Category: Moms

Micronutrient supplementation benefits

Micronutrient supplementation benefits

How to Benefit from Micronutrient Supplementation. Shining light Micronutrient supplementation benefits wupplementation blindness. Micronutrients; macro impact, the story of vitamins and a hungry world external icon. Lancet Glob Health.

Micronutrient supplementation benefits -

Providing MMS to women during pregnancy can prevent long-lasting human capital losses in educational years and lifetime income [4]. Scaling up programs that deliver MMS to vulnerable mothers is now an urgent priority.

This requires efficient supply chain systems and building awareness of its health benefits among mothers, communities, and maternal healthcare providers. Pregnancy increases the daily requirement of several vitamins and minerals to meet the nutritional needs of the developing fetus and other metabolic functions.

Antenatal MMS is designed to address these heightened demands, which are often not met through diet alone. It is particularly useful for pregnant women in resource-poor settings where micronutrient intake is typically low due to poor dietary diversity, limited access to nutritious food, gender inequity, and prevalent social norms.

MMS is delivered in the form of a tablet, capsule, powder, or liquid that provides a combination of vitamins and minerals in the right amounts. It is often accompanied by nutrition education and counseling to help ensure daily consumption. The United Nations International Multiple Micronutrient Antenatal Preparation UNIMMAP MMS is an internationally accepted and standardized formulation that contains 15 essential vitamins and minerals, including iron and folic acid in recommended doses.

Composition of a multi-micronutrient supplement to be used in pilot programmes among pregnant women in developing countries. There is clear and consistent evidence from clinical trials that MMS provides additional benefits over IFAS, which is the existing standard of care for pregnant women in low- and middle-income countries LIMCs , in reducing adverse pregnancy outcomes.

Summary of benefits of MMS vs. Given the greater health benefits of MMS, transitioning from IFAS to MMS is highly cost-effective. This is despite the small incremental cost for MMS over IFA because of the additional micronutrients [5, 6, 7]. A tool to calculate the incremental benefits and costs of transitioning from IFAS to MMS has been developed by Nutrition International using rigorous methodology.

The importance of micronutrients is becoming increasingly apparent, especially in resource-poor settings in which women may enter pregnancy with multiple micronutrient MMN deficiencies [ 2 — 4 ]. Impaired antenatal nutrition can affect fetal development and growth in the short term, subsequent growth and cognitive development in the medium term, and risk of chronic disease in the longer term [ 3 ].

There is good evidence that folic acid in pregnancy reduces neural tube defects and the mortality arising from them [ 8 , 9 ]. While the evidence base is not substantial for iron and folic acid, a Cochrane review described a mean increase in birthweight of While there is evidence that MMN supplementation reduces the prevalence of small for gestational age SGA births [ 11 ], the primary rationale for recent recommendations to implement routine MMN supplementation for pregnant women in developing countries is that such birth weight increments will lead to reductions in childhood stunting and mortality [ 12 , 13 ].

In addition to the immediate effects on health, growth in early childhood is important because of its association with adult health and human capital [ 14 ].

The hypothesis of the developmental origins of health and disease proposes critical or sensitive periods in early development in which environmental influences can have lasting effects on growth and physiology [ 15 ].

In humans, these critical periods are thought to occur predominantly in prenatal life and extend into early childhood. Suggested mechanisms include an interplay between environment including maternal nutritional status , genes, and hormones, in which epigenetic regulation plays a part [ 3 , 15 , 16 ].

Evidence for the hypothesis comes mainly from observational studies showing associations between low birthweight and adverse adult health outcomes [ 17 ], from historical events such as the Dutch Hunger Winter [ 18 ], and from animal studies [ 19 ].

Long-term follow-up of children born during trials of maternal MMN supplementation offer a potentially stronger test of the hypothesis. If MMN supplements are to be recommended for pregnant women, it is important to know whether they lead to the sustained improvements in child health predicted by an increase in birthweight.

In this review, we searched for reports that followed up the trials included in the Cochrane review [ 20 ], focusing on childhood mortality and health-related outcomes growth, body composition, cardio-metabolic risk markers, cognition, lung function.

