Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children's cognition at age 9–12 years in Indonesia: follow-up of the SUMMIT randomised trial
| Autor: | Mandri Apriatni, Ayuniarti Islamiyah, Sudirman Siddiq, Susy Katikana Sebayang, Benyamin Harefa, Siti R. Adawiyah, Jarrad A. G. Lum, Michael T. Ullman, Elizabeth L. Prado, Husni Muadz, Katherine J. Alcock, Anuraj H. Shankar, Nina Hidayati |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Pediatrics Iron Mismatch negativity Mothers Social Environment 03 medical and health sciences 0302 clinical medicine Child Development Cognition Folic Acid Double-Blind Method Memory Medicine Humans 030212 general & internal medicine Early childhood Micronutrients Child Socioeconomic status 030109 nutrition & dietetics Socioemotional selectivity theory business.industry Public health lcsh:Public aspects of medicine Infant Newborn Infant Anemia lcsh:RA1-1270 General Medicine Maternal Nutritional Physiological Phenomena Anthropometry medicine.disease Child development Malnutrition Socioeconomic Factors Indonesia Dietary Supplements Female business Demography Follow-Up Studies |
| Zdroj: | The Lancet Global Health, Vol 5, Iss 2, Pp e217-e228 (2017) |
| Popis: | Summary Background Brain and cognitive development during the first 1000 days from conception are affected by multiple biomedical and socioenvironmental determinants including nutrition, health, nurturing, and stimulation. An improved understanding of the long-term influence of these factors is needed to prioritise public health investments to optimise human development. Methods We did a follow-up study of the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), a double-blind, cluster-randomised trial of maternal supplementation with multiple micronutrients (MMN) or iron and folic acid (IFA) in Indonesia. Of 27 356 live infants from birth to 3 months of age in 2001–04, we re-enrolled 19 274 (70%) children at age 9–12 years, and randomly selected 2879 from the 18 230 who were attending school at a known location. Of these, 574 children were oversampled from mothers who were anaemic or malnourished at SUMMIT enrolment. We assessed the effects of MMN and associations of biomedical (ie, maternal and child anthropometry and haemoglobin and preterm birth) and socioenvironmental determinants (ie, parental education, socioeconomic status, home environment, and maternal depression) on general intellectual ability, declarative memory, procedural memory, executive function, academic achievement, fine motor dexterity, and socioemotional health. The SUMMIT trial was registered, number ISRCTN34151616. Findings Children of mothers given MMN had a mean score of 0·11 SD (95% CI 0·01–0·20, p=0·0319) higher in procedural memory than those given IFA, equivalent to the increase in scores with half a year of schooling. Children of anaemic mothers in the MMN group scored 0·18 SD (0·06–0·31, p=0·0047) higher in general intellectual ability, similar to the increase with 1 year of schooling. Overall, 18 of 21 tests showed a positive coefficient of MMN versus IFA (p=0·0431) with effect sizes from 0·00–0·18 SD. In multiple regression models, socioenvironmental determinants had coefficients of 0·00–0·43 SD and 22 of 35 tests were significant at the 95% CI level, whereas biomedical coefficients were 0·00–0·10 SD and eight of 56 tests were significant, indicating larger and more consistent impact of socioenvironmental factors (p Interpretation Maternal MMN had long-term benefits for child cognitive development at 9–12 years of age, thereby supporting its role in early childhood development, and policy change toward MMN. The stronger association of socioenvironmental determinants with improved cognition suggests present reproductive, maternal, neonatal, and child health programmes focused on biomedical determinants might not sufficiently enhance child cognition, and that programmes addressing socioenvironmental determinants are essential to achieve thriving populations. Funding Grand Challenges Canada Saving Brains Program. |
| Databáze: | OpenAIRE |
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