Prenatal and postnatal small-quantity lipid-based nutrient supplements and children's social-emotional difficulties at ages 9-11 y in Ghana: follow-up of a randomized controlled trial.
Prenatal and postnatal small-quantity lipid-based nutrient supplements and children's social-emotional difficulties at ages 9-11 y in Ghana: follow-up of a randomized controlled trial.
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DOI：
10.1016/j.ajcnut.2023.05.025
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发表时间：
2023-08
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在生命早期提供少量脂质营养补充剂 (SQ-LNS) 可改善生长和发育。在国际脂质营养补充剂 DYAD-加纳试验中，产前和产后 SQ-LNS 减少了 5 岁时的社交情感困难，对家庭环境较差的儿童的影响更大。我们的目的是调查产前和产后 SQ-LNS 对 9-11 岁儿童社交情感问题的影响。 2009-2011 年，1320 名妊娠 ≤ 20 周的孕妇被随机分配每天接受以下治疗直至产后 6 个月：1）铁和叶酸直至分娩，然后安慰剂，2）多种微量营养素（MMN）或 3）SQ-LNS（20 克/天）。第 3 组的儿童在 6 至 18 个月期间接受了 SQ-LNS。 2021 年，我们使用 6 种评估工具评估了儿童的社会情感结果，这些工具使用看护者、教师和/或自我报告来衡量社会情感困难、行为问题、气质、情绪、焦虑和情绪管理。我们评估了 966 名儿童的结果，其中包括 1217 名符合重新入学资格的参与者中的 79.4%。 SQ-LNS 组和对照组（非 LNS 组合并）之间没有发现显着差异。很少有儿童（<2%）在 9-11 岁时经历过父母报告的高度社交情感困难，而该队列中 5 岁时的患病率很高（25%）。在幼儿家庭环境不太丰富的儿童中，SQ-LNS 组的自我报告行为问题比对照组低 0.37 SD（−0.04 至 0.82）（P 交互作用 = 0.047）。之前在 5 岁时发现的 SQ-LNS 对社交情感发展的总体积极影响并没有持续到 9-11 岁；然而，有一些证据表明，对生活在贫乏环境中的儿童有积极影响。缺乏效果可能是由于青春期前社会情感问题的发生率较低，导致该年龄在这一结果领域从早期营养干预中获益的可能性很小。在青春期，当社会情感问题更常见时，进行随访可能会产生进一步的见解。该试验在 ClinicalTrials.gov 上注册为 NCT00970866。 https://clinicaltrials.gov/ct2/show/record/NCT00970866
Provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) during early life improves growth and development. In the International Lipid-Based Nutrient Supplements DYAD–Ghana trial, prenatal and postnatal SQ-LNS reduced social–emotional difficulties at age 5 y, with greater effects among children in less-enriched home environments. We aimed to investigate the effect of prenatal and postnatal SQ-LNS on children's social–emotional problems at age 9–11 y. In 2009–2011, 1320 pregnant women ≤20 wk gestation were randomly assigned to receive the following daily until 6 mo postpartum: 1) iron and folic acid until delivery, then placebo, 2) multiple micronutrients (MMNs), or 3) SQ-LNS (20 g/d). Children in group 3 received SQ-LNS from 6 to 18 mo. In 2021, we evaluated children's social–emotional outcomes with 6 assessment tools that used caregiver, teacher, and/or self-report to measure socioemotional difficulties, conduct problems, temperament, mood, anxiety, and emotion management. We assessed outcomes in 966 children, comprising 79.4% of 1217 participants eligible for re-enrolment. No significant differences were found between the SQ-LNS and control (non-LNS groups combined) groups. Few children (<2%) experienced high parent-reported social–emotional difficulties at 9–11 y, in contrast to the high prevalence at age 5 in this cohort (25%). Among children in less-enriched early childhood home environments, the SQ-LNS group had 0.37 SD (−0.04 to 0.82) lower self-reported conduct problems than the control group (P-interaction = 0.047). Overall positive effects of SQ-LNS on social–emotional development previously found at age 5 y are not sustained to age 9–11 y; however, there is some evidence of positive effects among children in less-enriched environments. The lack of effects may be owing to low prevalence of social–emotional problems at preadolescence, resulting in little potential to benefit from early nutritional intervention at this age in this outcome domain. Follow-up during adolescence, when social-emotional problems more typically onset, may yield further insights. This trial was registered at clinicaltrials.gov as NCT00970866. https://clinicaltrials.gov/ct2/show/record/NCT00970866
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