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Effects of Pre- and Postnatal Nutrition Interventions on Child Growth and Body Composition: The MINIMat Trial in Rural Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Nutritional insults and conditions in fetal life and infancy may influence later growth and body composition as well as the development of chronic diseases in adult life. We studied the effects of maternal food and micronutrient supplementation and exclusive breast-feeding counseling on offspring growth 0-54 months and body composition at 54 months of age. We also validated and developed equations for a leg-to-leg bioimpedance analyzer in order to assess body composition of Bangladeshi children aged 4-10 years.

In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early (around 9 weeks) or a Usual invitation (around 20 weeks) to food supplementation and to one of three daily micronutrient supplementations with capsules of either 30 mg Fe and 400 µg folic acid, or 60 mg Fe and 400 µg folic acid, or multiple micronutrient supplements (MMS) (15 micronutrients including 30 mg Fe and 400 µg folic acid). They were also randomized to exclusive breastfeeding counseling (EBC) or to usual health messages (UHM). Growth of their children was measured from birth to 54 months, when body composition also was assessed.

There were no differences in background characteristics across the different intervention groups. There was no differential effect by prenatal interventions on birth weight or length. Early invitation to food supplementation reduced stunting from early infancy up to 54 months for boys (average difference 6.5 percent units, 95% CI=1.7 to 11.3, p=0.01), but not for girls (average difference 2.4 percent units, 95% CI=-2.2 to 7.0, p=0.31). MMS resulted in more stunting than standard Fe60F (average difference 4.8 percent units, 95% CI=0.8 to 8.9, p=0.02). Breast-feeding counseling prolonged the duration of exclusive breastfeeding (difference 35.0 days, 95% CI 30.6-39.5, p<0.001). Neither the pregnancy interventions nor the breast-feeding counseling influenced body composition at 54 months.

Early food supplementation in pregnancy reduced the occurrence of stunting in boys 0-54 months, while prenatal MMS increased the proportion of stunting. Early food and multiple micronutrient supplementation or exclusive breastfeeding intervention provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age. The effects on postnatal growth suggest programming effects in early fetal life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 811
Keyword [en]
body composition, child growth, exclusive breast feeding, food supplementation, multiple micronutrients, pregnancy, programming
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-180479ISBN: 978-91-554-8467-5 (print)OAI: oai:DiVA.org:uu-180479DiVA: diva2:550554
Public defence
2012-10-17, Rosensalen, Akademiska sjukhuset, Entrance 95/96 nbv, Akademiska sjukhuset, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2012-09-25 Created: 2012-09-07 Last updated: 2014-08-18
List of papers
1. Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh
Open this publication in new window or tab >>Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh
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2011 (English)In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 10, 134- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring's growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes.

METHODS:

In the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab), Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 ug folic acid (Fe30F), 60 mg Fe and 400 ug folic acid (Fe60F) or MMS combined with either an early (immediately after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community) program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54 months, and 2735 children were available for analysis at 54 months.

RESULTS:

There were no differences in characteristics of mothers and households among the different intervention groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the proportion of stunting from early infancy up to 54 months for boys (p=0.01), but not for girls (p=0.31). MMS resulted in more stunting than standard Fe60F (p=0.02). There was no interaction between the food and micronutrient supplementation on the growth outcome.

CONCLUSIONS:

Early food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal growth suggest programming effects in early fetal life. The study is registered as an International Standard Randomized Controlled Trial, number ISRCTN16581394.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-164145 (URN)10.1186/1475-2891-10-134 (DOI)000300369000001 ()22152147 (PubMedID)
Available from: 2011-12-16 Created: 2011-12-16 Last updated: 2017-12-08Bibliographically approved
2. Body composition of Bangladeshi children: comparison and development of  leg-to-leg bioelectrical impedance equation
Open this publication in new window or tab >>Body composition of Bangladeshi children: comparison and development of  leg-to-leg bioelectrical impedance equation
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2012 (English)In: Journal of Health, Population and Nutrition, ISSN 1606-0997, E-ISSN 2072-1315, Vol. 30, no 3, 281-290 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate the validity of the Tanita TBF 300A leg-to-leg bioimpedance analyzer for estimating fat-free mass (FFM) in Bangladeshi children aged 4-10 years and to develop novel prediction equations for use in this population, using deuterium dilution as the reference method. Two hundred Bangladeshi children were enrolled. The isotope dilution technique with deuterium oxide was used for estimation of total body water (TBW).  FFM estimated by Tanita was compared to results of deuterium oxide dilution technique. Novel prediction equations were created for estimating FFM, using linear regression models, fitting child height and impedance as predictors.  There was a significant difference in FFM and BF% (percentage of body fat) between methods (p<0.01), Tanita under-estimating TBW in boys (p=0.001) and under-estimating BF% in girls (p<0.001). A basic linear regression model with height and impedance explained 83% of the variance in FFM estimated by deuterium oxide dilution. The best fit equation to predict FFM from linear regression modeling was achieved by adding weight, sex and age to the basic model, bringing the adjusted R2 to 89% (standard error=0.90, p<0.001). These data suggest Tanita analyzer may be a valid field assessment technique in Bangladeshi children when using population-specific prediction equations such as the ones developed here. 

