Prenatal multiple micronutrient (MM) supplementation improves birth weight through increased fetal growth and gestational age, but whether maternal or fetal growth factors are involved is unclear. ...Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh. In a double-blind, cluster-randomized, controlled trial of MM vs. iron and folic acid (IFA) supplementation, we measured placental growth hormone (PGH) at 10 weeks and PGH and human placental lactogen (hPL) at 32 weeks gestation in maternal plasma (n = 396) and insulin, insulin-like growth factor-1 (IGF-1), and IGF binding protein-1 (IGFBP-1) in cord plasma (n = 325). Birth size and gestational age were also assessed. Early pregnancy mean (SD) BMI was 19.5 (2.4) kg/m2 and birth weight was 2.68 (0.41) kg. There was no effect of MM on concentrations of maternal hPL or PGH, or cord insulin, IGF-1, or IGFBP-1. However, among pregnancies of female offspring, hPL concentration was higher by 1.1 mg/L in the third trimester (95% CI: 0.2, 2.0 mg/L; p = 0.09 for interaction); and among women with height <145 cm, insulin was higher by 59% (95% CI: 3, 115%; p = 0.05 for interaction) in the MM vs. IFA group. Maternal hPL and cord blood insulin and IGF-1 were positively, and IGFBP-1 was negatively, associated with birth weight z score and other measures of birth size (all p<0.05). IGF-1 was inversely associated with gestational age (p<0.05), but other growth factors were not associated with gestational age or preterm birth. Prenatal MM supplementation had no overall impact on intrauterine growth factors. MM supplementation altered some growth factors differentially by maternal early pregnancy nutritional status and sex of the offspring, but this should be examined in other studies.
ClinicalTrials.gov NCT00860470.
Palestine refugees comprise the largest refugee population in the world, most of whom are encamped in Middle Eastern countries. In the Gaza Strip, where ∼1.4 million Palestinians reside, there are ...high prevalences of anemia and multiple micronutrient deficiencies (MNDs), including those of iron, zinc, vitamins A, B12, D, and E, ranging from 11.4% to 84.7% among pregnant women and 2.9% to 70.9% among preschool children. Dietary diversification and adequate food fortification are framed in policies but remain aspirational goals. Alternative, effective, targeted preventive approaches include, for women, replacement of antenatal iron-folic acid with multiple micronutrient supplementation, and for young children, point-of-use multiple micronutrient powder fortification to prevent anemia, both of which can reduce other MNDs and may bring additional health benefits. These interventions coupled with monitoring of dietary intakes, periodic assessment of MNDs, and implementation research to improve existing nutrition interventions are warranted to protect the health of the Middle East Palestinian diaspora.
We assessed the effect of supplementing newborns with 50000 IU of vitamin A on all-cause infant mortality through 24 weeks of age.
This was a community-based, double-masked, cluster-randomized, ...placebo-controlled trial conducted in 19 unions in rural northwest Bangladesh. The study was nested into and balanced across treatment arms of an ongoing placebo-controlled, weekly maternal vitamin A or beta-carotene supplementation trial. Study-defined sectors (N = 596) were evenly randomized for newborns of participating mothers to receive a single, oral supplement of vitamin A (50000 IU) or placebo as droplets of oil squeezed from a gelatinous capsule. Mothers provided informed consent for newborn participation at approximately 28 weeks' gestation. After birth, typically at home (where >90% of births occurred), infants were supplemented and their vital status was followed through 24 weeks of age. The main outcome measure was mortality through 24 weeks of age.
We obtained maternal consent to dose 17116 live-born infants (99.8% of all eligible) among whom 15937 (93.1%) were visited to be supplemented <30 days after birth and for whom vital status at 24 weeks of age was known. Dosed infants (n = 15902 99.8%) received their study supplement at a median age of 7 hours. Relative to control subjects, the risk of death in vitamin A-supplemented infants was 0.85, reflecting a 15% reduction in all-cause mortality. Protective relative risks were indistinguishable by infant gender, gestational age, birth weight, age at dosing, maternal age, parity, or across the 3 treatment arms of the maternal supplementation trial.
Newborn vitamin A dosing improved infant survival through the first 6 months of life in Bangladesh. These results corroborate previous findings from studies in Indonesia and India and provide additional evidence that vitamin A supplementation shortly after birth can reduce infant mortality in South Asia.
