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Effect of Vitamin D Supplementation in Early Life on Children's Growth and Body Composition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Ma, K, Wei, SQ, Bi, WG, Weiler, HA, Wen, SW
Nutrients. 2021;(2)
Abstract
BACKGROUND Vitamin D deficiency during pregnancy or infancy is associated with adverse growth in children. No systematic review has been conducted to summarize available evidence on the effect of vitamin D supplementation in pregnancy and infancy on growth and body composition in children. OBJECTIVE We aim to summarize the available evidence on the effect of vitamin D supplementation in pregnancy and infancy on child growth and body composition. METHOD A systematic review and meta-analysis were performed on the effects of vitamin D supplementation during early life on children's growth and body composition (bone, lean and fat). A literature search of randomized controlled trials (RCTs) was conducted to identify relevant studies on the effects of vitamin D supplementation during pregnancy and infancy on children's body composition (bone, lean and fat) in PubMed, EMBASE and Cochrane Library from inception to 31 December 2020. A Cochrane Risk Assessment Tool was used for quality assessment. The comparison was vitamin D supplementation vs. placebo or standard care. Random-effects and fixed-effect meta-analyses were conducted. The effects are presented as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS A total of 3960 participants from eleven randomized controlled trials were eligible for inclusion. Vitamin D supplementation during pregnancy was associated with higher triceps skinfold thickness (mm) (MD 0.33, 95% CI, 0.12, 0.54; I2 = 34%) in neonates. Vitamin D supplementation during pregnancy or infancy was associated with significantly increased length for age z-score in infants at 1 year of age (MD 0.29, 95% CI, 0.03, 0.54; I2 = 0%), and was associated with lower body mass index (BMI) (kg/m2) (MD -0.19, 95% CI -0.34, -0.04; I2 = 0%) and body mass index z-score (BMIZ) (MD -0.12, 95% CI -0.21, -0.04; I2 = 0%) in offspring at 3-6 years of age. Vitamin D supplementation during early life was not observed to be associated with children's bone, lean or fat mass. CONCLUSION Vitamin D supplementation during pregnancy or infancy may be associated with reduced adiposity in childhood. Further large clinical trials of the effects of vitamin D supplementation on childhood body composition are warranted.
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The effects of rapid growth on body mass index and percent body fat: A meta-analysis.
Chen, Y, Wang, Y, Chen, Z, Xin, Q, Yu, X, Ma, D
Clinical nutrition (Edinburgh, Scotland). 2020;(11):3262-3272
Abstract
BACKGROUND & AIMS Rapid growth in childhood and obesity are highly prevalent in congenital deficiency infants, but the associations between them remain controversial. This meta-analysis was performed to explore the effects of rapid growth on body mass index (BMI) and percent body fat (PBF), and to clarify potential confounders. METHODS A systematic search was performed using electronic databases including EMBASE (1985 to July 2019) and Medline (1966 to July 2019) for English articles. China National Knowledge Infrastructure Chinese citation database (CNKI) and WANFANG database were used to search articles in Chinese. Reference lists were also screened as supplement. All relevant studies that compare BMI or PBF between rapid group and control group were identified. The definition of rapid growth should be clearly specified. Means and standard deviations/95% confidence intervals (CIs) of BMI and PBF should be available. Relevant information was extracted independently by two reviewers. Study quality was reassessed using the Newcastle-Ottawa Scale. Publication bias and heterogeneity were detected. The random effect model was adopted for combined and stratified analysis. RESULTS About the effect of rapid growth on BMI, seventeen researches (4473 participants) involving 49 comparisons were included. Pooled analysis showed rapid group had higher BMI of 0.573 (95% CI, 0.355 to 0.791; P < 0.001). Stratified analyses revealed that catch-up weight gain, follow-up age >6 years old, rapid growth duration >2 years, full-term, comparing rapid growth SGA infants with control SGA infants, and from developed and developing countries, would all lead to higher BMI in rapid groups. About the effect of rapid growth on PBF, eleven researches (4594 participants) involving 37 comparisons were included. Pooled analysis showed rapid group had higher PBF of 2.005 (95% CI, 1.581 to 2.429; P < 0.001). Subgroup analyses suggested that catch-up weight gain, follow-up age ≤6 years old, rapid growth duration >2 years, full-term, comparing rapid growth SGA infants with control AGA infants, and participants from developing countries, would lead to increased PBF in rapid groups. CONCLUSION Rapid growth has a positive correlation with BMI and PBF. However, stratified analyses show that it is catch-up weight gain that lead to higher BMI and PBF, but not catch-up growth. In addition, rapid growth have long-term effect on BMI and short-term effect on PBF. Rapid growth duration longer than 2 years may increase the risk effect of rapid growth on BMI and PBF. But given that rapid growth would induce multiple health outcomes apart from BMI and PBF, the benefits and risks of rapid growth must be carefully considered and weighted.
