Iron Status is Associated with Body Composition in Cambodian Infants and Young Children.

Objectives: Malnutrition in early childhood predisposes to a higher risk for non-communicable diseases such as obesity and cardio-vascular diseases later in life through not fully understood metabolic alterations. Little is known about body composition in early childhood in relation to micronutrient status. Methods: Infants were recruited through the WinFood project which studied the effectiveness of fortified complementary foods (FCF) in improving health and growth. Anthropometry (weight, height, MUAC, skinfolds), body composition (deuterium dilution) and micronutrient status (iron, zinc, vitamin A) were measured at 6 mo and 15 mo of age. Results: From 269 Cambodian infants data on body composition and micronutrient status were available for both time-points. Lean body mass increased with 1.96 ±0.59 kg, whereas percentage body fat decreased from 21.7% to 14.9% over the study period (P<0.001). At 6 and 15 mo of age, body fat was strongly correlated to ponderal growth (WHZ, P<0.01) but not to length growth (HAZ) or gender. Vitamin A and zinc status were not related to fat mass. Iron status at 6 and 15 months of age significantly correlated with body composition, with infants with no iron stores at endpoint having a higher fat mass (14.0% vs 15.5%, P=0.02). Infants without iron deficiency during the study had significant lower fat mass (13.3%) than infants who were iron deficient at both timepoints (16.4%, P<0.01) Conclusions: Iron status, but not vitamin A or zinc status, was related to body composition in Cambodian infants. FCF aimed at improving iron status in early childhood may have long-term health benefits.

Post-partum High-dose Vitamin A Supplementation to Improve Vitamin A Status of Mother and Infant: The Role of Timing and Inflammation.

Objectives: Vitamin A deficiency (VAD) in infancy remains an important health problem. Postpartum maternal high-dose vitamin A supplementation (MHDVAS) was recommended but recently cancelled by WHO as efficacy was unclear. We investigated effects of inflammation and timing of MHDVAS on VA status in mothers and newborns. Methods: In a randomized, double-blinded placebo-controlled trial, 400 pregnant women were randomly assigned at 28–32 weeks gestation, to receive MHDVAS within 1 week after delivery (WK1) or 6 weeks post-partum (WK6). Breastmilk, plasma VA and inflammation markers were measured at several time-points during the first 6 months post-partum. Results: Retinol concentrations during pregnancy and 6 months post-partum were strongly correlated (R=0.53, P<0.001). Prevalence of VAD(<0.70 μmol/L) in mothers 6 months post-partum was low (2.7%), but high in infants (33.6%), regardless of intervention. 77.6% of infants had retinol concentrations <1.05 μmol/L. Breastmilk vitamin A concentrations (<1.05 μmol/L) were deficient in only 5% of the women first week post-partum, but increased to 28% of the women 6 months postpartum and tended to be higher in the WK1 compared to the WK6 (31.4% and 24.5%,P<0.10). Retinol liver stores were significantly higher in children from mothers receiving MHDVAS at WK6 as compared to WK1 (P<0.001), with 27% and 46.9% of the infants having insufficient VA liver stores respectively. Conclusions: Lactation caused depletion of vitamin A stores in mothers. Delaying the high-dose VAS post-partum from WK1 to WK6 did not affect circulating retinol, but did significantly increased VA liver stores in infants 6 months after birth. Health-benefits should be evaluated in a larger trial.

Effects of maternal micronutrient supplementation on fetal loss and under-2-years child mortality: long-term follow-up of a randomised controlled trial from Guinea-Bissau

A number of trials on maternal multi-micronutrient supplementation (MMS) have found a benefical effect on birth weight, but few have demonstrated a beneficial effect on infant survival. We examined the effect of two different preparations of antenatal MMS on fetal loss and under-2-years child mortality, as compared with iron-folic acid supplementation among 2,100 pregnant women in Guinea-Bissau. Women receiving a 1xRDA MMS preparation (consisting of 14 vitamins and minerals) had a marginally reduced risk of fetal loss (Relative risk (RR) 0.65, 95% CI 0.40; 1.05), and women receiving a 2xRDA MMS preparation had a similar effect (RR 0.67, 95% CI 0.42; 1.08), the pooled effect being 0.66 (95% CI 0.44; 0.99). None of the supplements reduced under-2-years mortality or the combination of fetal loss and under-2-years mortality. There was a marginally negative effect of both the 1xRDA (RR 2.10, 95% CI 0.99; 4.46) and the 2xRDA (RR 2.02, 95% CI 0.95; 4.32) MMS preparation on mortality specifically between 92­365 days of age. (Afr. J. Reprod. Health 2010; 14[2]:17-26)