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ORIGINAL RESEARCH COMMUNICATION |
1 From the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (CPS, PC, SCL, and KPW), and the Nepal Nutrition Intervention Project-Sarlahi, Society for Prevention of Blindness, Kathmandu, Nepal (SCL and SKK).
2 Supported by the Center for Human Nutrition, Department of International Health of the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, in collaboration with the National Society for the Prevention of Blindness, Kathmandu, Nepal, with funding from Bill and Melinda Gates Foundation, Seattle, WA. The antenatal micronutrient supplementation trial was conducted under the Micronutrients for Health Cooperative Agreement no. HRN-A-00-97-00015-00 and the Global Research Activity Cooperative Agreement no.GHS-A-00-03-00019-00 between the Johns Hopkins University and the Office of Health, Infectious Diseases and Nutrition, US Agency for International Development, Washington, DC, and with additional support from the Bill and Melinda Gates Foundation, Seattle, WA, and the Sight and Life Research Institute, Baltimore, MD. The preschool child iron and zinc supplementation trial was funded by the National Institutes of Health, Bethesda, MD (HD 38753); the Bill and Melinda Gates Foundation, Seattle, WA (810-2054); and a Cooperative Agreement between Johns Hopkins University and the Office of Health and Nutrition, US Agency for International Development, Washington, DC (HRN-A-00-97-00015-00). CPS was supported by a Proctor & Gamble predoctoral fellowship. 3 Address correspondence to P Christian, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Room E2541, Baltimore, MD 21205. E-mail: pchristi{at}jhsph.edu.
Background: We previously reported that a randomized controlled trial of antenatal micronutrient supplements in rural Nepal decreased the risk of low birth weight by 
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.
Design: 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 cm2; –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.
Conclusion: Antenatal supplementation with zinc may benefit child growth, particularly in areas where a deficiency of this nutrient is common.
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