Keyword
Bioelectrical impedance, Body composition, Children, Deuterium oxide dilution, Bangladesh
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-180353 (URN)000309630700006 ()
Available from: 2012-09-07 Created: 2012-09-04 Last updated: 2017-12-07Bibliographically approved
3. Early invitation to food and/or multiple micronutrient supplementation in pregnancy does not affect body composition in offspring at 54 months: follow-up of the MINIMat randomized trial, Bangladesh
Open this publication in new window or tab >>Early invitation to food and/or multiple micronutrient supplementation in pregnancy does not affect body composition in offspring at 54 months: follow-up of the MINIMat randomized trial, Bangladesh
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2015 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 11, no 3, 385-397 p.Article in journal (Refereed) Published
Abstract [en]

Growth patterns in early life are associated with later health. The effect of nutrition during in utero development on later body composition is unclear. We evaluated whether prenatal early invitation to food and/or multiple micronutrient supplementation (MMS) in pregnancy has an effect on offspring body composition at 54 months of age. In Maternal and Infant Nutrition Interventions in Matlab trial (ISRCTN16581394) in Bangladesh, 4436 pregnant women were randomised into six equally sized groups: double-masked supplementation with capsules of either 30mg Fe and 400g folic acid, or 60mg Fe and 400g folic acid, or MMS (15 micronutrients), was combined with a randomised early invitation (around 9 weeks) or a usual invitation (around 20 weeks) to start food supplementation (608kcal 6 days per week). At 54 months, the body composition of the offspring was assessed by leg-to-leg bioelectrical impedance analysis. Of the 3267 live singletons with birth anthropometry, 2290 children were measured at 54 months, representing 70% of the live births. There was no interaction between the food and micronutrient supplementation on body composition outcomes. There were no significant differences in a range of anthropometric and body composition measurements, including weight, height, mid-upper arm circumference, head circumference, skinfold thickness, and fat mass and fat-free mass between the different prenatal food and micronutrient groups using an intention-to-treat analysis. This analysis shows that early invitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age.

Keyword
body composition, child growth, food supplementation, multiple micronutrients, pregnancy, socio-economic status
National Category
Nutrition and Dietetics Pediatrics
Identifiers
urn:nbn:se:uu:diva-180434 (URN)10.1111/mcn.12021 (DOI)000356881000008 ()23241449 (PubMedID)
Available from: 2012-09-07 Created: 2012-09-06 Last updated: 2017-12-07Bibliographically approved
4. Effects of exclusive breastfeeding intervention on child growth and body composition: the MINIMat trial, Bangladesh
Open this publication in new window or tab >>Effects of exclusive breastfeeding intervention on child growth and body composition: the MINIMat trial, Bangladesh
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2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 8, 815-823 p.Article in journal (Refereed) Published
Abstract [en]

AIM:

Exclusive breastfeeding (EBF) for 6 months is recommended for optimal infant health, but the evidence for longer-term impacts is weak. We examined whether randomization to receive EBF counselling (BFC) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition.

METHODS:

In the Maternal and Infant Nutrition Interventions in Matlab trial, 4436 pregnant women were randomized to six equally sized, food and micronutrient groups. Of these, 3214 were randomized during the last trimester of pregnancy to receive either BFC or the usual/standard health message (UHM). Their infants were extensively followed up, with anthropometric measurements between 0 and 54 months and assessment of body composition at 54 months.

RESULTS:

The mean duration of EBF in the BFC group was 111 days compared to 76 days in the UHM group (mean difference: 35.0 days, 95% CI 30.6-39.5, p < 0.001). There was no difference in growth trajectories between the BFC and UHM groups and no difference in body composition at 54 months. Children exposed to prenatal multiple micronutrients (vs 60 mg iron and folate) combined with BFC (vs UHM), however, had slower linear growth (mean difference -0.17 SD score, p < 0.01).

CONCLUSION:

Exclusive breastfeeding counselling resulted in neither differential growth trajectories in infancy and childhood, nor body composition differences at 54 months. The combination of prenatal multiple micronutrient supplementation (MMS) and BFC was unfavourable for linear growth during 0-54 months, which raises questions about possible negative effects of MMS.

Keyword
Body composition; Child growth; Exclusive breastfeeding; Pregnancy; Supplementation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-203744 (URN)10.1111/apa.12282 (DOI)000320777700022 ()23638711 (PubMedID)
Available from: 2013-07-18 Created: 2013-07-18 Last updated: 2017-12-06Bibliographically approved

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