The impact of reducing dietary aflatoxin exposure on child linear growth: a cluster randomised controlled trial in Kenya
The impact of reducing dietary aflatoxin exposure on child linear growth: a cluster randomised controlled trial in Kenya
复制标题
DOI：
10.1136/bmjgh-2018-000983
复制
发表时间：
2018-11-01
影响因子：
8.1
通讯作者：
Leroy, Jef L.
中科院分区：
文献类型：
--
作者：
Hoffmann, Vivian;Jones, Kelly;Leroy, Jef L.
观察性研究已经证明黄曲霉毒素（AF）暴露与婴幼儿线性生长减少之间存在关联。我们的目的是评估减少房颤暴露对肯尼亚东部农村地区儿童线性生长和血清房颤水平的影响。方法采用整群随机对照设计（28个干预组和28个对照组）。干预组接受了交换（用安全的玉米替换受污染的玉米）和库存干预（鼓励家庭从供应清洁玉米的库存商那里购买）。怀孕第五个月到最后一个月的妇女被邀请参加这项研究。结果分别是试验开始后儿童年龄长度Z-score （LAZ）、发育迟缓患病率和儿童血清AFB(1)-赖氨酸加合物水平24（终点，主要结果）和11至19个月（中线，次要结果）。在1230名未出生的婴儿中，881名（72%）被纳入LAZ分析，798名（65%）被纳入血清AFB(1)分析。干预显著降低了血清AFB(1)-赖氨酸加合物水平（干预效应-0.273,95% CI -0.547 ~ 0.001；单侧p=0.025），但对终末LAZ或发育迟缓没有影响（终末平均LAZ为-1.64）。在中线，干预使LAZ增加了0.16个百分点（95% CI -0.009至0.33；单侧p=0.032），使发育迟缓减少了7个百分点（95% CI -0.125至-0.007；单侧p=0.015），但对血清AFB(1)水平没有影响。结论提高无AF玉米的可及性可显著降低终线血清AF，但对儿童线性生长无影响。中线分析表明AF可能影响年轻时的线性生长。
Introduction Observational studies have documented an association between aflatoxin (AF) exposure and reduced linear growth in infants and young children. Our objective was to assess the effectiveness of reducing AF exposure on child linear growth and serum AF levels in rural areas in Eastern Kenya.Methods A cluster randomised controlled design was used (28 intervention and 28 control clusters). The intervention arm received a swapping (contaminated maize was replaced with safe maize) and a stockist intervention (households were encouraged to purchase from a stockist supplied with clean maize). Women in the fifth to final month of pregnancy were invited to enrol in the study. Outcomes were child length-for-age Z-score (LAZ), the prevalence of stunting and child serum AFB(1)-lysine adduct level 24 (endline, primary outcomes) and 11 to 19 months (midline, secondary outcomes) after trial commencement, respectively. The trial was registered with socialscienceregistry.org.Results Of the 1230 unborn children enrolled in the study, 881 (72%) were included in the LAZ and 798 (65%) in the serum AFB(1) analysis. The intervention significantly reduced endline In serum AFB(1)-lysine adduct levels (intervention effect-0.273, 95% CI -0.547 to 0.001; one-sided p=0.025), but had no effect on endline LAZ or stunting (mean LAZ at endline was -1.64). At midline, the intervention increased LAZ by 0.16 (95% CI -0.009 to 0.33; one-sided p=0.032) and reduced stunting by seven percentage points (95% CI -0.125 to -0.007; one-sided p=0.015), but had no impact on serum AFB(1) levels.Conclusion Improving access to AF-free maize substantially reduced endline serum AF, but had no effect on child linear growth. The midline analysis suggests that AF may affect linear growth at younger ages.