Micronutrient Fortification to Improve Growth and Health of Maternally HIV-Unexposed and Exposed Zambian Infants A Randomised Controlled Trial 英文参考文献.docVIP

MicronutrientFortificationtoImproveGrowthand HealthofMaternallyHIV-UnexposedandExposed ZambianInfants:ARandomisedControlledTrial TheChilenjeInfantGrowth,NutritionandInfection(CIGNIS)StudyTeam* Abstract Background: The period of complementary feeding, starting around 6 months of age, is a time of high risk for growth falteringandmorbidity.Lowmicronutrientdensityoflocallyavailablefoodsisacommonprobleminlowincomecountries. ChildrenofHIV-infectedwomenareespeciallyvulnerable.AlthoughantiretroviralprophylaxiscanreducebreastmilkHIV transmission in early infancy, there are no clear feeding guidelines for after 6 months. There is a need for acceptable, feasible,affordable,sustainableandsafe(AFASSbyWHOterminology)foodsforbothHIV-exposedandunexposedchildren after6monthsofage. MethodsandFindings:WeconductedinLusaka,Zambia,arandomiseddouble-blindtrialoftwolocallymadeinfantfoods: porridges made of flour composedof maize, beans, bambaranuts and groundnuts. Oneflour contained abasal and the otherarichlevelofmicronutrientfortification.Infants(n=743)aged6monthswererandomisedtoreceiveeitherregimefor 12months.Theprimaryoutcomewasstunting(length-for-ageZ,22)atage18months.Nosignificantdifferenceswere seenbetweentrialarmsoverallinproportionstuntedat18months(adjustedoddsratio0.87;95%CI0.50,1.53;P=0.63), meanlength-for-ageZscore,orrateofhospitalreferralordeath.AmongchildrenofHIV-infectedmotherswhobreastfed ,6 months (53% of HIV-infected mothers), the richly-fortified porridge increased length-for-age and reduced stunting (adjustedoddsratio0.17;95%CI0.04,0.84;P=0.03).Richfortificationimprovedironstatusat18monthsasmeasuredby hemoglobin,ferritinandserumtransferrinreceptors. Conclusions:Inthewholestudypopulation,therichmicronutrientfortificationdidnotreducestuntingorhospitalreferral but did improve iron status and reduce anemia. Importantly, in the infants of HIV-infected mothers who stopped breastfeedingbefore6months,therichfortificationimprovedlineargrowth.Provisionofsuchfortifiedfoodsmaybe