Zinc, Mental Health and School Performance in Mexico

描述(由申请人提供)：目前的申请是2002年10月首次审查的提案1 R01 MH067981-01的修订版。心理健康问题是儿童和青少年中一个重大的公共卫生问题。我们将通过埃默里大学国际卫生系和墨西哥国家萨鲁德公共研究院的合作努力，评估学龄儿童锌、心理健康和学习表现之间的关系。中心假设是，在有缺锌风险和严重心理健康问题的人群中，补锌将改善儿童的心理健康和学习表现。这一假设将通过在墨西哥中部进行随机、双盲、安慰剂对照试验来检验。 7至11岁的儿童(n=744)将被招募参加基线评估，每天补充10毫克锌或安慰剂6个月，以及补充后评估。信息将从儿童、主要照顾者和教师那里获得。心理健康的结果包括抑郁和焦虑的症状；其他结果包括学校表现以及注意力不集中和活动水平低的问题。将获得有关锌状况和人体测量的生化指标以及潜在混杂因素的信息，如社会人口学、疾病/感染、贫血、微量营养素状况(维生素A、铁、叶酸)、饮食摄入量、照顾者的心理状况和环境压力因素。数据分析将包括确保随机化有效性后的组比较(意向治疗)，以及控制潜在混杂因素的影响的分析，以及根据潜在的中介和调节变量探索基线关系和锌的影响。拟议研究的总体目标是更好地了解具体的营养缺乏和环境压力如何影响儿童的心理健康和学习成绩，并为解决世界各地儿童日益增长的心理健康需求提供预防性、互补性的方法。

DESCRIPTION (provided by applicant): The current application is a revision of proposal 1 R01 MH067981-01 initially reviewed in October 2002. Mental health problems are a significant public health concern among children and adolescents. We will evaluate relationships among zinc, mental health, and school performance in school-age children through a collaborative effort between the Department of International Health of Emory University and the Instituto Nacional de Salud Publica in Mexico. The central hypothesis is that zinc supplementation will improve the mental health and school performance of children in a population at risk for zinc deficiency and with significant mental health problems. This hypothesis will be tested by conducting a randomized double-blinded, placebo-controlled trial in central Mexico. Children, ages 7 to 11 (n=744), will be recruited to participate in a baseline assessment, six months of daily supplementation with 10 mg zinc or placebo, and a post-supplementation assessment. Information will be obtained from the children, primary caregivers, and teachers. The mental health outcomes include symptoms of depression and anxiety; other outcomes include school performance and problems of poor attention and low activity levels. Information will be obtained on biochemical indices of zinc status and anthropometry, and on potential confounders such as sociodemographics, illness/infection, anemia, micronutrient status (vitamin A, iron, folate), dietary intake, psychological status of the caregiver, and environmental stressors. Data analysis will include group comparisons (intent-to-treat) after ensuring effectiveness of randomization, along with analyses controlling for effects of potential confounders, and exploration of baseline relationships and the effects of zinc in light of potential mediating and moderating variables. The overall goal of the proposed research is to understand better how specific nutritional deficiencies and environmental stressors influence children's mental health and school performance, and to contribute preventive, complementary approaches to addressing the growing mental health needs of children worldwide.