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[Effect of nutrition on growth and neurodevelopment in the preterm infant: a systematic review].
Aguilar Cordero, MJ, Sánchez López, AM, Mur Villar, N, Hermoso Rodríguez, E, Latorre García, J
Nutricion hospitalaria. 2014;(2):716-29
Abstract
INTRODUCTION The energy needs of preterm infants are high and more so when the body weight is lower; for this reason, and to safeguard the infant's future development, it is important to ensure an optimal caloric intake is obtained. AIM: To analyse leading research papers related to nutrition in the preterm newborn and its effects on growth and development. METHOD Systematic review of relevant studies, based on the application of a search strategy, from March to September 2014. The literature search was conducted using document analysis and information synthesis to classify and compile the information extracted, followed by a comparative evaluation. The validity of the articles obtained was corroborated by the weight of findings obtained, by the citations received by the articles and by their applicability to our healthcare environment. RESULTS The search process produced 61 studies that met the selection criteria. The research question addressed has been widely examined and many studies have reported findings related to the nutrition of preterm infants. The direct relationship between nutritional intake and the growth rate of preterm infants is well documented. CONCLUSIONS Proper nutrition in the preterm infant has positive effects on its growth and neurodevelopment. It has been reported that a greater intake of proteins and lipids favours the growth of preterm infants, but not weight gain. Studies have demonstrated the beneficial effect of breast milk on the brain, the retina and the blood vessels; however, there is a negative correlation between adiposity and brain volume.
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Provision of multiple rather than two or fewer micronutrients more effectively improves growth and other outcomes in micronutrient-deficient children and adults.
Allen, LH, Peerson, JM, Olney, DK
The Journal of nutrition. 2009;(5):1022-30
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Abstract
Deficiencies of multiple micronutrients (MMN) usually coexist in developing countries, but supplements have usually provided only 1 or 2 micronutrients (MN). To inform policy, in this article we compared the relative benefits of supplying MMN vs. a placebo or 1 or 2 MN on the following: children's growth, health, and development; pregnancy outcome; nutritional status; and HIV/AIDS mortality and morbidity in adults. Sufficient data were available to perform random-effects meta-analyses of randomized controlled trials (RCT) for the effects of MMN on child growth and nutritional status. Results for other outcomes are presented as effect sizes (ES) when available. In children, MMN interventions resulted in small but significantly greater improvements in length or height (ES = 0.13; 95% CI: 0.055, 0.21) and weight (ES = 0.14; 95% CI: 0.029, 0.25), hemoglobin (ES = 0.39; 95% CI: 0.25, 0.53), serum zinc (ES = 0.23; 95% CI: 0.18, 0.43), serum retinol (ES = 0.33; 95% CI: 0.050, 0.61), and motor development. A Cochrane review reported that compared with no supplementation or a placebo, MMN supplementation during pregnancy reduced the relative risk of low birth weight (0.83), small-for-gestational age (0.92), and anemia (0.61); however, MMN were not more effective than iron + folic acid alone. There is some evidence that MMN supplementation improves CD4 counts and HIV-related morbidity and mortality in adults. The efficacy of MMN varies across trials, but overall there is evidence that outcomes are better than when providing < or =2 MN. The policy implications of these studies are discussed.