We hypothesized that, compared with iron and folic acid, antenatal MMN supplementation would lead to longer-term improvements in health and survival.

We attempted to find all reports of follow-up of children born in the individual or cluster randomized controlled trials included in the Cochrane review. The review included 17 trials and excluded The main reasons for exclusion were not meeting intervention and comparison group criteria, not assessing supplementation in a healthy population, and providing supplementation within food fortification initiatives [ 20 ].

Participants were children born in the trials in the Cochrane review [ 20 ] who had been subsequently followed up. All intervention groups received iron and folic acid.

For consistency, the comparison group chosen a priori was iron 60 mg and folic acid μg, where possible, as this regimen is generally recommended for pregnant women [ 21 ].

We planned to consider all trials together, with the possibility of subgroup examination when supplementation regimens differed.

Trials with co-interventions for example, food supplements were eligible provided that the co-intervention was similar in both allocation arms. If a second randomization was conducted after birth, we did not include arms that received MMN supplements in the comparison group.

The primary outcomes were mortality difference per livebirths , height and weight as continuous WHO z scores, adjusted for age and sex , and head circumference continuous difference , presented as unadjusted differences intervention minus control.

At a population level, risk differences may be more interpretable than odds ratios because they give a clearer impression of the effects of an intervention in terms of potential policy. Mortality difference was either as described in the trial paper or follow-up report, or calculated from available trial profiles.

Cognitive and motor development were as assessed by trialists, including use of indexes such as the Bayley Mental Development Index, Bayley Psychomotor Development Index, Stanford-Binet Test, DENVER II Developmental Screening Test and Wechsler Intelligence Scale for Children.

Effect modification by maternal nutritional status and child sex was reported when available. Birth outcomes were not considered as they had been reported previously [ 11 , 22 ]. We searched PubMed, Web of Science and the Global Health Library for articles that included trial lead author names, location, trial number, or the given trial name Additional file 1 : Text S1.

Study titles and abstracts were screened for eligibility by DD and JCKW independently. Differences were resolved by discussion. Full papers were obtained for potentially eligible citations. The results were assessed for multiple publications and one study was excluded.

We did not assess reports of maternal outcomes. No exclusions were applied for age, dates of coverage, or language. Publications from each trial were examined by two review authors unconnected with the trial independently AC, BM, CHDF, DD, DO, HSS, and JCKW , using a pre-tested data extraction form.

We contacted trial authors for clarifications and consolidated multiple reports from the same trial using data from the later follow-up. We used anthropometric z scores adjusted for age and sex WHO reference ranges.

Meta-analyses were conducted if sufficient reports were available, using the DerSimonian and Laird model. Outcome measures were risk differences per livebirths mortality , differences in anthropometry z scores height-for-age HAZ and weight-for-age WAZ and absolute values head circumference and blood pressure.

We assessed heterogeneity using the I 2 statistic. In view of anticipated contextual heterogeneity, we used a random effects model for all meta-analyses. Missing data were reported under attrition bias, but no further analyses were conducted.

For cluster-randomised trials, we used reported cluster-adjusted estimates, irrespective of the method employed. If the analyses had not been adjusted for cluster design effect, we used a previously reported design effect from the trial paper to inflate the variance.

Analysis was conducted in Stata, version 12 StataCorp, College Station, TX, USA. Risk of bias for each study was assessed by two review authors unconnected with the trial independently AC, BM, CHDF, DD, DO, HSS, and JCKW , using a pre-tested data extraction form. Differences were resolved by discussion and trial authors were contacted for clarifications.

We used the same categorisation of bias of individual trials as in the Cochrane review We reported on bias in follow-up reports in the following categories: selection, attrition, reporting, performance and detection. We evaluated reporting bias by inspection of funnel plots for the primary outcomes of mortality, weight-for-age, height-for-age and head circumference.

We performed sub-group analyses including trials that used UNIMMAP only and trials with different iron dosage ~30 or 60 mg in control groups. Sensitivity analyses were not conducted. Follow-up reports were identified for nine of the trials in the Cochrane review. In total, 88, women were recruited.

