为两岁以下儿童的健康和营养用多种微量营养素粉末家庭强化食品(审查)

Luz Maria De-Regil, Parminder S Suchdev, Gunn E Vist, Silke Walleser, Juan Pablo Peña-Rosas
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Micronutrient powders (MNP) are single-dose packets containing multiple vitamins and minerals in powder form that can be sprinkled onto any semi-solid food.The use of MNP for home or point-of-use fortification of complementary foods has been proposed as an intervention for improving micronutrient intake in children under two years of age.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To assess the effects and safety of home (point-of-use) fortification of foods with multiple micronutrient powders on nutritional, health and developmental outcomes in children under two years of age.</p>\n </section>\n \n <section>\n \n <h3> Search methods</h3>\n \n <p>We searched the following databases in February 2011: Cochrane Central Register of Controlled Trials (CENTRAL) (<i>The Cochrane Library</i>), MEDLINE (1948 to week 2 February 2011), EMBASE (1980 to Week 6 2011), CINAHL (1937 to current), CPCI-S (1990 to 19 February 2011), Science Citation Index (1970 to 19 February 2011), African Index Medicus (searched 23 February 2011), POPLINE (searched 21 February 2011), ClinicalTrials.gov (searched 23 February 2011), mRCT (searched 23 February 2011), and World Health Organization International Clinical Trials Registry Platform (ICTRP) (searched 23 February 2011). We also contacted relevant organisations (25 January 2011) for the identification of ongoing and unpublished studies.</p>\n </section>\n \n <section>\n \n <h3> Selection criteria</h3>\n \n <p>We included randomised and quasi-randomised trials with either individual or cluster randomisation. Participants were children under the age of two years at the time of intervention, with no specific health problems. The intervention was consumption of food fortified at the point of use with multiple micronutrient powders formulated with at least iron, zinc and vitamin A compared with placebo, no intervention or the use of iron containing supplements, which is the standard practice.</p>\n </section>\n \n <section>\n \n <h3> Data collection and analysis</h3>\n \n <p>Two review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies and assessed the risk of bias of the included studies.</p>\n </section>\n \n <section>\n \n <h3> Main results</h3>\n \n <p>We included eight trials (3748 participants) conducted in low income countries in Asia, Africa and the Caribbean, where anaemia is a public health problem. The interventions lasted between two and 12 months and the powder formulations contained between five and 15 nutrients. Six trials compared the use of MNP versus no intervention or a placebo and the other two compared the use of MNP versus daily iron drops. Most of the included trials were assessed as at low risk of bias.</p>\n \n <p>Home fortification with MNP reduced anaemia by 31% (six trials, RR 0.69; 95% CI 0.60 to 0.78) and iron deficiency by 51% (four trials, RR 0.49; 95% CI 0.35 to 0.67) in infants and young children when compared with no intervention or placebo, but we did not find an effect on growth.</p>\n \n <p>In comparison with daily iron supplementation, the use of MNP produced similar results on anaemia (one trial, RR 0.89; 95% CI 0.58 to 1.39) and haemoglobin concentrations (two trials, MD -2.36 g/L; 95% CI -10.30 to 5.58); however, given the limited amount of data these results should be interpreted cautiously.</p>\n \n <p>No deaths were reported in the trials and information on side effects and morbidity, including malaria, was scarce.</p>\n \n <p>It seems that the use of MNP is efficacious among infants and young children six to 23 months of age living in settings with different prevalences of anaemia and malaria endemicity, regardless of whether the intervention lasts two, six or 12 months or whether recipients are male or female.</p>\n </section>\n \n <section>\n \n <h3> Authors' conclusions</h3>\n \n <p>Home fortification of foods with multiple micronutrient powders is an effective intervention to reduce anaemia and iron deficiency in children six months to 23 months of age. The provision of MNP is better than no intervention or placebo and possibly comparable to commonly used daily iron supplementation. The benefits of this intervention as a child survival strategy or on developmental outcomes are unclear. Data on effects on malaria outcomes are lacking and further investigation of morbidity outcomes is needed. The micronutrient powders containing multiple nutrients are well accepted but adherence is variable and in some cases comparable to that achieved in infants and young children receiving standard iron supplements as drops or syrups.</p>\n </section>\n \n <section>\n \n <h3> Plain Language Summary</h3>\n \n <p><b>Use of a powder mix of vitamins and minerals to fortify complementary foods immediately before consumption and improve health and nutrition in children under two years of age</b></p>\n \n <p>Deficiencies of vitamins and minerals, particularly of iron, vitamin A and zinc, affect approximately half of the infants and young children under two years of age worldwide. Exclusive breastfeeding until six months of age and continued breastfeeding for at least two years are recommended to maintain children's adequate health and nutrition. After six months of age, infants start receiving semi-solid foods but the amount of vitamins and minerals can be insufficient to fulfil all the requirements of the growing baby. Micronutrient powders (MNP) are single-dose packets of powder containing iron, vitamin A, zinc and other vitamins and minerals that can be sprinkled onto any semi-solid food at home or at any other point of use to increase the content of essential nutrients in the infant's diet during this period. This is done without changing the usual baby diet.</p>\n \n <p>This review includes eight good quality trials that involved 3748 infants and young children from low income countries in Asia, Africa and the Caribbean. 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The use of MNP was beneficial for male and female infants and young children six to 23 months of age, independent of whether they lived in settings with different anaemia and malaria backgrounds or whether the intervention was provided for two, six or 12 months. 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引用次数: 212

