Effects of prenatal micronutrient and early food supplementation on metabolic status of the offspring at 4.5 years of age. The MINIMat randomized trial in rural Bangladesh.
Fetal nutritional insults may alter the later metabolic phenotype. We hypothesized that early timing of prenatal food supplementation and multiple micronutrient supplementation (MMS) would favourably influence childhood metabolic phenotype.



Pregnant women recruited 1 January to 31 December 2002 in Matlab, Bangladesh, were randomized into supplementation with capsules of either 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, and randomized to food supplementation (608 kcal) either with early invitation (9 weeks' gestation) or usual invitation (at 20 weeks). Their children (n = 1667) were followed up at 4.5 years with assessment of biomarkers of lipid and glucose metabolism, inflammation and oxidative stress.



Children in the group with early timing of food supplementation had lower cholesterol (difference -0.079 mmol/l, 95% confidence interval (CI) -0.156; -0.003), low-density lipoprotein (LDL) (difference -0.068 mmol/l, 95% CI -0.126; -0.011) and ApoB levels (difference -0.017 g/l, 95% CL -0.033; -0.001). MMS supplementation resulted in lower high-density lipoprotein (HDL) (difference -0.028 mmol/l, 95% CL -0.053; -0.002), lower glucose (difference -0.099 mmol/l, 95% CL -0.179; -0.019) and lower insulin-like growth factor 1 (IGF-1) (difference on log scale -0.141 µg/l, 95% CL -0.254; -0.028) than 60 mg iron and 400 μg folic acid. There were no effects on markers of inflammation or oxidative stress.



Findings suggest that in a population where malnutrition is prevalent, nutrition interventions during pregnancy may modify the metabolic phenotype in the young child that could have consequences for later chronic disease risks.
International Maternal and Child Health, Women's and Children's Health, Uppsala University, Uppsala, Sweden, lotta.ekstrom@kbh.uu.se.
Eva-Charlotte
EC
Ekström
International Maternal and Child Health, Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Emma
E
Lindström
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Rubhana
R
Raqib
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Shams
S
El Arifeen
Oxidative Stress and Inflammation, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden, and Chaire d'Excellence Program, Department of Biochemistry, Molecular Biology and Nutrition, Universite d'Auvergne, Clermont-Ferrand, France and.
Samar
S
Basu
Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Kerstin
K
Brismar
International Maternal and Child Health, Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Katarina
K
Selling
International Maternal and Child Health, Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Lars-Åke
LÅ
Persson
D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001786:Blood Glucose; D002657:Child Development; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007501:Iron / Q000008:administration & dosage*; D050356:Lipid Metabolism; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena; D012424:Rural Population; D055815:Young Adult
D001786:Blood Glucose; D018977:Micronutrients; D007334:Insulin-Like Growth Factor I; D005492:Folic Acid; D007501:Iron
Food; Micronutrient; Prenatal; Supplementation; early childhood; metabolic
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