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Effects of exclusive breastfeeding intervention on child growth and body composition: the MINIMat trial, Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell barnhälsa och nutrition/Persson)
Medical Research Council – International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell sexuell och reproduktiv hälsa/Larsson)
International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
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2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 8, 815-823 p.Article in journal (Refereed) Published
Abstract [en]

AIM:

Exclusive breastfeeding (EBF) for 6 months is recommended for optimal infant health, but the evidence for longer-term impacts is weak. We examined whether randomization to receive EBF counselling (BFC) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition.

METHODS:

In the Maternal and Infant Nutrition Interventions in Matlab trial, 4436 pregnant women were randomized to six equally sized, food and micronutrient groups. Of these, 3214 were randomized during the last trimester of pregnancy to receive either BFC or the usual/standard health message (UHM). Their infants were extensively followed up, with anthropometric measurements between 0 and 54 months and assessment of body composition at 54 months.

RESULTS:

The mean duration of EBF in the BFC group was 111 days compared to 76 days in the UHM group (mean difference: 35.0 days, 95% CI 30.6-39.5, p < 0.001). There was no difference in growth trajectories between the BFC and UHM groups and no difference in body composition at 54 months. Children exposed to prenatal multiple micronutrients (vs 60 mg iron and folate) combined with BFC (vs UHM), however, had slower linear growth (mean difference -0.17 SD score, p < 0.01).

CONCLUSION:

Exclusive breastfeeding counselling resulted in neither differential growth trajectories in infancy and childhood, nor body composition differences at 54 months. The combination of prenatal multiple micronutrient supplementation (MMS) and BFC was unfavourable for linear growth during 0-54 months, which raises questions about possible negative effects of MMS.

Place, publisher, year, edition, pages
2013. Vol. 102, no 8, 815-823 p.
Keyword [en]
Body composition; Child growth; Exclusive breastfeeding; Pregnancy; Supplementation
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-203744DOI: 10.1111/apa.12282ISI: 000320777700022PubMedID: 23638711OAI: oai:DiVA.org:uu-203744DiVA: diva2:637506
Available from: 2013-07-18 Created: 2013-07-18 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Effects of Pre- and Postnatal Nutrition Interventions on Child Growth and Body Composition: The MINIMat Trial in Rural Bangladesh
Open this publication in new window or tab >>Effects of Pre- and Postnatal Nutrition Interventions on Child Growth and Body Composition: The MINIMat Trial in Rural Bangladesh
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Nutritional insults and conditions in fetal life and infancy may influence later growth and body composition as well as the development of chronic diseases in adult life. We studied the effects of maternal food and micronutrient supplementation and exclusive breast-feeding counseling on offspring growth 0-54 months and body composition at 54 months of age. We also validated and developed equations for a leg-to-leg bioimpedance analyzer in order to assess body composition of Bangladeshi children aged 4-10 years.

In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early (around 9 weeks) or a Usual invitation (around 20 weeks) to food supplementation and to one of three daily micronutrient supplementations with capsules of either 30 mg Fe and 400 µg folic acid, or 60 mg Fe and 400 µg folic acid, or multiple micronutrient supplements (MMS) (15 micronutrients including 30 mg Fe and 400 µg folic acid). They were also randomized to exclusive breastfeeding counseling (EBC) or to usual health messages (UHM). Growth of their children was measured from birth to 54 months, when body composition also was assessed.

There were no differences in background characteristics across the different intervention groups. There was no differential effect by prenatal interventions on birth weight or length. Early invitation to food supplementation reduced stunting from early infancy up to 54 months for boys (average difference 6.5 percent units, 95% CI=1.7 to 11.3, p=0.01), but not for girls (average difference 2.4 percent units, 95% CI=-2.2 to 7.0, p=0.31). MMS resulted in more stunting than standard Fe60F (average difference 4.8 percent units, 95% CI=0.8 to 8.9, p=0.02). Breast-feeding counseling prolonged the duration of exclusive breastfeeding (difference 35.0 days, 95% CI 30.6-39.5, p<0.001). Neither the pregnancy interventions nor the breast-feeding counseling influenced body composition at 54 months.

Early food supplementation in pregnancy reduced the occurrence of stunting in boys 0-54 months, while prenatal MMS increased the proportion of stunting. Early food and multiple micronutrient supplementation or exclusive breastfeeding intervention provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age. The effects on postnatal growth suggest programming effects in early fetal life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 811
Keyword
body composition, child growth, exclusive breast feeding, food supplementation, multiple micronutrients, pregnancy, programming
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-180479 (URN)978-91-554-8467-5 (ISBN)
Public defence
2012-10-17, Rosensalen, Akademiska sjukhuset, Entrance 95/96 nbv, Akademiska sjukhuset, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2012-09-25 Created: 2012-09-07 Last updated: 2014-08-18

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Khan, Ashraful IslamEkström, Eva-CharlottePersson, Lars-Åke

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