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Deworming drugs for treating soil-transmitted intestinal worms in children: effects on growth and school performance.
Taylor-Robinson, DC, Jones, AP, Garner, P
The Cochrane database of systematic reviews. 2007;(4):CD000371
Abstract
BACKGROUND In areas where intestinal worm infections occur, the World Health Organization recommends treating all school children at regular intervals with deworming drugs to improve growth and school performance. The evidence base for this policy needs to be established for countries to commit resources to implement these programmes. OBJECTIVES To summarize the effects of deworming drugs used to treat soil-transmitted intestinal worms (nematode geohelminths) on growth and school performance in children. SEARCH STRATEGY In May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, mRCT, and reference lists. SELECTION CRITERIA Randomized and quasi-randomized controlled trials (RCTs) comparing deworming drugs for geohelminth worms with placebo or no treatment in children aged 16 years or less, reporting on growth, nutritional status, school performance, or cognition tests. DATA COLLECTION AND ANALYSIS Two authors independently assessed the trials and evaluated methodological quality; one author extracted data, and another checked a sample. Continuous data were analysed using the weighted mean difference (WMD) with 95% confidence intervals (CI). The random-effects model (RE model) was used in the presence of statistically significant heterogeneity. MAIN RESULTS Thirty-four RCTs, including six cluster-RCTs, met the inclusion criteria. Four trials had adequate allocation concealment, and three cluster-RCTs failed to take design effects into account in their analysis. Weight increased after one dose of a deworming drug (WMD 0.34 kg, 95% CI 0.05 to 0.64, RE model; 2448 children, 9 trials); however, there was considerable heterogeneity between trials that was not explained by background intestinal worm infection or intensity. A meta-analysis of multiple dose trials reporting on outcomes within a year of starting treatment showed no significant difference in weight gain (1714 children, 6 trials); however, one cluster-RCT did show effects on weight at one year in a subgroup analysis. In the seven multiple dose trials with follow up beyond 12 months, only one showed a significant increase in weight. Six of seven trials reported clear data on cognitive tests and school performance: five reported no significant effects, and one showed some improvements in three out of 10 cognitive tests. AUTHORS' CONCLUSIONS Deworming drugs used in targeted community programmes may be effective in relation to weight gain in some circumstances but not in others. No effect on cognition or school performance has been demonstrated.
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Childhood growth and chronic disease: evidence from countries undergoing the nutrition transition.
Stein, AD, Thompson, AM, Waters, A
Maternal & child nutrition. 2005;(3):177-84
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Evidence is accumulating that the pattern of growth in childhood is associated with development of cardiovascular disease in adulthood, but such evidence comes mostly from developed countries. We conducted a review of studies from countries undergoing the nutrition transition. Five birth cohorts with measures of child growth and outcomes through adolescence were identified, from China, India, Guatemala, Brazil and the Philippines. Across studies there are major differences in data availability and in statistical approaches to modelling child growth and its effects. Nevertheless, generally consistent associations of growth failure in early childhood and development of overweight in later childhood with the risk of elevated blood pressure, glucose, and serum lipids in adulthood were observed. As these cohorts mature they will provide a wealth of critical information on the relation between early life factors and later disease risk, and efforts should be made to ensure ongoing follow-up using standardized approaches and more comprehensive assessments.
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Weight monitoring of breastfed babies in the UK - centile charts, scales and weighing frequency.
