title: The role of zinc and iron-folic acid supplementation on early child temperament and eating behaviors in rural Nepal: a randomized controlled trial.
abstract: Child eating behaviors play an important role in nutrient intake, ultimately affecting child growth and later outcomes in adulthood. The study assessed the effects of iron-folic acid and zinc supplementation on child temperament and child eating behaviors in rural Nepal. Children (N = 569) aged 4-17 months in Sarlahi district, southern Nepal were randomized to receive daily supplements of placebo, iron-folic acid, zinc, or zinc plus iron-folic acid and followed for approximately 1 year. At baseline and four follow-up visits mothers completed questionnaires including information on demographic characteristics and child temperament and eating behaviors. The main effects of zinc and iron-folic acid supplementation on temperament and eating behaviors were assessed through crude and adjusted differences in mean cumulative score changes between visits 1 and 5. The adjusted rate-of-change for these outcomes was modeled using generalized estimating equations. Mean changes in temperament scores and in eating behavior scores between visits 1 and 5 were not significant in either the zinc or non-zinc group. Children in the iron-folic acid group increased temperament scores by 0.37 points over 5 visits (95% CI 0.02, 0.7), which was not significant after adjustment. Neither the adjusted rate-of-change in temperament scores between zinc and non-zinc (β = -0.03, 95% CI -0.3, 0.2) or iron-folic acid and non-iron-folic acid (β = 0.08, 95% CI -0.2, 0.3) were significantly different. Adjusted rate of change analysis showed no significant difference between zinc and non-zinc (β = -0.14, 95% CI -0.3, 0.04) or between iron and non-iron eating behavior scores (β = -0.11, 95% CI -0.3, 0.1). Only among children with iron-deficiency anemia at baseline was there a significant decrease in eating behavior score, indicating better eating behaviors, when supplemented with zinc (β = -0.3, 95% CI -0.6, -0.01), Ultimately, this effect of zinc on eating behaviors was the only effect we observed after approximately one year of micronutrient supplementation.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00109551.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America; Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Mary Katherine
authors.initials: MK
authors.lastname: Charles
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Emily H
authors.initials: EH
authors.lastname: Siegel
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America; Nepal Nutrition Intervention Project-Sarlahi (NNIP-S), Hariaun, Nepal.
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America; Nepal Nutrition Intervention Project-Sarlahi (NNIP-S), Hariaun, Nepal.
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.affiliation: Nepal Nutrition Intervention Project-Sarlahi (NNIP-S), Hariaun, Nepal; Division of Nutritional Sciences, Program in International Nutrition, Cornell University, Ithaca, New York, United States of America.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
authors.affiliation: George Washington University, School of Public Health, Washington, District of Columbia, United States of America.
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
mesh_terms: D002657:Child Development / Q000187:drug effects*; D019587:Dietary Supplements; D005247:Feeding Behavior / Q000187:drug effects*; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D009390:Nepal / Q000453:epidemiology; D062486:Public Health Surveillance; D012424:Rural Population; D011795:Surveys and Questionnaires; D013694:Temperament / Q000187:drug effects*; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D005492:Folic Acid; D007501:Iron; D015032:Zinc
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