Little is known of the usual food intakes of rural adolescents in South Asia. This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 ...years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake patterns for 22 food groups. Latent class analysis was used to assign individuals to dietary patterns based on class membership probabilities. The following five dietary patterns (class membership probabilities) were identified: (1) “least diverse” (0.20); (2) “traditional” (0.28); (3) “low vegetable/low fish” (0.23), (4) “moderately high meat” (0.20); and (5) “most diverse” (0.09). The least diverse pattern had the lowest median consumption of most foods and traditional had a relatively higher intake of most vegetables and fish. The most diverse pattern consumed both healthy and processed foods much more often than other patterns. The two most diverse patterns (4 and 5) were associated with higher socioeconomic status, body mass index, height‐for‐age Z‐score, and male gender, and the least diverse pattern showed inverse associations with these characteristics. The most diverse pattern may represent an early wave of the nutrition transition in rural Bangladesh.
This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake patterns for 22 food groups. These were then used to generate dietary patterns.
Lee et al examines antenatal micronutrients and the mitochondrial genome. Antenatal micronutrient deficiency is a common threat to maternal health and pregnancy outcomes in low- and middle-income ...countries. Although effects of nutrient-dense dietary interventions during pregnancy remain to be clarified, large trials in undernourished regions, such as South Asia, indicate that antenatal multiple micronutrient supplementation, beyond iron-folic acid alone, can attenuate, if not eliminate, nutrient deficiencies), and reduce risks of low birth weight, fetal loss, and infant mortality). These effects have been broadly affirmed across low-income regions of the world. Whereas compelling evidence of pregnancy benefit accrues, molecular, cellular, and physiological pathways that explain overall, as well as differential, effects of antenatal MM interventions remain largely presumptive. This is a gap in knowledge and insight that promises to be filled by a nutritional omics revolution in the coming decades.
Nepal has a rich history of vitamin A research and a national, biannual preschool vitamin A supplementation (VAS) programme that has sustained high coverage for 25 years despite many challenges, ...including conflict. Key elements of programme success have included (a) evidence of a 26–30% reduction in child mortality from two, in‐country randomized trials; (b) strong political and donor support; (c) positioning local female community health volunteers as key operatives; (d) nationwide community mobilization and demand creation for the programme; and (e) gradual expansion of the programme over a period of several years, conducting and integrating delivery research, and monitoring to allow new approaches to be tested and adapted to available resources. The VAS network has served as a platform for delivering other services, including anthelmintic treatment and screening for acute malnutrition. We estimate that VAS has saved over 45,000 young lives over the past 15 years of attained national coverage. Consumption of vitamin A‐ and carotenoid‐rich foods by children and women nationally remains low, indicating that supplementation is still needed. Current challenges and opportunities to improving vitamin A status include lower VAS coverage among younger children (infants 6–11 months of age), finding ways to increase availability and access to dietary vitamin A sources, and ensuring local programme investments given the recent decentralization of the government.
Provitamin A carotenoid-biofortified maize is a conventionally bred staple crop designed to help prevent vitamin A deficiency. Lactating women are a potential target group, because regularly eating ...biofortified maize may increase vitamin A in breast milk-a critical source of vitamin A for breastfeeding infants.
We assessed whether daily consumption of biofortified orange maize would increase the retinol concentration in the breast milk of Zambian women.
Lactating women (n = 149) were randomly assigned to receive orange maize delivering 600 μg retinol equivalents (REs)/d as carotenoid plus placebo (OM), low-carotenoid white maize plus 600 μg REs/d as retinyl palmitate (VA), or white maize plus placebo (WM). Boiled maize (287 g dry weight/d) was served as 2 meals/d, 6 d/wk for 3 wk. We measured initial and final breast milk plasma retinol and β-carotene concentrations, and plasma inflammatory protein concentrations.
Groups were comparable at enrollment, with an overall geometric mean milk retinol concentration of 0.95 μmol/L (95% CI: 0.86, 1.05 μmol/L); 56% of samples had milk retinol <1.05 μmol/L. Median capsule and maize intake was 97% and 258 g dry weight/d, respectively. Final milk β-carotene did not vary across groups (P = 0.76). Geometric mean (95% CI) milk retinol concentration tended to be higher in the OM 1.15 μmol/L (0.96, 1.39 μmol/L) and VA 1.17 μmol/L (0.99, 1.38 μmol/L) groups than in the WM group 0.91 μmol/L (0.72, 1.14 μmol/L); P = 0.13, and the proportion of women with milk retinol <1.05 μmol/L was 52.1%, 42.9%, and 36.7% in the WM, OM, and VA groups, respectively (P-trend = 0.16).
