAZ, and WAZ were measured at baseline and after 6 mo of treatment. FeFA with or without Zn reduced the time it took for children to walk assisted. Children who received any iron walked unassisted sooner than those who received no iron [median difference approximately 15 d, P = 0.035, risk ratio (RR) = 1.28, 95% CI = 1.02, 1.61] and this effect was stronger in those who had iron deficiency anemia (IDA) at baseline (median difference was approximately 30 d; P = 0.002; RR = 1.68; 95% CI = 1.21, 2.32). FeFA alone and Zn alone improved Hb and ZPP compared with placebo. There were no significant treatment effects on changes in HAZ or WAZ. The effects of treatment on time to walking may have been mediated by improvements in iron status or hemoglobin, but were not mediated through improvements in growth.

Young Zanzibari Children with Iron Deficiency, Iron Deficiency Anemia, Stunting, or Malaria Have Lower Motor Activity Scores and Spend Less Time in Locomotion , ,3

“…In this sample of Zanzibari children, iron deficiency with or without anemia was associated with lower odds of walking alone at baseline (8) and iron1folic acid supplementation with or without zinc reduced the time necessary for children to acquire the skill of walking unassisted (32). Elsewhere, iron deficiency anemia has been associated with lower scores on global tests of cognitive and psychomotor development (33)(34)(35)(36)(37).…”

Iron Supplementation in Pregnancy or Infancy and Motor Development: A Randomized Controlled Trial

“…A benefit of iron supplementation in infancy on earlier onset of specific motor milestones has been reported in some previous RCTs. [42][43][44] Similarly, an association between better iron status in infancy and earlier onset of walking was reported in 2 observational studies. 45,46 These locomotor-related benefits of iron supplementation may enhance infant development in other domains (eg, cognitive, socialemotional).…”

Decreased Parasite Load and Improved Cognitive Outcomes Caused by Deworming and Consumption of Multi-Micronutrient Fortified Biscuits in Rural Vietnamese Schoolchildren

“…33 In preschool children (6-59 months of age) in Tanzania, iron supplementation for 12 months improved language and motor development in children. 34 Improvements in the digits span forward test were also reported in South African primary school children biscuits fortified with iron, iodine, and betacarotene. 28 Thus, vitamin and mineral deficiencies in children may limit the child's optimal ability in cognition and intelligence.…”