The trials were spread geographically: two in Africa [ 23 , 24 ], one in the Americas [ 25 ], and six in Asia [ 26 — 31 ]. All sites were rural, with the exception of Nepal Janakpur urban and rural and Guinea semi-urban. Mean ages of mothers were similar and ranged from Mean maternal BMI, measured at recruitment during pregnancy, ranged from Trial characteristics, with results summarized in the way in which they were presented in the trial papers, are shown in Table 1 and have been previously described in detail [ 20 , 32 ].

Six of the nine trials used the UNIMMAP supplement developed by UNICEF, the United Nations University, and WHO, and were designed to provide the recommended daily allowances. It contained vitamin A μg, thiamine 1. The Bangladesh JiVitA trial used the same micronutrients as UNIMMAP in similar doses.

The supplement used in Nepal Sarlahi contained micronutrients in similar doses with 60 mg iron , plus magnesium and vitamin K, but no selenium or iodine [ 34 ].

The supplement used in Mexico included iron In some cases, a comparison group of iron 60 mg and folic acid μg was not available: Nepal Sarlahi included additional vitamin A [ 34 ], Mexico did not include folic acid [ 25 ], Indonesia used 30 mg iron [ 29 ], and Bangladesh JiVitA used 27 mg iron and μg folate [ 26 ].

Supplement constituents are shown in Additional file 1 : Table S1. Supplementation was initiated in early to mid-pregnancy, with a range of median commencement gestation across studies of 14 weeks Table 1. We found 20 follow-up reports Table 2 and Additional file 1 : Figure S1.

We divided the findings into five general categories: mortality [ 26 , 27 , 35 — 41 ], anthropometry [ 35 , 38 , 39 , 41 — 44 ] and body composition [ 39 , 44 , 45 ], cardiovascular [ 39 , 43 , 46 , 47 ], cognitive [ 37 , 48 — 51 ], and respiratory [ 52 ].

Primary publications from the Bangladesh JiVitA and MINIMat trials included follow-up mortality data and were included in the list of follow-up reports. Meta-analyses were conducted for mortality, weight, height, head circumference and blood pressure outcomes. Meta-analysis showed no difference between intervention and control groups risk difference, —0.

No difference by age was seen. Subgroup analysis including trials that used only the UNIMMAP supplement showed a risk difference of 3. Subgroup analysis for trials that used 60 mg iron in control groups yielded a risk difference of 4.

Forest plot showing mortality rate per livebirths meta-analysis using a random effects model. Seven reports described anthropometry Table 4.

No differences were seen in any report at the most recent follow-up for WAZ, HAZ or head circumference, nor in any secondary anthropometric outcomes.

Differences were seen at younger ages in two trials. In the Burkina Faso trial, greater mean WAZ β, 0. In the Nepal Janakpur trial, greater mean WAZ β, 0.

Small increases were seen in head, chest, hip, and mid-upper arm circumferences at 2. Effect modification by maternal BMI or child sex was not found in any report with the exception of the Bangladesh MINIMat trial, in which stunting was greater in boys in the MMN group Males, 7.

A test for interaction was not reported. Meta-analyses for WAZ and HAZ showed no difference between multiple micronutrient and 60 mg iron and folic acid groups. The differences in WAZ and HAZ were 0.

Meta-analysis for head circumference was possible for three trials Mexico, Bangladesh MINIMat and Nepal Janakpur and showed no difference 0. Subgroup analysis including UNIMMAP trials made little difference: WAZ 0. The Bangladesh MINIMat trial found no difference in biceps, triceps, subscapular or suprailiac skinfold thicknesses.

The Nepal Janakpur trial found an increase in triceps skinfold thickness at 2. The Nepal Sarlahi trial found no difference in triceps or subscapular skinfold thickness at 7.

Neither the Bangladesh MINIMat nor the Nepal Janakpur trial found a difference in lean mass or fat mass measured using bio-impedance [ 39 , 45 , 53 , 54 ]. Cardiovascular outcomes were only examined in trials from South Asia Table 4.

The Bangladesh MINIMat and Nepal Janakpur trials measured blood pressure, while the Nepal Sarlahi trial investigated metabolic syndrome blood pressure, HbA 1c , urine microalbumin:creatinine, cholesterol, glucose, insulin, homeostasis model assessment of insulin resistance.