Daily biofortified maize consumption did not increase mean milk retinol concentration in lactating Zambian women; however, there was a plausible downward trend in the risk of low milk retinol across intervention groups. This trial was registered at clinicaltrials.gov as NCT01922713.
The earthquake that struck Nepal on April 25, 2015, left 500 000 families homeless and almost 3 million people in need of humanitarian assistance.1 While there is speculation about the long-term ...effect of this disaster on Nepal's tourism-driven economy, the arrival of monsoon rains raises more immediate concerns about household food security and child nutrition.
Background: Micronutrient deficiencies may be related to poor fetal growth and short gestation. Few studies have investigated the contribution of maternal vitamin A deficiency to these ...outcomes.Objective: In rural northwestern Bangladesh, we examined the effects of weekly antenatal vitamin A and β-carotene supplementation on birth weight, length, circumferential body measures, and length of gestation.Design: With the use of a cluster-randomized, placebo-controlled trial design, pregnant women were enrolled in the first trimester and began receiving their allocated supplements (vitamin A, β-carotene, or placebo) weekly until 3 mo postpartum. Birth anthropometric measures were made at home.Results: Of 13,709 newborns whose birth weight was measured within 72 h of birth, mean (±SD) weight was 2.44 ± 0.42 kg, the prevalence of low birth weight (LBW) was 54.4%, and that of small-for-gestational age (SGA) was 70.5%. Birth weight, length, and chest, head, and arm circumferences did not differ between supplementation and placebo groups nor did rates of LBW and SGA. Mean gestational age at birth was 38.3 ± 2.9 wk, and 25.6% of births occurred before 37 wk. Neither gestational age nor preterm birth rate differed with vitamin A or β-carotene supplementation.Conclusions: In this rural South Asian population with a high burden of LBW and preterm birth but modest levels of maternal vitamin A deficiency, antenatal vitamin A or β-carotene supplementation did not benefit these birth outcomes. Other nutritional and nonnutritional interventions should be examined to reduce risks of these adverse outcomes in rural South Asia. This trial was registered at clinicaltrials.gov as NCT00198822.
Abstract Objective B1a lymphocytes—which constitutively produce most natural antibodies (NAb)—arise from an early wave of progenitors unique to fetal life. Vitamin A regulates early lymphopoiesis. In ...animals, deficiency during this critical period compromises B1 cell populations. The aim of this study was to investigate the effect of maternal supplementation with vitamin A or β-carotene from preconception through lactation on NAb concentrations of offspring. Methods Participants (N = 290) were born to participants of a cluster-randomized, placebo-controlled trial of weekly maternal vitamin A or β-carotene supplementation (7000 μg retinol equivalents) conducted in Sarlahi, Nepal (1994–1997) and assessed at ages 9 to 13 y (2006–2008). Serum retinol was measured by reversed-phase high-performance liquid chromatography at mid-pregnancy and 3 mo of age. Enzyme-linked immunosorbent assay (ELISA) was used to measure children's plasma NAb concentrations at 9 to 13 y. Results Unadjusted geometric mean concentrations were 20.08 U/mL (95% confidence interval CI, 17.82–22.64) in the vitamin A group compared with 17.64 U/mL (95% CI, 15.70–19.81) and 15.96 U/mL (95% CI, 13.43–18.96) in the β-carotene and placebo groups ( P = 0.07), respectively. After adjustment, maternal vitamin A supplementation was associated with a 0.39 SD increase in NAb concentrations ( P = 0.02). The effect was mediated by infant serum retinol in our statistical models. Although girls had 1.4-fold higher NAb concentrations ( P < 0.001), sex did not modify the vitamin A effect. Conclusions In an undernourished population, maternal vitamin A supplementation enhanced NAb concentrations of preadolescent children. We posit that this was due to a greater allotment of B1a precursors during fetal life and a sustained higher count of NAb-secreting B1a cells.
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