title: Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal.
abstract: BACKGROUND
  We previously reported that a randomized controlled trial of antenatal micronutrient supplements in rural Nepal decreased the risk of low birth weight by approximately 15%.
  
  
  OBJECTIVE
  The objective was to examine the effects of micronutrient supplementation on growth and body composition in children of supplemented mothers through school age.
  
  
  METHODS
  Mothers received 1 of 5 micronutrient supplements daily: folic acid, folic acid + iron, folic acid + iron + zinc, multiple micronutrients, or a control. All of the supplements contained vitamin A. Children born during this trial were revisited at age 6-8 y to measure height, weight, midupper arm circumference, waist circumference, and triceps and subscapular skinfold thicknesses. Arm fat and muscle area were estimated by using standard formulas, and height-for-age, weight-for-age, and body mass index-for-age z scores were calculated by using the World Health Organization growth standard.
  
  
  RESULTS
  Of the 3771 surviving children, 3324 were revisited and consented to anthropometric measurements. Maternal supplementation with folic acid + iron + zinc resulted in an increase in mean height (0.64 cm; 95% CI: 0.04, 1.25) and a reduction in mean triceps skinfold thickness (-0.25 mm; 95% CI: -0.44, -0.06), subscapular skinfold thickness (-0.20 mm; 95% CI: -0.33, -0.06), and arm fat area (-0.18 cm(2); -0.34, -0.01). No significant differences were found between groups in mean weight or body mass index-for-age z scores, waist circumference, or arm muscle area. Other micronutrient combinations including a multiple micronutrient formulation failed to show a growth benefit.
  
  
  CONCLUSIONS
  Antenatal supplementation with zinc may benefit child growth, particularly in areas where a deficiency of this nutrient is common.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Christine P
authors.initials: CP
authors.lastname: Stewart
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology* / Q000187:drug effects; D015992:Body Mass Index; D049628:Body Size; D002648:Child; D047108:Embryonic Development / Q000187:drug effects*; D005260:Female; D005492:Folic Acid / Q000494:pharmacology; D006128:Growth / Q000187:drug effects*; D006801:Humans; D007230:Infant, Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D007501:Iron / Q000494:pharmacology*; D009390:Nepal; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena / Q000187:drug effects*; D015032:Zinc / Q000494:pharmacology*
chemical_list: D005492:Folic Acid; D007501:Iron; D015032:Zinc