Date Published: March 20, 2017
Publisher: Public Library of Science
Author(s): Jie Wang, Suying Chang, Liyun Zhao, Wentao Yu, Jian Zhang, Qingqing Man, Li He, Yifan Duan, Hui Wang, Robert Scherpbier, Shi-an Yin, Frank Wieringa.
Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation.
Baseline and follow-up cross-sectional surveys were conducted before and after a nutrition intervention program in 3 national poverty counties in China. Soybean-based complementary food supplements called Yingyangbao (YYB) in Chinese and training materials on child feeding were distributed to households with children aged 6–23 months for 18 months. Representative children were selected by probability proportional to size sampling methods to assess compliance of YYB and the intervention efficacy. A questionnaire was designed to collect data on basic characteristics of children, breastfeeding, 24-hour dietary intake, and consumption and appetite of YYB. Anthropometrics and hemoglobin were measured in the field, and anemia prevalence was evaluated. Venous blood was drawn from children aged 12–35 months to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children’s anemia.
Of the children involved in the follow-up survey (n = 693), the P50 (P25, P75) intake of YYB was 6.7 (3.5, 7.0) sachets weekly, and 54.7% of the children liked the taste of YYB. Compared with the baseline situation (n = 823), the proportion of children fed a diverse diet and foods rich in iron or vitamin A increased (P < 0.01) in the follow-up study. The prevalence of stunting and underweight decreased (P < 0.05), the prevalence of anemia decreased from 28.0% to 19.9% (P < 0.01), and the prevalence of vitamin B12 deficiency decreased from 26.8% to 15.4% (P < 0.01). For children aged 12–23 months, those who liked YYB and consumed 6 or more sachets of YYB weekly were at lower risk for anemia (OR = 0.34, 95% CI 0.13–0.90, P < 0.05), but the risk of stunting was associated with a non-diverse diet (OR = 1.48, 95% CI 1.06–2.07, P < 0.05). The quality of diet and nutritional status of children aged 6–23 months are significantly improved by the intervention of YYB and nutrition education, and good compliance to YYB contributes to a low risk for anemia. Chinese Clinical Trial Registry ChiCTR-OOC-16008846
Ending all forms of malnutrition by 2030 is one of the targets of the sustainable development goals as reported in the Global Nutrition Report 2015. Older infants and young children are at the greatest risk for malnutrition, mainly in the forms of poor growth and micronutrient deficiency . In 2014, stunting prevalence was 23.8%, and 159 million children under age 5 were still affected by stunting worldwide, with 57% of stunted children living in Asia . Global anemia prevalence in 2010 was 32.9%, and the burden was highest in children under age 5, which was the only age group with negative trends from 1990 to 2010 . In China, stunting affected 19.0% and anemia affected 16.6% of children aged 0–5 years in poorer areas . Furthermore, children under 2 years old in poor areas were at the greatest risk for anemia and poor growth [4–7]. Infants and young children were key targeted populations for combating malnutrition.
Malnutrition and inappropriate feeding practices during the first two years of life have been shown to increase susceptibility to infection, which results in morbidity and mortality, and to adversely affect a child’s growth and development. Food-based nutrition intervention programs have been shown to effectively improve nutritional status for the targeted populations. However, the adherence or acceptance to the intervention product would be an important factor affecting the food-based intervention efficacy. Our study showed that the quality of diet and nutritional status of children aged 6–23 months were improved by the intervention of YYB and nutrition education and that better adherence to YYB contributes to a greater efficacy of intervention.
Micronutrient supplements (Yingyangbao) together with nutrition education significantly improve dietary quality and decrease the prevalence of stunting, underweight, anemia, vitamin A insufficiency and vitamin B12 deficiency in children.