The role of zinc and iron-folic acid supplementation on early child temperament and eating behaviors in rural Nepal: a randomized controlled trial.

Pamela J Surkan,Subarna K Khatry,James M Tielsch,Rebecca J Stoltzfus,Emily H Siegel,Steven C Leclerq,Joanne Katz,Mary Katherine Charles,Rachel A Nugent

doi:10.1371/journal.pone.0114266

Pamela J Surkan, Subarna K Khatry + Show 7 more

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https://doi.org/10.1371/journal.pone.0114266

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Abstract

Child eating behaviors play an important role in nutrient intake, ultimately affecting child growth and later outcomes in adulthood. The study assessed the effects of iron-folic acid and zinc supplementation on child temperament and child eating behaviors in rural Nepal. Children (N = 569) aged 4–17 months in Sarlahi district, southern Nepal were randomized to receive daily supplements of placebo, iron-folic acid, zinc, or zinc plus iron-folic acid and followed for approximately 1 year. At baseline and four follow-up visits mothers completed questionnaires including information on demographic characteristics and child temperament and eating behaviors. The main effects of zinc and iron-folic acid supplementation on temperament and eating behaviors were assessed through crude and adjusted differences in mean cumulative score changes between visits 1 and 5. The adjusted rate-of-change for these outcomes was modeled using generalized estimating equations. Mean changes in temperament scores and in eating behavior scores between visits 1 and 5 were not significant in either the zinc or non-zinc group. Children in the iron-folic acid group increased temperament scores by 0.37 points over 5 visits (95% CI 0.02, 0.7), which was not significant after adjustment. Neither the adjusted rate-of-change in temperament scores between zinc and non-zinc (β = −0.03, 95% CI −0.3, 0.2) or iron-folic acid and non-iron-folic acid (β = 0.08, 95% CI −0.2, 0.3) were significantly different. Adjusted rate of change analysis showed no significant difference between zinc and non-zinc (β = −0.14, 95% CI −0.3, 0.04) or between iron and non-iron eating behavior scores (β = −0.11, 95% CI −0.3, 0.1). Only among children with iron-deficiency anemia at baseline was there a significant decrease in eating behavior score, indicating better eating behaviors, when supplemented with zinc (β = −0.3, 95% CI −0.6, −0.01), Ultimately, this effect of zinc on eating behaviors was the only effect we observed after approximately one year of micronutrient supplementation.Trial RegistrationClinicalTrials.gov NCT00109551

Highlights

Malnutrition remains a pervasive global problem, predominantly for children living in lowand middle-income countries
Child temperament has been characterized by individual differences in behavior, self-regulation and reactivity based on any given individual’s unique physiological status that tend to persist over time.[7,8]
For infants included in the temperament analysis, compliance with treatment was lowest among the group taking iron-folic acid only and highest among the placebo group

Summary

Introduction

Malnutrition remains a pervasive global problem, predominantly for children living in lowand middle-income countries. In South-central Asia, 33% of children under age five are estimated to be underweight, with micronutrient deficiencies affecting both physical and cognitive developmental processes.[1] As in many low-income countries, iron and zinc deficiencies are a significant problem in rural Nepal,[2] where an estimated 43% of children below the age of two suffer from iron-deficiency anemia[3] and 16% are estimated to have serum zinc levels under 9.2 μmols/L.[4] Both child temperament and child eating behaviors are related to various aspects of child nutrition.[5,6]. Eating behaviors play an important role in nutrient intake,[14] affecting child growth[11] and long-term major health outcomes into adulthood.[15]

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