Abstract
Yingyangbao (YYB) is a nutrient-dense complementary food supplement for infants and young children in China. There has been considerable interest and research on the potential effects of YYB on hematological and anthropometric outcomes in China, but limited effort has been made to consolidate and synthesize the evidence to inform the research and policy agendas. Eight English databases and three Chinese databases were searched from January 2001 to June 2019 to identify YYB intervention studies. A total of 32 quasi-experimental, post-only, concurrent-control studies or pre-post studies were identified, and 26 were included in the meta-analyses. A pooled analysis of post-only studies with concurrent-control determined that YYB was associated with an increase of 4.43 g/L (95% confidence interval (CI) 1.55, 7.30) hemoglobin concentration, 2.46 cm (CI 0.96, 3.97) in height, and 0.79 kg (CI 0.25, 1.32) weight in infants and young children. YYB was also associated with reductions in the prevalence of anemia (risk ratio (RR) = 0.55; 95% CI: 0.45, 0.67), stunting (RR = 0.60; 95% CI: 0.44, 0.81), and underweight (RR = 0.51; 95% CI: 0.39, 0.65). Overall, YYB was found to be associated with improved hematological and anthropometric indicators among infants and young children in China; however, randomized trials are needed to causally assess the efficacy of YYB due to the inherent risk of bias in existing quasi-experimental studies; rigorous implementation and cost-effectiveness evaluations are also needed.
Highlights
China is home to 83 million children under 5 years of age, accounting for 13% of the global population in that age category in 2017 [1,2]
This article sought to examine the effectiveness of providing YYB to infants and children on all health and nutrition outcomes assessed in published studies, including: (1) anthropometric outcomes including height, weight, height-for-age z score (HAZ), weight-for-age Z score (WAZ), weight-for-height Z score (WHZ), stunting prevalence, underweight prevalence, and wasting prevalence; (2) hematological parameters, including hemoglobin (Hb) concentration (g/L) and anemia prevalence
Outcomes reported in three or more studies were examined in meta-analysis, and as a result, 26 studies were in the meta-analyses (13 post-only studies with concurrent-control and 13 pre-post studies)
Summary
China is home to 83 million children under 5 years of age, accounting for 13% of the global population in that age category in 2017 [1,2]. China still has large number of undernourished children. In 2013, around seven-million Chinese children were stunted and two-million were underweight [3,4]. Anemia remains a severe problem in China, in rural areas: 28% of rural children between 6 and months old and 21% between and 24 months are estimated to be anemic [5]. To improve child nutritional status in rural China, Yingyangbao (YYB) was developed as a nutrient-dense complementary food supplement for infants and young children 6–36 months old. YYB provides calories (usually around 50 kcal per sachet) and protein (3 g per sachet) [6,7,8]
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