Multimicronutrient Interventions but Not Vitamin A or Iron Interventions Alone Improve Child Growth: Results of 3 Meta-Analyses

Abstract

Meta-analyses of randomized controlled intervention trials were conducted to assess the effects of vitamin A, iron, and multimicronutrient interventions on the growth of children < 18 y old. A PubMed database search and other methods identified 14 vitamin A, 21 iron, and 5 multimicronutrient intervention studies that met the design criteria. Weighted mean effect sizes and CI were calculated using a random effects model for changes in height and weight. Tests for homogeneity and stratified analyses by predefined characteristics were conducted. Vitamin A interventions had no significant effect on growth; effect sizes were 0.08 (95% CI: -0.20, 0.36) for height and -0.01 (95% CI: -0.24, 0.22) for weight. Iron interventions also had no significant effect on child growth. Overall effect sizes were 0.09 (95% CI: -0.07, 0.24) for height and 0.13 (95% CI: -0.05, 0.30) for weight. The results were similar across categories of age, duration of intervention, mode and dosage of intervention, and baseline anthropometric status. Iron interventions did result in a significant increase in hemoglobin (Hb) concentrations with an effect size of 1.49 (95% CI: 0.46, 2.51). Multimicronutrient interventions had a positive effect on child growth; the effect sizes were 0.28 (95% CI: 0.16, 0.41) for height and 0.28 (95% CI: -0.07, 0.63) for weight. Interventions limited to only vitamin A or iron did not improve child growth. Multimicronutrient interventions, on the other hand, improved linear and possibly ponderal growth in children.

Association of antioxidant vitamins and oxidative stress levels in pregnancy with infant growth during the first year of life

“…The foetus is totally dependent on the mother for the supply of nutrients essential to maintain its life. An optimal maternal nutritional status has been shown to reduce the risks of a preterm birth and low birth weight (1)(2)(3) , improve postnatal growth (4,5) , and reduce both maternal and infant morbidity and mortality (6)(7)(8)(9) . Despite a trend of improved infant growth in most countries due to enhanced intakes of macronutrients (10) , a low maternal nutritional status during the critical stage of foetal development subsequently contributes to growth retardation in the offspring and adverse health outcomes in later life (11) .…”

Evidências do impacto da suplementação de vitamina A no grupo materno-infantil

“…Ramakhrishnan et al 29 não referem efeito benéfico da suplementação de vitamina A no crescimento e desenvolvimento físico de crianças e adolescentes. Irlam et al 30 e Wiysonge et al 31 , que revisaram o efeito da suplementação em crianças, adultos e gestantes com HIV, relatam efeito protetor somente no grupo infantil, com redução na mortalidade geral e por causas relacionadas à AIDS, redução na morbidade por diarréia e aumento de peso ao nascer.…”

Thriposha supplementation in healthy Sri Lankan preschool children: effect on growth

“…However, most of the studies have focused on the role of one or two micronutrient deficiencies on an individual linear growth faltering and the extent to which supplementation of such alone in improving growth (9). Ramakrishnan et al, (1) have noted that vitamin A or iron administered as single nutrients had no significant effect on growth, suggesting that correcting multiple nutrient deficiencies simultaneously is more efficacious. The increased effectiveness of multi mineral-vitamin interventions when compared with either one or two mineral interventions may be explained by the high prevalence of concurrent micronutrient deficiencies in these settings (8,10) and/or the positive synergistic effects between some of these nutrients at the level of both absorption and metabolism (for example, vitamin A and iron, vitamin A and zinc, iron and vitamin C) (10).…”

“…Child undernutrition, as indicated by linear growth failure and wasting, remains a major public health concern worldwide because of its contribution to childhood morbidity/mortality and long-term consequences, such as reduced adult muscle mass and increased obstetric risk (1). Although substantial progress has been made over the past few decades, stunting and wasting still affect about 13.5% and 14.0% preschool children, respectively.…”