Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years.
Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years.
复制标题
用于改善三个月至五岁社会经济弱势儿童的身心健康的食品补充剂。
DOI：
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发表时间：
2015
影响因子：
8.4
通讯作者：
M. Petticrew
中科院分区：
文献类型：
--
作者：
E. Kristjansson;Damian K. Francis;S. Liberato;Maria Benkhalti Jandu;V. Welch;M. Batal;T. Greenhalgh;T. Rader;E. Noonan;B. Shea;L. Janzen;G. Wells;M. Petticrew
背景
营养不良每年导致 500 万五岁以下儿童死亡。此外，在整个生命周期中，营养不良会增加感染、认知功能差、慢性病和死亡率的风险。因此，对于决策者来说，掌握幼儿营养干预措施有效性的证据非常重要。
目标
主要目标1。评估单独或联合干预的补充喂养干预措施对于改善三个月至五岁弱势儿童的身心健康的有效性。次要目标1。评估此类计划减少营养不良造成的社会经济不平等的潜力。2．评估实施情况并了解这可能对结果产生怎样的影响。3．以确定补充喂养是否有任何不良影响。
搜寻方法
我们检索了 CENTRAL、Ovid MEDLINE、PsycINFO 和其他七个数据库，了解截至 2014 年 1 月的所有可用年份。我们还检索了 ClinicalTrials.gov 和多个灰色文献来源。此外，我们还检索了相关文章和评论的参考文献列表，并向该领域的专家询问了正在进行的和未发表的试验。
选择标准
为来自所有国家的三个月至五岁儿童提供补充食品（有或没有共同干预）的随机对照试验（RCT）、整群随机对照试验、对照临床试验（CCT）、对照前后研究（CBA）和间断时间序列（ITS）。允许进行营养教育等辅助治疗。对照必须未经处理。
数据收集和分析
两名或两名以上综述作者独立审查检索、选择纳入或排除的研究、提取数据并评估偏倚风险。我们使用均值差 (MD) 或标准化均值差 (SMD) 和 95% 置信区间 (CI) 对连续数据进行荟萃分析，并在必要时对聚类进行校正。我们分别分析了低收入和中等收入国家以及高收入国家的研究，并将随机对照试验与 CBA 分开分析。我们进行了流程评估，以了解哪些因素影响有效性。
主要结果
我们纳入了 32 项研究（21 项 RCT 和 11 项 CBA）；其中 26 项（16 项随机对照试验和 10 项 CBA）正在进行荟萃分析。超过 50% 的随机对照试验被认为因随机选择和不完整的结果评估而存在低偏倚风险。我们认为大多数 RCTS 在分配隐藏、结果评估盲法和选择性结果报告方面不明确。因为儿童和家长知道他们得到了食物，所以我们判断参与者和人员的盲法对于所有研究来说都面临着高风险。补充喂养对低收入和中等收入国家的增长产生了积极影响。随机对照试验的荟萃分析显示，六个月内，补充补充剂的儿童比对照组儿童平均增重 0.12 公斤（95% 置信区间 (CI) 0.05 至 0.18，9 项试验，1057 名受试者，中等质量证据）。在 CBA 中，效果类似；一年增加 0.24 公斤（95% CI 0.09 至 0.39，1784 名参与者，证据质量极低）。在高收入国家，一项随机对照试验发现体重没有差异，但在澳大利亚一项包含 116 名原住民儿童的 CBA 中，对体重的影响为 0.95 公斤（95% CI 0.58 至 1.33）。对于身高，对 9 项随机对照试验的荟萃分析显示，服用补充剂的儿童在六个月内比未服用补充剂的儿童平均长高了 0.27 厘米（95% CI 0.07 至 0.48，1463 名参与者，中等质量证据）。 7 个 CBA 的荟萃分析显示没有效果证据（平均差 (MD) 0.52 cm，95% CI -0.07 至 1.10，7 项试验，1782 名受试者，证据质量非常低）。随机对照试验的荟萃分析表明，年龄别体重 z 得分 (WAZ)（MD 0.15，95% CI 0.05 至 0.24，8 项试验，1565 名受试者，中等质量证据）和年龄别身高 z 得分 (HAZ)（MD 0.15，95% CI 0.06 至 0.24，9 项试验，4638 名受试者）有益处。参与者，中等质量的证据），但不适用于 身高体重 z 得分 MD 0.10（95% CI -0.02 至 0.22，7 项试验，4176 名受试者，中等质量证据）。 CBA 的荟萃分析显示对 WAZ、HAZ 或 WHZ 没有影响（证据质量非常低）。在 RCT 的荟萃分析中，我们发现血红蛋白具有中等的积极作用（SMD 0.49，95% CI 0.07 至 0.91，5 项试验，300 名受试者）。心理社会结果。低收入和中等收入国家的八项随机对照试验评估了心理社会结果。我们对两项研究的荟萃分析显示，进食对精神运动发育具有中等积极影响（SMD 0.41，95% CI 0.10 至 0.72，178 名受试者）。对认知发展影响的证据很少且混杂。我们发现了大量泄漏的证据。当在家喂养时，儿童只能从补充剂中获得 36% 的能量。然而，当补充食品在日托中心或喂养中心提供时，泄漏的情况较少；儿童吸收了补充剂中 85% 的能量。补充食品通常对于年幼的儿童（两岁以下）和较贫穷/营养不良的儿童更有效。性别结果是模棱两可的。我们的结果还表明，在日托/喂养中心提供的喂养计划以及提供中到高比例的每日推荐摄入量（% RDI）能量的喂养计划更有效。
作者的结论
低收入和中等收入国家的幼儿喂养计划可以发挥作用，但良好的实施是关键。
BACKGROUND
Undernutrition contributes to five million deaths of children under five each year. Furthermore, throughout the life cycle, undernutrition contributes to increased risk of infection, poor cognitive functioning, chronic disease, and mortality. It is thus important for decision-makers to have evidence about the effectiveness of nutrition interventions for young children.