摘要

维生素和矿物质缺乏,特别是铁、维生素A和锌的缺乏,影响着全世界20多亿人。幼儿由于生长迅速和不适当的饮食习惯而极易受到伤害。微量营养素粉末(MNP)是一种单剂量的粉末,含有多种维生素和矿物质,可以撒在任何半固体食物上。已建议将MNP用于家庭或使用点辅食强化,作为改善两岁以下儿童微量营养素摄入量的干预措施。目的评估家庭(使用点)强化含有多种微量营养素粉末的食品对两岁以下儿童的营养、健康和发育结果的影响和安全性。我们于2011年2月检索了以下数据库:Cochrane中央对照试验登记(Central) (Cochrane图书馆)、MEDLINE(1948年至2011年2月2日)、EMBASE(1980年至2011年6周)、CINAHL(1937年至今)、CPCI-S(1990年至2011年2月19日)、Science Citation Index(1970年至2011年2月19日)、African Index Medicus(2011年2月23日检索)、POPLINE(2011年2月21日检索)、ClinicalTrials.gov(2011年2月23日检索)、mRCT(2011年2月23日检索)、和世界卫生组织国际临床试验注册平台(ICTRP)(2011年2月23日检索)。我们还联系了相关组织(2011年1月25日),以确定正在进行和未发表的研究。我们纳入了随机和准随机试验,可采用个体随机或集群随机。参与者是在干预时两岁以下的儿童,没有具体的健康问题。干预措施是食用在使用时添加了至少含有铁,锌和维生素A的多种微量营养素粉末的食物,与安慰剂相比,不进行干预或使用含铁补充剂,这是标准做法。资料收集和分析两位综述作者根据纳入标准独立评估研究的合格性,从纳入研究中提取数据并评估纳入研究的偏倚风险。我们纳入了在亚洲、非洲和加勒比低收入国家进行的8项试验(3748名参与者),在这些国家,贫血是一个公共卫生问题。干预持续了2到12个月,粉末配方含有5到15种营养素。六项试验比较了MNP与不干预或安慰剂的使用,另外两项试验比较了MNP与每日铁滴剂的使用。大多数纳入的试验被评估为低偏倚风险。家庭强化MNP可减少31%的贫血(6项试验,RR 0.69;95% CI 0.60 ~ 0.78)和缺铁51%(4项试验,RR 0.49;(95% CI 0.35 ~ 0.67),与不干预或安慰剂相比,但我们没有发现对生长的影响。与每日补铁相比,使用MNP对贫血产生相似的结果(一项试验,RR 0.89;95% CI 0.58 - 1.39)和血红蛋白浓度(两项试验,MD -2.36 g/L;95% CI -10.30 ~ 5.58);然而,由于数据量有限,这些结果应谨慎解释。试验中没有死亡报告,关于副作用和发病率(包括疟疾)的资料很少。在贫血和疟疾流行率不同的环境中生活的6至23个月的婴幼儿中,MNP的使用似乎是有效的,无论干预是持续2个月、6个月还是12个月,也无论接受者是男性还是女性。作者的结论:家庭强化含有多种微量营养素粉末的食物是减少6个月至23个月大的儿童贫血和缺铁的有效干预措施。提供MNP优于不干预或安慰剂,可能与常用的每日补铁相当。这种干预作为儿童生存策略或对发展结果的益处尚不清楚。缺乏对疟疾结果的影响的数据,需要进一步调查发病率结果。 含有多种营养素的微量营养素粉末被广泛接受,但依从性是可变的,在某些情况下与接受以滴剂或糖浆形式的标准铁补充剂的婴儿和幼儿所取得的效果相当。在食用辅食之前立即使用维生素和矿物质混合粉来强化辅食,改善两岁以下儿童的健康和营养全世界大约有一半的婴儿和两岁以下儿童缺乏维生素和矿物质,特别是缺乏铁、维生素a和锌。建议纯母乳喂养至6个月,并继续母乳喂养至少两年,以保持儿童的充分健康和营养。6个月后,婴儿开始接受半固体食物,但维生素和矿物质的数量可能不足以满足成长中的婴儿的所有需求。微量营养素粉末(MNP)是单剂量的粉末包,含有铁、维生素A、锌和其他维生素和矿物质,可以洒在家中或任何其他使用地点的任何半固体食物上,以增加婴儿在此期间饮食中必需营养素的含量。这是在不改变婴儿日常饮食的情况下完成的。本综述包括8项高质量试验,涉及来自亚洲、非洲和加勒比低收入国家的3748名婴幼儿。我们发现,含有5至15种维生素和矿物质的各种MNP配方已被给予2至12个月大的婴儿和6至23个月大的幼儿。