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This Article Full Text (Publish Ahead of Print[PDF]) All Versions of this Article: 89/4/1125    most recent ajcn.2008.26874v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ramakrishnan, U. Articles by Martorell, R. Search for Related Content PubMed PubMed Citation Articles by Ramakrishnan, U. Articles by Martorell, R. Agricola Articles by Ramakrishnan, U. Articles by Martorell, R.

Multiple micronutrient supplementation during early childhood increases child size at 2 y of age only among high compliers^1,2,3

¹ From the Nutrition and Health Sciences Program and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (UR, RF, and RM), and the Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico (LMN and JR).

² Supported by the Micronutrient Initiative (Ottawa, Canada), the Thrasher Research Fund, UNICEF, the Mexican Council for Science and Technology (CONACyT), Instituto Nacional de Salud Pública, and Emory University.

³ Reprints not available. Address correspondence to U Ramakrishnan, Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322. E-mail: uramakr{at}sph.emory.edu.

ABSTRACT

Background: Micronutrient deficiencies are common, even in middle-income countries.

Objective: The objectives were to determine whether multiple micronutrient (MM) supplementation from 3 to 24 mo of age improves growth and whether the effect is modified by MM supplementation during pregnancy.

Design: We conducted a randomized, double-blind, controlled trial in central Mexico. Singleton live births (n = 650) from a prenatal MM trial were randomly assigned to receive either MM supplements (1–1.5 times the Recommended Dietary Allowance of vitamins A, B-6, B-12, and C; folic acid; iron; zinc; and other nutrients) or supplements containing similar amounts of iron and vitamin A (Fe-A) within the maternal supplementation groups (MM and iron only) 6 d/wk from 3 to 24 mo of age. Anthropometric measurements were obtained at 3 and 24 mo of age.

Results: There was no effect of supplement group on child growth in intention-to-treat analyses. However, infants who consumed MM supplements regularly (greater than the median compliance of 79%) were 0.8 (95% CI: –0.4, 1.9) and 1.6 (95% CI: 0.4, 2.8) cm taller at 24 mo in the maternal MM and iron-only groups, respectively, than were those in the Fe-A group; these differences were 0.2 (95% CI: –1.0, 1.4) and –0.5 (95% CI: –1.7, 0.7) cm among those with compliance below the median. Mean body mass index (in kg/m²) was significantly higher in those exposed to iron only in utero and Fe-A during childhood (16.2) than in the other groups (15.8).

Conclusions: MM supplements increased the length of children who consumed them regularly from 3 to 24 mo. Strategies that promote compliance through effective delivery of micronutrient interventions are needed.

Received for publication August 25, 2008. Accepted for publication January 20, 2009.