Background

Appropriate feeding of infants and young children is essential for healthy growth and the prevention of stunting, wasting, and overweight. We aimed to assess the beneficial versus harmful effects of providing fortified complementary foods to children in the complementary feeding period.

Methods

In this systematic review and meta-analysis, we searched the databases Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Global Index Medicus, Web of Science, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to March 9, 2021. We included randomised controlled trials and controlled clinical trials done in infants and children aged 6–23 months with no identified health problems. Consumption of foods fortified centrally (ie, during industrial processing) with one micronutrient or a combination of vitamins, minerals, or both was compared with the same complementary foods, but without micronutrient fortification. Two review authors independently screened studies for eligibility, extracted data, assessed risk of bias, and rated the certainty of the evidence. The main outcomes were growth (measured by Z scores for weight for age, weight for height or length, and height or length for age, or other growth measures), stunting, wasting, nutrient adequacy or excess, anaemia, haemoglobin concentration, iron status, serum zinc concentration, and serum retinol concentration. We used a random-effects meta-analysis for combining data. This study is registered with PROSPERO, CRD42021245876.

Findings

We included 16 studies with 6423 participants, 13 of which were done in malaria-endemic areas. Overall, 12 studies were included in the quantitative syntheses. We identified five further ongoing studies. There was no difference between participants who received fortified complementary foods and those who received non-fortified complementary foods in weight-for-age Z scores (mean difference −0·01, 95% CI −0·07 to 0·06; five trials; 1206 participants; moderate-certainty evidence), weight-for-height or length Z scores (−0·05, −0·19 to 0·10; four trials; 1109 participants; moderate-certainty evidence), and height or length-for-age Z scores (−0·01, −0·21 to 0·20; four trials; 811 participants; low-certainty evidence); stunting and wasting were not assessed in any study as outcomes. Moderate-certainty evidence from six trials with 1209 patients showed that providing fortified complementary foods to children aged 6–23 months reduced the risk of anaemia (risk ratio 0·57, 95% CI 0·39 to 0·82). Those who received fortified complementary foods compared with those who did not had higher haemoglobin concentrations (mean difference 3·44 g/L, 95% CI 1·33 to 5·55; 11 trials; 2175 participants; moderate-certainty evidence) and ferritin concentration (0·43 μg/L on log scale, 0·14 to 0·72; six trials; 903 participants; low-certainty evidence). The intervention led to no effects on serum zinc concentration (−0·13 g/dL, −0·82 to 0·56; two trials; 333 participants; low-certainty evidence) and serum retinol concentration (0·03 μmol/L, −0·02 to 0·08; five trials; 475 participants; moderate-certainty evidence).

Interpretation

Fortified complementary foods are effective strategies to prevent anaemia in infants and young children aged 6–23 months in malaria-endemic regions. Effects of complementary food fortification should be further investigated in low-income and middle-income countries, but should also be assessed in high-income countries, and in regions where malaria is not endemic.

Funding

WHO.

中文翻译：

---

与 6-23 个月婴幼儿微量营养素强化辅食相关的健康结果：系统回顾和荟萃分析

背景

适当喂养婴幼儿对于健康成长和预防发育迟缓、消瘦和超重至关重要。我们的目的是评估在辅食期为儿童提供强化辅食的有益和有害影响。

方法

在此系统评价和荟萃分析中，我们搜索了 Cochrane 对照试验中央登记册、MEDLINE、Embase、护理和相关健康文献累积索引、全球医学索引、科学网、ClinicalTrials.gov 和 WHO 国际临床试验数据库注册平台从成立到 2021 年 3 月 9 日。我们纳入了在未发现健康问题的 6-23 个月婴儿和儿童中进行的随机对照试验和对照临床试验。将使用一种微量营养素或维生素、矿物质或两者的组合集中强化（即在工业加工过程中）的食物的消费量与相同的补充食物进行比较，但没有微量营养素强化。两位综述作者独立筛选符合条件的研究、提取数据、评估偏倚风险、并对证据的可信度进行评级。主要结果是生长（通过年龄别体重、身高或身长别体重、年龄别身高或身长或其他生长指标的 Z 分数衡量）、发育迟缓、消瘦、营养充足或过剩、贫血、血红蛋白浓度、铁状态、血清锌浓度和血清视黄醇浓度。我们使用随机效应荟萃分析来合并数据。本研究在 PROSPERO 注册，CRD42021245876。

发现

我们纳入了 16 项研究，共有 6423 名参与者，其中 13 项是在疟疾流行地区进行的。总体而言，12 项研究被纳入定量综合。我们确定了另外五项正在进行的研究。接受强化辅食的参与者和接受非强化辅食的参与者在年龄别体重 Z 分数上没有差异（平均差 -0·01，95% CI -0·07 至 0·06；五项试验；1206 名参与者；中等质量证据）、身高别体重或身长 Z 分数（-0·05、-0·19 至 0·10；四项试验；1109 名参与者；中等质量证据）以及身高或身长-年龄别 Z 分数（-0·01，-0·21 至 0·20；四项试验；811 名参与者；低质量证据）；任何研究都没有将发育迟缓和消瘦作为结果进行评估。来自 1209 名患者的六项试验的中等质量证据表明，为 6-23 个月大的儿童提供强化辅食可降低贫血风险（风险比 0·57，95% CI 0·39 至 0·82）。接受强化辅食的人与未接受强化辅食的人相比，血红蛋白浓度更高（平均差 3·44 g/L，95% CI 1·33 至 5·55；11 项试验；2175 名参与者；中等质量证据）和铁蛋白浓度（对数标度为 0·43 μg/L，0·14 至 0·72；六项试验；903 名参与者；低质量证据）。干预对血清锌浓度（-0·13 g/dL，-0·82 至 0·56；两项试验；333 名受试者；低质量证据）和血清视黄醇浓度（0·03 μmol/L）没有影响, −0·02 至 0·08；五项试验；475 名参与者；中等质量证据）。

解释

强化辅食是预防疟疾流行地区 6-23 个月婴幼儿贫血的有效策略。补充食品强化的影响应在低收入和中等收入国家进一步调查，但也应在高收入国家和疟疾未流行的地区进行评估。

资金

WHO。