Multiple micronutrient supplementation during early childhood increases child size at 2 y of age only among high compliers.
BACKGROUND
Micronutrient deficiencies are common, even in middle-income countries.


OBJECTIVE
The objectives were to determine whether multiple micronutrient (MM) supplementation from 3 to 24 mo of age improves growth and whether the effect is modified by MM supplementation during pregnancy.


METHODS
We conducted a randomized, double-blind, controlled trial in central Mexico. Singleton live births (n = 650) from a prenatal MM trial were randomly assigned to receive either MM supplements (1-1.5 times the Recommended Dietary Allowance of vitamins A, B-6, B-12, and C; folic acid; iron; zinc; and other nutrients) or supplements containing similar amounts of iron and vitamin A (Fe-A) within the maternal supplementation groups (MM and iron only) 6 d/wk from 3 to 24 mo of age. Anthropometric measurements were obtained at 3 and 24 mo of age.


RESULTS
There was no effect of supplement group on child growth in intention-to-treat analyses. However, infants who consumed MM supplements regularly (greater than the median compliance of 79%) were 0.8 (95% CI: -0.4, 1.9) and 1.6 (95% CI: 0.4, 2.8) cm taller at 24 mo in the maternal MM and iron-only groups, respectively, than were those in the Fe-A group; these differences were 0.2 (95% CI: -1.0, 1.4) and -0.5 (95% CI: -1.7, 0.7) cm among those with compliance below the median. Mean body mass index (in kg/m(2)) was significantly higher in those exposed to iron only in utero and Fe-A during childhood (16.2) than in the other groups (15.8).


CONCLUSIONS
MM supplements increased the length of children who consumed them regularly from 3 to 24 mo. Strategies that promote compliance through effective delivery of micronutrient interventions are needed.
Ramakrishnan
Usha
U
Nutrition and Health Sciences Program and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. uramakr@sph.emory.edu
Neufeld
Lynnette M
LM
Flores
Rafael
R
Rivera
Juan
J
Martorell
Reynaldo
R
D000886:Anthropometry; D001827:Body Height / Q000187:drug effects* / Q000502:physiology; D002675:Child, Preschool; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D004311:Double-Blind Method; D005260:Female; D006128:Growth / Q000187:drug effects* / Q000502:physiology; D006130:Growth Disorders / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage / Q000097:blood; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena / Q000502:physiology; D008800:Mexico; D018977:Micronutrients / Q000008:administration & dosage*; D008903:Minerals / Q000008:administration & dosage; D010349:Patient Compliance; D014815:Vitamins / Q000008:administration & dosage
D018977:Micronutrients; D008903:Minerals; D014815:Vitamins; D007501:Iron