Impact of linear growth-improving interventions on childhood overnutrition at 24 months: a randomized controlled trial

IF 6.9 1区医学 Q1 NUTRITION & DIETETICS American Journal of Clinical Nutrition Pub Date : 2025-03-01 Epub Date: 2025-02-04 DOI:10.1016/j.ajcnut.2025.01.019

Rukman Manapurath , Ranadip Chowdhury , Sunita Taneja , Nita Bhandari , Anura V Kurpad , Sarita Devi , Pratibha Dwarkanath , Tor A Strand

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Abstract

Background

Childhood malnutrition, both undernutrition and overnutrition, is a major health concern in many low- and middle-income countries (LMICs). Efforts to reduce early undernutrition could also lead to obesity. In an earlier study, we reported the successful impact of a package of preconception, pregnancy, postnatal, and/or early childhood interventions (health, nutrition, psychosocial support, and water, sanitation, and hygiene) delivered in the first 1000 d, on reducing stunting in low-to-middle-income populations, in comparison with routine care. However, the impact of these interventions on early body composition and subsequent overweight is not known.

Objectives

The objective of this study was to estimate the effect of a package of interventions directed at preventing stunting in the first 1000 d on body composition at 1 mo and childhood overweight and/or obesity at 24 mo of age.

Methods

Infant body composition was measured by deuterium dilution at 1 mo of age, along with the prevalence of childhood overweight and/or obesity at 24 mo, defined by a body mass index-for-Age Z (BMIz) score >+2 standard deviation.

Results

Children in the preconception, pregnancy, and early childhood intervention group and those in the pregnancy and early childhood intervention group had higher body mass index z scores than those in routine care. However, the prevalence of overweight and/or obesity was low (ranging from 0.0 to 1.3%). Pregnancy interventions significantly increased neonatal fat-free mass (mean difference 0.1 kg, 95% confidence interval [CI]: 0.01, 0.2). However, there was no significant change in fat mass.

Conclusions

Comprehensive interventions from preconception to early childhood improve linear growth but do not result in overweight and/or obesity at 24 mo. With better resultant linear and ponderal growth, they converge with the World Health Organization's “double-duty actions for nutrition” for LMIC settings, where childhood overweight and/or obesity is a growing concern.

This trial was registered at Clinical Trials Registry - India as CTRI/2017/06/008908.

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线性生长改善干预对24个月儿童营养过剩的影响：一项随机对照试验。

背景：儿童营养不良，包括营养不足和营养过剩，是许多低收入和中等收入国家（LMICs）的一个主要健康问题。减少早期营养不良的努力也可能导致肥胖。在早期的一项研究中，我们报告了与常规护理相比，在前1000天提供的一揽子孕前、孕期、产后和/或幼儿干预（健康、营养、社会心理支持、水、环境卫生和个人卫生）对减少中低收入人群发育迟缓的成功影响。然而，这些干预措施对早期身体成分和随后的超重的影响尚不清楚。目的：本研究的目的是评估旨在预防前1000天发育迟缓的一揽子干预措施对1月龄时身体成分和24月龄时儿童超重和/或肥胖的影响。方法：在1月龄时用氘稀释法测量婴儿身体组成，以及24月龄时儿童超重和/或肥胖的患病率，以年龄体重指数Z （bmi）评分>+2标准差定义。结果：孕前、妊娠和幼儿干预组及妊娠和幼儿干预组儿童的体重指数z得分高于常规护理组。然而，超重和/或肥胖的患病率很低（范围从0.0到1.3%）。妊娠干预显著增加新生儿无脂质量（平均差0.1 kg， 95%可信区间[CI]: 0.01, 0.2）。然而，脂肪量没有明显变化。结论：从孕前到幼儿期的综合干预措施可改善线性生长，但不会导致24个月时超重和/或肥胖。这些干预措施与世界卫生组织针对低收入和中等收入国家的“营养双重责任行动”一致，在这些国家，儿童超重和/或肥胖日益受到关注。该试验已在印度临床试验注册中心注册为CTRI/2017/06/008908。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Clinical Nutrition 医学-营养学

CiteScore

12.40

自引率

4.20%

发文量

332

审稿时长

38 days

期刊介绍： American Journal of Clinical Nutrition is recognized as the most highly rated peer-reviewed, primary research journal in nutrition and dietetics.It focuses on publishing the latest research on various topics in nutrition, including but not limited to obesity, vitamins and minerals, nutrition and disease, and energy metabolism. Purpose: The purpose of AJCN is to: Publish original research studies relevant to human and clinical nutrition. Consider well-controlled clinical studies describing scientific mechanisms, efficacy, and safety of dietary interventions in the context of disease prevention or health benefits. Encourage public health and epidemiologic studies relevant to human nutrition. Promote innovative investigations of nutritional questions employing epigenetic, genomic, proteomic, and metabolomic approaches. Include solicited editorials, book reviews, solicited or unsolicited review articles, invited controversy position papers, and letters to the Editor related to prior AJCN articles. Peer Review Process: All submitted material with scientific content undergoes peer review by the Editors or their designees before acceptance for publication.