The Nepal Janakpur cohort showed a reduction in mean systolic blood pressure of 2. The Bangladesh MINIMat cohort showed no difference at 4. The Nepal Sarlahi trial found neither a difference in blood pressure at 7.

Meta-analysis of the three trials showed no difference in blood pressure: the difference in systolic blood pressure was 0.

Subgroup analysis for trials that used iron 60 mg in the control group was similar: systolic blood pressure difference 0. The Bangladesh MINIMat, China, and Indonesia trials all assessed subgroups of children: in Bangladesh, children born in a month period, at 7 months of age [ 48 ]; in China, in the middle year of the trial up to 1 year of age [ 49 ] and at 8.

The Nepal Sarlahi study administered cognitive, motor and executive function tests at 7—9 years of age. Mean cognitive scores were a little lower for the MMN group compared to iron, folic acid and vitamin A Universal Nonverbal Intelligence Test score, —2. Results of motor and executive function tests were mixed [ 51 ].

The Bangladesh MINIMat and China trials found no difference in motor or psychomotor scores [ 48 , 49 ]. The Indonesia trial found an increase in motor ability in an adjusted analysis expressed as a fraction of the variation of the score 0.

The Bangladesh MINIMat follow-up found no difference in problem solving or behaviour [ 48 ]. In the China trial, there were no differences at 3 or 6 months, but age-adjusted scores at 1 year were higher for mental development in the MMN supplementation group 1.

The Indonesia trial follow-up found no difference in visuospatial and visual attention, executive functioning, language ability, or socioemotional development [ 37 ]. For completeness, we mention stratified analyses.

These differences were equivalent to approximately 5 months of age [ 37 ]. The Nepal Janakpur trial investigated lung function at 8.

No difference in lung function was found between allocation groups: forced expiratory volume in the first second, —0. The trials were considered high quality and bias was not thought to be important. There was potential selection bias in the Guinea-Bissau trial as a result of inadequately concealed allocation [ 24 ], and potential attrition bias for the Nepal Janakpur and Mexico trials, in which exclusions prior to randomization were not reported [ 25 , 30 ].

The trials were powered on the primary outcomes of gestational age and birthweight and mortality, in the case of the Bangladesh JiVitA Indonesia trials [ 29 ]. Follow-up reports described power or sample size calculations before data collection, with the exception of the Bangladesh MINIMat cardiovascular [ 46 ], Burkina Faso anthropometry [ 35 ] and Nepal Sarlahi anthropometry and cardiovascular reports follow-up publications [ 44 , 47 ].

Some clinical heterogeneity was present as participants were from different countries and ages of follow-up varied. The intervention was the same in most cases, but as described above the Bangladesh JiVitA, Mexico and Nepal Sarlahi trials used slightly different multiple micronutrient formulations, and the Bangladesh JiVitA, Indonesia, Mexico and Nepal Sarlahi trials used different controls.

Although choice of outcomes varied from one report to another, similar methods were used to assess similar outcomes. Primarily a result of inadequate randomisation and allocation concealment, this has been covered in the Cochrane assessment [ 20 ].

An additional potential source of bias is selection of trials from the Cochrane review that did not show an increase in birthweight associated with MMN supplementation. The Cochrane review included 14 trials in its analysis of SGA. Of the five not considered here [ 56 — 60 ], one showed a significant reduction in SGA Fawzi et al.

Supplement composition was substantially different in this trial, which compared a supplement containing eight vitamins and no minerals with a 60 mg iron and μg folic acid control [ 57 ]. Meta-analysis of the trials included in our review showed an increase in birthweight of Similarly, three of the 11 trials included in the meta-analysis of neonatal mortality did not conduct follow-up studies.

None of these trials showed a reduction in neonatal mortality. Meta-analysis of neonatal mortality rate for included trials produced an RR of 1.

Participants and data collectors in all follow-up reports remained blind to allocation, with the exception of Guinea-Bissau, where this was not mentioned explicitly in the report. Excluding this group, follow-up rates were similar to those of the other reports. These biases work in opposite directions and were accounted for in the analyses [ 50 ].