在家庭强化食品中使用至少含有铁、锌和维生素A的MNP,可以降低两岁以下儿童患贫血和缺铁的风险。研究没有发现对生长有任何影响。虽然这种创新干预的可接受性很高,但通常推荐的铁滴剂或糖浆没有额外的益处,然而很少有研究比较这些不同的干预措施。试验中没有死亡报告,关于副作用和发病率(包括疟疾)的资料很少。MNP的使用对6至23个月大的男女婴儿和幼儿有益,无论他们是否生活在不同贫血和疟疾背景的环境中,也无论干预是提供2个月、6个月还是12个月。最适当的使用安排(每日或间歇性)、适当的维生素和矿物质组成的粉末混合物以及如何在公共卫生方案中有效地提供这种干预措施,以解决多种微量营养素缺乏症,目前仍不清楚。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)

Background

Vitamin and mineral deficiencies, particularly those of iron, vitamin A and zinc, affect more than two billion people worldwide. Young children are highly vulnerable because of rapid growth and inadequate dietary practices. Micronutrient powders (MNP) are single-dose packets containing multiple vitamins and minerals in powder form that can be sprinkled onto any semi-solid food.The use of MNP for home or point-of-use fortification of complementary foods has been proposed as an intervention for improving micronutrient intake in children under two years of age.

Objectives

To assess the effects and safety of home (point-of-use) fortification of foods with multiple micronutrient powders on nutritional, health and developmental outcomes in children under two years of age.

Search methods

We searched the following databases in February 2011: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (1948 to week 2 February 2011), EMBASE (1980 to Week 6 2011), CINAHL (1937 to current), CPCI-S (1990 to 19 February 2011), Science Citation Index (1970 to 19 February 2011), African Index Medicus (searched 23 February 2011), POPLINE (searched 21 February 2011), ClinicalTrials.gov (searched 23 February 2011), mRCT (searched 23 February 2011), and World Health Organization International Clinical Trials Registry Platform (ICTRP) (searched 23 February 2011). We also contacted relevant organisations (25 January 2011) for the identification of ongoing and unpublished studies.

