Pediatric Nutrition in Practice

150 Saleem  Bhutta

plementation programs commonly focus on 1 or
2 micronutrients at a time. Previously, research
has been even more reductionist, focusing on a
single micronutrient; however, in the last decade,
the effect of MMN interventions on the health
and development of infants and children has
been promoted. A Cochrane review assessed 23
trials of MMN supplementation and reported an
11–13% reduction in low-birth-weight and
small-for-gestational-age infants without any
impact on anemia and IDA [8, 24]. A meta-anal-
ysis comparing MMN interventions for children
from HIV/AIDS-affected populations [25] re-
sulted in small but significantly greater improve-
ments in length (or height) and weight as well as
hemoglobin levels and motor development in
these children. MMN induced a significant re-
duction in the prevalence of respiratory infec-
tions (26%), diarrhea (11–18%) and fever (7%).
However, to date, their role in reducing child
mortality is not well established [25–27]. In con-
clusion, providing MMN, compared to 0–2 mi-
cronutrients at a time, reduces anemia and im-
proves growth and motor development among
young children [25].

Provision of MMN during Pregnancy and
Fetal Outcome

MMN during pregnancy result in a significant
reduction in the incidence of low-birth-weight
(pooled RR 0.86, 95% CI 0.81–0.91) and small-
for-gestational-age infants (pooled RR 0.83, 95%
CI 0.73–0.95) and an increase in mean birth
weight (mean difference 52.6 g, 95% CI 43.2–
62). However, there was no significant differ-
ence in the overall risk of preterm birth, stillbirth
and maternal or neonatal mortality in mothers
who had received a lower amount of micronutri-
ents [11].

Interventions to Combat Micronutrient

Deficiencies in Children

Dietary or micronutrient supplementation inter-

ventions in micronutrient-deficient populations

are supported by the best evidence, as recently

reported by Bhutta et al. [8]. Breastfeeding pro-

motion is not only associated with decreased

morbidity but also with a 44–45% reduction in

all-cause and infection-related neonatal mortal-

ity [1, 8]. Vitamin A supplementation to young

children has shown promising results, namely a

reduction of 24% in all-cause mortality, as pub-

lished in a recent Cochrane review [14]. In a sys-

temic review, iron supplementation also showed

marked decrease in anemia and some improve-

ment in cognitive development in young chil-

dren [8, 28]. Preventive zinc supplementation

has been associated with a reduction in the prev-

alence of diarrhea and pneumonia in young chil-

dren but has no significant effect on mortality

[21].

Conclusion

• Four micronutrients (vitamin A, zinc, iron
  and iodine) are essential for child develop-
  ment


• Their sufficiency helps in improving linear
  growth and motor development, along with
  reducing anemia and the functional status of
  infants as well as preschool and school chil-
  dren

References 1 Black RE, Victora CG, Walker SP, Bhut-

ta ZA, Christian P, de Onis M, et al: Ma-

ternal and child undernutrition and

overweight in low-income and middle-

income countries. Lancet 2013; 382: 427–

451.

2 Ahmed T, Hossain M, Sanin KI: Global

burden of maternal and child undernu-

trition and micronutrient deficiencies.

Ann Nutr Metab 2012; 61(suppl 1):8–17.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 147–151

DOI: 10.1159/000375276