Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal.
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.
Stewart
Christine P
CP
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Christian
Parul
P
LeClerq
Steven C
SC
West
Keith P
KP
Khatry
Subarna K
SK
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*
D005492:Folic Acid; D007501:Iron; D015032:Zinc