Selection criteria

We included randomised and quasi-randomised trials with either individual or cluster randomisation. Participants were children under the age of two years at the time of intervention, with no specific health problems. The intervention was consumption of food fortified at the point of use with multiple micronutrient powders formulated with at least iron, zinc and vitamin A compared with placebo, no intervention or the use of iron containing supplements, which is the standard practice.

Data collection and analysis

Two review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies and assessed the risk of bias of the included studies.

Main results

We included eight trials (3748 participants) conducted in low income countries in Asia, Africa and the Caribbean, where anaemia is a public health problem. The interventions lasted between two and 12 months and the powder formulations contained between five and 15 nutrients. Six trials compared the use of MNP versus no intervention or a placebo and the other two compared the use of MNP versus daily iron drops. Most of the included trials were assessed as at low risk of bias.

Home fortification with MNP reduced anaemia by 31% (six trials, RR 0.69; 95% CI 0.60 to 0.78) and iron deficiency by 51% (four trials, RR 0.49; 95% CI 0.35 to 0.67) in infants and young children when compared with no intervention or placebo, but we did not find an effect on growth.

In comparison with daily iron supplementation, the use of MNP produced similar results on anaemia (one trial, RR 0.89; 95% CI 0.58 to 1.39) and haemoglobin concentrations (two trials, MD -2.36 g/L; 95% CI -10.30 to 5.58); however, given the limited amount of data these results should be interpreted cautiously.

No deaths were reported in the trials and information on side effects and morbidity, including malaria, was scarce.

It seems that the use of MNP is efficacious among infants and young children six to 23 months of age living in settings with different prevalences of anaemia and malaria endemicity, regardless of whether the intervention lasts two, six or 12 months or whether recipients are male or female.

Authors' conclusions

Home fortification of foods with multiple micronutrient powders is an effective intervention to reduce anaemia and iron deficiency in children six months to 23 months of age. The provision of MNP is better than no intervention or placebo and possibly comparable to commonly used daily iron supplementation. The benefits of this intervention as a child survival strategy or on developmental outcomes are unclear. Data on effects on malaria outcomes are lacking and further investigation of morbidity outcomes is needed. The micronutrient powders containing multiple nutrients are well accepted but adherence is variable and in some cases comparable to that achieved in infants and young children receiving standard iron supplements as drops or syrups.

Plain Language Summary

Use of a powder mix of vitamins and minerals to fortify complementary foods immediately before consumption and improve health and nutrition in children under two years of age

Deficiencies of vitamins and minerals, particularly of iron, vitamin A and zinc, affect approximately half of the infants and young children under two years of age worldwide. Exclusive breastfeeding until six months of age and continued breastfeeding for at least two years are recommended to maintain children's adequate health and nutrition. After six months of age, infants start receiving semi-solid foods but the amount of vitamins and minerals can be insufficient to fulfil all the requirements of the growing baby. Micronutrient powders (MNP) are single-dose packets of powder containing iron, vitamin A, zinc and other vitamins and minerals that can be sprinkled onto any semi-solid food at home or at any other point of use to increase the content of essential nutrients in the infant's diet during this period. This is done without changing the usual baby diet.

This review includes eight good quality trials that involved 3748 infants and young children from low income countries in Asia, Africa and the Caribbean. We found that a variety of MNP formulations containing between five and 15 vitamins and minerals have been given for between two and 12 months to infants and young children aged six to 23 months of age.

The use of MNP containing at least iron, zinc and vitamin A for home fortification of foods was associated with a reduced risk of anaemia and iron deficiency in children under two. The studies did not find any effects on growth. Although the acceptability of this innovative intervention was high, there is no additional benefit to usually recommended iron drops or syrups, however few studies compared these different interventions. No deaths were reported in the trials and information on side effects and morbidity, including malaria, was scarce. The use of MNP was beneficial for male and female infants and young children six to 23 months of age, independent of whether they lived in settings with different anaemia and malaria backgrounds or whether the intervention was provided for two, six or 12 months. The most appropriate arrangements for use (daily or intermittently), the appropriate vitamin and mineral composition of the mix of powders and the way to deliver this intervention effectively in public health programmes to address multiple micronutrient deficiencies remain unclear.

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