OBJECTIVES
Primary objective1. To assess the effectiveness of supplementary feeding interventions, alone or with co-intervention, for improving the physical and psychosocial health of disadvantaged children aged three months to five years.Secondary objectives1. To assess the potential of such programmes to reduce socio-economic inequalities in undernutrition.2. To evaluate implementation and to understand how this may impact on outcomes.3. To determine whether there are any adverse effects of supplementary feeding.
SEARCH METHODS
We searched CENTRAL, Ovid MEDLINE, PsycINFO, and seven other databases for all available years up to January 2014. We also searched ClinicalTrials.gov and several sources of grey literature. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished trials.
SELECTION CRITERIA
Randomised controlled trials (RCTs), cluster-RCTs, controlled clinical trials (CCTs), controlled before-and-after studies (CBAs), and interrupted time series (ITS) that provided supplementary food (with or without co-intervention) to children aged three months to five years, from all countries. Adjunctive treatments, such as nutrition education, were allowed. Controls had to be untreated.
DATA COLLECTION AND ANALYSIS
Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data, and assessed risk of bias. We conducted meta-analyses for continuous data using the mean difference (MD) or the standardised mean difference (SMD) with a 95% confidence interval (CI), correcting for clustering if necessary. We analysed studies from low- and middle-income countries and from high-income countries separately, and RCTs separately from CBAs. We conducted a process evaluation to understand which factors impact on effectiveness.
MAIN RESULTS
We included 32 studies (21 RCTs and 11 CBAs); 26 of these (16 RCTs and 10 CBAs) were in meta-analyses. More than 50% of the RCTs were judged to have low risk of bias for random selection and incomplete outcome assessment. We judged most RCTS to be unclear for allocation concealment, blinding of outcome assessment, and selective outcome reporting. Because children and parents knew that they were given food, we judged blinding of participants and personnel to be at high risk for all studies.Growth. Supplementary feeding had positive effects on growth in low- and middle-income countries. Meta-analysis of the RCTs showed that supplemented children gained an average of 0.12 kg more than controls over six months (95% confidence interval (CI) 0.05 to 0.18, 9 trials, 1057 participants, moderate quality evidence). In the CBAs, the effect was similar; 0.24 kg over a year (95% CI 0.09 to 0.39, 1784 participants, very low quality evidence). In high-income countries, one RCT found no difference in weight, but in a CBA with 116 Aboriginal children in Australia, the effect on weight was 0.95 kg (95% CI 0.58 to 1.33). For height, meta-analysis of nine RCTs revealed that supplemented children grew an average of 0.27 cm more over six months than those who were not supplemented (95% CI 0.07 to 0.48, 1463 participants, moderate quality evidence). Meta-analysis of seven CBAs showed no evidence of an effect (mean difference (MD) 0.52 cm, 95% CI -0.07 to 1.10, 7 trials, 1782 participants, very low quality evidence). Meta-analyses of the RCTs demonstrated benefits for weight-for-age z-scores (WAZ) (MD 0.15, 95% CI 0.05 to 0.24, 8 trials, 1565 participants, moderate quality evidence), and height-for-age z-scores (HAZ) (MD 0.15, 95% CI 0.06 to 0.24, 9 trials, 4638 participants, moderate quality evidence), but not for weight-for-height z-scores MD 0.10 (95% CI -0.02 to 0.22, 7 trials, 4176 participants, moderate quality evidence). Meta-analyses of the CBAs showed no effects on WAZ, HAZ, or WHZ (very low quality evidence). We found moderate positive effects for haemoglobin (SMD 0.49, 95% CI 0.07 to 0.91, 5 trials, 300 participants) in a meta-analysis of the RCTs.Psychosocial outcomes. Eight RCTs in low- and middle-income countries assessed psychosocial outcomes. Our meta-analysis of two studies showed moderate positive effects of feeding on psychomotor development (SMD 0.41, 95% CI 0.10 to 0.72, 178 participants). The evidence of effects on cognitive development was sparse and mixed.We found evidence of substantial leakage. When feeding was given at home, children benefited from only 36% of the energy in the supplement. However, when the supplementary food was given in day cares or feeding centres, there was less leakage; children took in 85% of the energy provided in the supplement. Supplementary food was generally more effective for younger children (less than two years of age) and for those who were poorer/ less well-nourished. Results for sex were equivocal. Our results also suggested that feeding programmes which were given in day-care/feeding centres and those which provided a moderate-to-high proportion of the recommended daily intake (% RDI) for energy were more effective.
AUTHORS' CONCLUSIONS
Feeding programmes for young children in low- and middle-income countries can work, but good implementation is key.
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DOI：
10.1093/ajcn/54.1.62
发表时间：
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期刊：
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DOI：
10.1079/pns19880039
发表时间：
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期刊：
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影响因子：
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作者：
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