Where recorded, differences between children retained and lost to follow-up were small. Children lost to follow-up tended to have mothers with more education Bangladesh MINIMat, Nepal Janakpur, Mexico and Nepal Sarlahi , lower parity and younger age Bangladesh MINIMat and Mexico , and were more likely to live in an urban location Nepal Janakpur , have differences in ethnicity and assets Nepal Sarlahi , and lower birthweight and shorter gestation Bangladesh MINIMat.

Maternal age, weight, height and parity also differed in Guinea-Bissau, but the directions of these effects were not reported. We could not make a definitive assessment of reporting bias as follow-up protocols were unpublished, but funnel plots for mortality, HAZ, WAZ and head circumference, using results from the most recent follow-up report, did not suggest publication bias for the primary outcomes Additional file 1 : Figure S5.

We found 20 follow-up reports for nine trials, covering a range of health outcomes. Nine studies reported on mortality, six on weight, six on height, and four on cognitive function, but there were few reports of other outcomes. Our hypothesis was not confirmed — we found no evidence that antenatal MMN supplementation, compared with iron and folic acid supplementation, led to improved survival, improved growth, lower blood pressure, or improved lung function in childhood.

Potential improvements in cognitive outcomes were observed, but these were small and inconsistent and tended to be seen in subgroups.

The trials had low risks of bias and were generally considered of high-quality [ 20 ]. The degree of loss to follow-up was not substantial, although in some cases only subgroups were followed up.

Differential loss to follow-up between intervention and control groups did not appear to be an issue, and neither did selective publication, as most trials reported null findings. The evidence on antenatal MMN supplementation comes from a large sample and a substantial number of trials, many of which were coordinated.

The trials considered here were spread geographically, although 13 of the 20 follow-up reports were from South Asia, which may have affected generalizability. Differences between the Nepal and Bangladesh reports emphasize the fact that variation can occur within similar populations.

The main limitation was that not all trials had published reports on follow-up. We cannot be certain whether a selection bias exists, but we found no indication of this.

Follow-up reports have published null findings, rather than positive ones. If a publication bias does exist, it would not work in this direction. None of the trials had initially set out to observe childhood outcomes.

While power calculations were performed prior to most follow-ups, trials were powered on birth outcomes and larger sample sizes may be required to detect small differences in childhood.

Functional outcomes were measured at different ages and may not be comparable. We attempted to address this by using z scores, adjusted for age and sex, as primary outcomes.

This was not always possible and limits inferences from the head circumference and blood pressure findings. We tried to make comparisons as similar as possible, but our findings could be vitiated by slightly different MMN and control supplement compositions in some trials.

Antenatal MMN supplementation was initially hypothesized to reduce mortality, but increases in neonatal mortality were suspected in some trials [ 64 ]. A meta-analysis did not find a difference in neonatal mortality overall, but raised concerns about increased early neonatal mortality OR, 1.

The Cochrane review found a reduction in stillbirths 0. The reduction in stillbirths is interesting and potentially important [ 65 ]. Our analyses did not identify evidence of an effect on child mortality and do not support the assumptions made in the Lives Saved Tool.

Overall, follow-up reports did not show differences in anthropometry or body composition. A transient improvement was seen in early life in the Burkina Faso and Nepal Janakpur trials, and there was a suggestion of increased stunting in Bangladesh, but these findings were not replicated in other reports.

There was a consistent lack of effect on height. It is conceivable that MMN supplementation could have physiological effects that are not manifest in substantial anthropometric change.

For example, transient greater weight in early childhood could have long-term benefits, even if not apparent in the short-term. Small improvements in mental development were seen in China [ 49 ] at 1 year but not at 9 years, cognitive score was lower in Nepal Sarlahi [ 51 ], and the Bangladesh MINIMat and Indonesia trials found improvements in subgroups of mothers with poorer nutritional status only [ 37 , 48 ].

Considering the number and range of tests conducted, antenatal MMN supplements did not appear to lead to a consistent cognitive benefit. When found, differences tended to be small and three of the five reports involved children under 4 years, in whom cognitive tests are less reliable than in older children.

Further assessment of these cohorts is warranted. Comparison of follow-ups did not confirm the impression of transiently lower systolic blood pressure at 2.

