The Role of Zinc and Iron-Folic Acid Supplementation on Early Child Temperament and Eating Behaviors in Rural Nepal: A Randomized Controlled Trial

Child eating behaviors play an important role in nutrient intake, ultimately affecting child growth and later outcomes in adulthood. The study assessed the effects of iron-folic acid and zinc supplementation on child temperament and child eating behaviors in rural Nepal. Children (N = 569) aged 4–17 months in Sarlahi district, southern Nepal were randomized to receive daily supplements of placebo, iron-folic acid, zinc, or zinc plus iron-folic acid and followed for approximately 1 year. At baseline and four follow-up visits mothers completed questionnaires including information on demographic characteristics and child temperament and eating behaviors. The main effects of zinc and iron-folic acid supplementation on temperament and eating behaviors were assessed through crude and adjusted differences in mean cumulative score changes between visits 1 and 5. The adjusted rate-of-change for these outcomes was modeled using generalized estimating equations. Mean changes in temperament scores and in eating behavior scores between visits 1 and 5 were not significant in either the zinc or non-zinc group. Children in the iron-folic acid group increased temperament scores by 0.37 points over 5 visits (95% CI 0.02, 0.7), which was not significant after adjustment. Neither the adjusted rate-of-change in temperament scores between zinc and non-zinc (β = −0.03, 95% CI −0.3, 0.2) or iron-folic acid and non-iron-folic acid (β = 0.08, 95% CI −0.2, 0.3) were significantly different. Adjusted rate of change analysis showed no significant difference between zinc and non-zinc (β = −0.14, 95% CI −0.3, 0.04) or between iron and non-iron eating behavior scores (β = −0.11, 95% CI −0.3, 0.1). Only among children with iron-deficiency anemia at baseline was there a significant decrease in eating behavior score, indicating better eating behaviors, when supplemented with zinc (β = −0.3, 95% CI −0.6, −0.01), Ultimately, this effect of zinc on eating behaviors was the only effect we observed after approximately one year of micronutrient supplementation.Trial RegistrationClinicalTrials.gov NCT00109551

儿童进食行为对营养素摄入至关重要，最终影响儿童生长发育及成年后的远期健康结局。本研究旨在评估叶酸铁剂（iron-folic acid）与锌补充剂对尼泊尔农村地区儿童气质类型及进食行为的影响。
研究纳入尼泊尔南部萨尔拉希区（Sarlahi district）年龄为4~17月龄的儿童共569名，将其随机分配至4组：每日服用安慰剂组、叶酸铁剂单独补充组、锌补充剂单独组以及锌联合叶酸铁剂联合补充组，随访时长约1年。在基线及第4次随访时，由儿童母亲完成调查问卷，内容涵盖人口统计学特征、儿童气质类型与进食行为相关信息。
本研究通过比较第1次与第5次随访间平均累积评分变化的粗差异与校正后差异，评估锌与叶酸铁剂补充对儿童气质及进食行为的主要效应，并采用广义估计方程（generalized estimating equations）对上述结局指标的校正后变化率进行建模分析。
结果显示，在锌补充组与非锌补充组中，第1次至第5次随访间的气质评分与进食行为评分平均变化均无统计学显著性。叶酸铁剂组儿童的气质评分在5次随访中共升高0.37分（95%置信区间（95% CI）：0.02, 0.7），经校正后该差异不再具有统计学意义。锌补充组与非锌补充组间气质评分的校正后变化率（β=-0.03，95%CI：-0.3, 0.2），以及叶酸铁剂补充组与非叶酸铁剂补充组间的校正后变化率（β=0.08，95%CI：-0.2, 0.3）均无显著差异。进食行为评分的校正后变化率分析显示，锌补充组与非锌补充组间（β=-0.14，95%CI：-0.3, 0.04）、铁剂补充组与非铁剂补充组间（β=-0.11，95%CI：-0.3, 0.1）均无显著差异。仅在基线时合并缺铁性贫血（iron-deficiency anemia）的儿童亚组中，给予锌补充可使其进食行为评分出现具有统计学意义的降低（β=-0.3，95%CI：-0.6, -0.01），提示其进食行为得到改善。
综上，在为期约1年的微量营养素补充干预后，本研究仅观察到锌对儿童进食行为存在上述显著效应。试验注册：ClinicalTrials.gov 编号NCT00109551