Anemia, motor development, and cognition: A randomized trial of iron-folic acid and/or zinc supplementation in young Nepali children

Few studies have examined the effect of iron-folic acid and zinc supplementation on the development of children less than two years of age who are at risk for nutritional deficiencies. The relation between poor nutritional status and cognitive development is not well understood. The objectives of this thesis were to (1) describe the epidemiology of anemia and iron-deficiency, (2) characterize the relation between hemoglobin concentration and growth and delays in motor milestone acquisition, and (3) examine the effect of supplementation with iron-folic acid and/or zinc on cognitive development among 569 4- to 17-month old children living in the south central Terai region of Nepal.; In two multivariate models, with and without EP, age and caste were found to be strong predictors of both hemoglobin concentration and anemia. Compared with American and British reference populations, the Nepali sample experienced at least a 1.5 month delay in achieving walking without support. Multivariate logistic models that controlled for age, sex, caste, and socio-economic status revealed that hemoglobin concentration and several growth variables (length-for-age, weight-for-length, weight-for-age, mid-upper arm circumference (MUAC), and head circumference) were each associated with motor milestone maturation. In addition, hemoglobin concentration and length-for-age were found to have an independent effect on motor milestone acquisition. Children with higher growth measurements and hemoglobin values attained motor milestones at an earlier age than children with lower values. Compliance data revealed that children consumed the supplements on average 5 of 7 days a week. The results suggest that the four groups were not similar prior to data collection. Compared to the other groups, the zinc group had more girls than boys, more high caste members, children from families possessing a greater number of material assets, and higher compliance than the three other groups (p < 0.05). Adjustment in linear regression models for cluster randomization, dose, sex, caste, socio-economic status, stunting, hemoglobin concentration, and iron deficiency revealed no effect of supplementation on information processing indices. Neither 39- nor 52-week infants enrolled in any one of the treatment groups compared with the placebo group had statistically significant differences on any of the four information processing outcomes. (Abstract shortened by UMI.)...