Mary de Boer, Andrew L Thorne-Lyman, Abu Ahmed Shamim, Lee Wu, Saijuddin Shaikh, Hasmot Ali, Keith P West, Parul Christian
{"title":"在孟加拉国的一项随机对照试验中，饮食多样性作为怀孕期间补充多种微量营养素对低出生体重影响的调节因素。","authors":"Mary de Boer, Andrew L Thorne-Lyman, Abu Ahmed Shamim, Lee Wu, Saijuddin Shaikh, Hasmot Ali, Keith P West, Parul Christian","doi":"10.1016/j.ajcnut.2025.07.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Meta-analysis of trials of multiple micronutrient supplements (MMS) vs iron-folic acid (IFA) suggests an overall benefit of 12% on low birthweight (LBW).</p><p><strong>Objective: </strong>Building on prior work showing that MMS is more effective in anemic and higher BMI females, this paper explores whether dietary quality modifies the effect of MMS on birthweight.</p><p><strong>Methods: </strong>A seven-day food frequency questionnaire was administered in late pregnancy to 19,160 pregnant participants in the JiVitA-3 cluster-randomized controlled trial of MMS vs. IFA supplementation in Bangladesh. A 10-item dietary diversity score (DDS) was created summing the number of food groups consumed ≥4 times/week. Risk ratios (RR) and 95% confidence intervals (CI) for the effect of MMS vs IFA on LBW were estimated by DDS. The interaction between DDS and MMS was tested using a generalized estimating equations log-binomial regression model to account for the cluster randomization. Point estimates and 95% CI for the effect of MMS on LBW were estimated at each DDS. Models were adjusted for confounders. We used p < 0.1 to determine statistical significance of the interaction.</p><p><strong>Results: </strong>The median DDS was 3 (IQR: 2-4), and 18.6% of PW had a score ≥ 5. The fully adjusted protective effect of MMS on LBW was inversely associated with dietary diversity [MMSxDDS RR: 1.02 (95% CI: 1.00, 1.04), p-interaction = 0.05]. The effect was greatest at the lowest DDS [DDS= 1, RR LBW: 0.86 (0.81, 0.91)] and decreased at higher scores [DDS = 7, RR: 0.92 (0.84, 1.00)].</p><p><strong>Conclusions: </strong>In rural Bangladesh, where maternal dietary diversity was generally low, MMS (compared to IFA) supplementation had the strongest effect on reducing low birth weight among pregnant females with the least diverse diet, possibly reflecting the additional benefit of supplementation in this vulnerable group.</p><p><strong>Clinicaltrials: </strong></p><p><strong>Gov identifier: </strong>NCT00860470.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dietary diversity as a modifier of the effect of supplementation with multiple micronutrients during pregnancy on low birth weight in a randomized controlled trial in Bangladesh.\",\"authors\":\"Mary de Boer, Andrew L Thorne-Lyman, Abu Ahmed Shamim, Lee Wu, Saijuddin Shaikh, Hasmot Ali, Keith P West, Parul Christian\",\"doi\":\"10.1016/j.ajcnut.2025.07.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Meta-analysis of trials of multiple micronutrient supplements (MMS) vs iron-folic acid (IFA) suggests an overall benefit of 12% on low birthweight (LBW).</p><p><strong>Objective: </strong>Building on prior work showing that MMS is more effective in anemic and higher BMI females, this paper explores whether dietary quality modifies the effect of MMS on birthweight.</p><p><strong>Methods: </strong>A seven-day food frequency questionnaire was administered in late pregnancy to 19,160 pregnant participants in the JiVitA-3 cluster-randomized controlled trial of MMS vs. IFA supplementation in Bangladesh. A 10-item dietary diversity score (DDS) was created summing the number of food groups consumed ≥4 times/week. Risk ratios (RR) and 95% confidence intervals (CI) for the effect of MMS vs IFA on LBW were estimated by DDS. The interaction between DDS and MMS was tested using a generalized estimating equations log-binomial regression model to account for the cluster randomization. Point estimates and 95% CI for the effect of MMS on LBW were estimated at each DDS. Models were adjusted for confounders. We used p < 0.1 to determine statistical significance of the interaction.</p><p><strong>Results: </strong>The median DDS was 3 (IQR: 2-4), and 18.6% of PW had a score ≥ 5. The fully adjusted protective effect of MMS on LBW was inversely associated with dietary diversity [MMSxDDS RR: 1.02 (95% CI: 1.00, 1.04), p-interaction = 0.05]. 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Dietary diversity as a modifier of the effect of supplementation with multiple micronutrients during pregnancy on low birth weight in a randomized controlled trial in Bangladesh.
Background: Meta-analysis of trials of multiple micronutrient supplements (MMS) vs iron-folic acid (IFA) suggests an overall benefit of 12% on low birthweight (LBW).
Objective: Building on prior work showing that MMS is more effective in anemic and higher BMI females, this paper explores whether dietary quality modifies the effect of MMS on birthweight.
Methods: A seven-day food frequency questionnaire was administered in late pregnancy to 19,160 pregnant participants in the JiVitA-3 cluster-randomized controlled trial of MMS vs. IFA supplementation in Bangladesh. A 10-item dietary diversity score (DDS) was created summing the number of food groups consumed ≥4 times/week. Risk ratios (RR) and 95% confidence intervals (CI) for the effect of MMS vs IFA on LBW were estimated by DDS. The interaction between DDS and MMS was tested using a generalized estimating equations log-binomial regression model to account for the cluster randomization. Point estimates and 95% CI for the effect of MMS on LBW were estimated at each DDS. Models were adjusted for confounders. We used p < 0.1 to determine statistical significance of the interaction.
Results: The median DDS was 3 (IQR: 2-4), and 18.6% of PW had a score ≥ 5. The fully adjusted protective effect of MMS on LBW was inversely associated with dietary diversity [MMSxDDS RR: 1.02 (95% CI: 1.00, 1.04), p-interaction = 0.05]. The effect was greatest at the lowest DDS [DDS= 1, RR LBW: 0.86 (0.81, 0.91)] and decreased at higher scores [DDS = 7, RR: 0.92 (0.84, 1.00)].
Conclusions: In rural Bangladesh, where maternal dietary diversity was generally low, MMS (compared to IFA) supplementation had the strongest effect on reducing low birth weight among pregnant females with the least diverse diet, possibly reflecting the additional benefit of supplementation in this vulnerable group.
期刊介绍：
American Journal of Clinical Nutrition is recognized as the most highly rated peer-reviewed, primary research journal in nutrition and dietetics.It focuses on publishing the latest research on various topics in nutrition, including but not limited to obesity, vitamins and minerals, nutrition and disease, and energy metabolism.
Purpose:
The purpose of AJCN is to:
Publish original research studies relevant to human and clinical nutrition.
Consider well-controlled clinical studies describing scientific mechanisms, efficacy, and safety of dietary interventions in the context of disease prevention or health benefits.
Encourage public health and epidemiologic studies relevant to human nutrition.
Promote innovative investigations of nutritional questions employing epigenetic, genomic, proteomic, and metabolomic approaches.
Include solicited editorials, book reviews, solicited or unsolicited review articles, invited controversy position papers, and letters to the Editor related to prior AJCN articles.
Peer Review Process:
All submitted material with scientific content undergoes peer review by the Editors or their designees before acceptance for publication.
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