Sachs, M, Dykes, F, Carter, B
Maternal & child nutrition. 2005;(2):63-76
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Weighing infants during their first 6 months is an important focus of growth monitoring and a common activity of child health care services worldwide. In these same months, health workers provide support for breastfeeding and promote continued exclusive breastfeeding. The literature on the practice of weighing breastfed babies is reviewed, as it applies to the United Kingdom. The shape of the growth curves for breastfed babies differs from that of formula-fed infants and also from centile charts previously in use. The World Health Organization commitment to the production of a new growth reference has generated discussion of the implications of charts in use. The country-specific charts in use in the UK are examined and the data used to construct them discussed with reference to clinical use for breastfed infants. Recent UK discussions on charts, as well as on the frequency of routine weighing for babies in the community are considered, and the available evidence on the accuracy of weighing in practice is noted. The choices made in constructing different charts; the physical condition of scales and their use in practice have implications for plotted growth. This paper aims to present a wide range of evidence available in this area in order to encourage debate on practice. A companion paper will discuss issues of interpretation, conveying information to parents, and interventions.
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Multimicronutrient interventions but not vitamin a or iron interventions alone improve child growth: results of 3 meta-analyses.
Ramakrishnan, U, Aburto, N, McCabe, G, Martorell, R
The Journal of nutrition. 2004;(10):2592-602
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Meta-analyses of randomized controlled intervention trials were conducted to assess the effects of vitamin A, iron, and multimicronutrient interventions on the growth of children < 18 y old. A PubMed database search and other methods identified 14 vitamin A, 21 iron, and 5 multimicronutrient intervention studies that met the design criteria. Weighted mean effect sizes and CI were calculated using a random effects model for changes in height and weight. Tests for homogeneity and stratified analyses by predefined characteristics were conducted. Vitamin A interventions had no significant effect on growth; effect sizes were 0.08 (95% CI: -0.20, 0.36) for height and -0.01 (95% CI: -0.24, 0.22) for weight. Iron interventions also had no significant effect on child growth. Overall effect sizes were 0.09 (95% CI: -0.07, 0.24) for height and 0.13 (95% CI: -0.05, 0.30) for weight. The results were similar across categories of age, duration of intervention, mode and dosage of intervention, and baseline anthropometric status. Iron interventions did result in a significant increase in hemoglobin (Hb) concentrations with an effect size of 1.49 (95% CI: 0.46, 2.51). Multimicronutrient interventions had a positive effect on child growth; the effect sizes were 0.28 (95% CI: 0.16, 0.41) for height and 0.28 (95% CI: -0.07, 0.63) for weight. Interventions limited to only vitamin A or iron did not improve child growth. Multimicronutrient interventions, on the other hand, improved linear and possibly ponderal growth in children.
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Effect of micronutrient supplementation on linear growth of children.
Bhandari, N, Bahl, R, Taneja, S
The British journal of nutrition. 2001;:S131-7
Abstract
This review summarizes the results of published, randomized clinical trials that have examined the impact of administration of micronutrients, singly or in combination to infants, preschool and school children on linear growth. Supplementation of single micronutrients resulted in small or no benefits on linear growth. A meta-analysis of zinc supplementation trials confirmed that zinc has a significant but small impact (0.22 sd units) on length gain in children 0-13 years of age. However, a recent study reported a substantially greater benefit (>1 sd) in stunted and non-stunted breast-fed infants 6-12 months of age. With iron supplementation, a beneficial effect was found only in anemic children. Vitamin A supplementation trials have reported little or no benefit on linear growth. Data currently available suggest some impact in children with clinical or biochemical vitamin A deficiency, but this issue needs confirmation. Few studies could be identified where a combination of micronutrients was given as a supplement or as fortified food; in the latter set of studies energy availability was assured. The impact on length without multiple micronutrient supplementation was no greater than that observed with single micronutrients. In conclusion, zinc and iron seem to have a modest effect on linear growth in deficient populations. Vitamin A is unlikely to have an important effect on linear growth. Limited available evidence does not allow us to conclude whether a combination of micronutrients, with or without additional food, would have a greater impact than that seen with zinc alone.