Only one trial considered other cardiovascular risk markers and found no effects. On the basis of the reports we have reviewed, current evidence does not support changing the recommendation for routine antenatal supplementation from iron and folic acid to MMN formulations.

It is possible — even probable — that the trial populations differed in their patterns of micronutrient deficiency. There was little evidence to suggest that this influenced the general findings.

Although there is consistent evidence that antenatal MMN supplementation increases birth weight, none of the studies demonstrated convincingly that it benefitted offspring in terms of functional or health outcomes, and the directions and magnitudes of effect were similar for mortality and anthropometric outcomes across the study sites.

The findings of the Cochrane review on which recent advocacy for routine antenatal MMN supplementation are based are supported by other meta-analyses that have shown an increase in mean birthweight of 22—54 g and corresponding reductions in low birthweight and SGA.

As may be expected, the erosion over time of anthropometric differences observed at birth suggests that infants of women who received antenatal MMN supplements lost an advantage over the first few years.

Gombart A, Pierre A, Maggini S. A Review of Micronutrients and the Immune System—Working in Harmony to Reduce the Risk of Infection. January 16, Tardy A-L, Pouteau E, Marquez D, et al. Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence.

What Are Macronutrients and Micronutrients? Cleveland Clinic. October 5, Micronutrients for Health. Oregon State University. Micronutrient Facts. Centers for Disease and Control and Prevention. February 1, World Health Organization Ames B.

Low Micronutrient Intake May Accelerate the Degenerative Diseases of Aging Through Allocation of Scarce Micronutrients by Triage. November 13, An P, Wan S, Luo Y, et al. Micronutrient Supplementation to Reduce Cardiovascular Risk. Journal of the American College of Cardiology.

December 13, Mount Sinai. Vitamin C. Mayo Clinic. November 17, The Principles of Nerve Cell Communication. Alcohol Health and Research World. April 2, Vitamins and Minerals. National Institutes of Health. February Precious Metals and Other Important Minerals for Health. Lee L, Burch P.

Overnutrition and Undernutrition of Nutrients. North Carolina State University. September 6, Vitamin A Fact Sheet. University of Washington. Ostrenga S. Are You Absorbing the Nutrients You Eat? Michigan State University.

Micronutrients, which are Micronutrieng vitamins and minerals that the body needs in small Micronutrient supplementation benefits, are Micronutrient supplementation benefits sjpplementation all food groups in different varieties, depending on Tooth sensitivity the plants or benefiits you consume tend to absorb. Micronutrient supplementation benefits an appropriate amount of vitamins and minerals is imperative for the proper functioning and development of the body and mind, as well as for healing processes and prevention of disease. Overall, vitamins are most necessary for immune function, blood clotting, the production of energy and oxygenation of the blood. Minerals are most beneficial for bone health, growth and fluid balance among other vital processes. Is your diet offering you the right micronutrients? More than 20 years of research [1, 2] have provided clear evidence Gelatin MMS is efficacious, safe, cost-effective, and affordable. Antenatal Multiple Micronutrient Supplementation MMS for pregnant women sup;lementation been Microjutrient to supplemnetation Micronutrient supplementation benefits beenfits status and, in Micronutrient supplementation benefits with iron Micfonutrient folic acid supplements Benefjtsfurther reduce the risk of adverse birth outcomes such as preterm birth, stillbirth, low birth weight, and small-for-gestational-age birth [1, 2, 3]. Providing MMS to women during pregnancy can prevent long-lasting human capital losses in educational years and lifetime income [4]. Scaling up programs that deliver MMS to vulnerable mothers is now an urgent priority. This requires efficient supply chain systems and building awareness of its health benefits among mothers, communities, and maternal healthcare providers. Pregnancy increases the daily requirement of several vitamins and minerals to meet the nutritional needs of the developing fetus and other metabolic functions.

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Every Vitamin \u0026 Mineral the Body Needs (Micronutrients Explained)

Author: Kigabar

4 thoughts on “Micronutrient supplementation benefits

  1. Absolut ist mit Ihnen einverstanden. Darin ist etwas auch mir scheint es die gute Idee. Ich bin mit Ihnen einverstanden.

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