Preschool iron-folic acid and zinc supplementation in children exposed to iron-folic acid in utero confers no added cognitive benefit in early school-age

Parul Christian, Mary E. Morgan, Laura E. Murray-Kolb, Steven C. LeClerq, Subarna K. Khatry, Barbara Schaefer, Pamela Marie Cole, Joanne Katz, James M. Tielsch

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

In Nepal, antenatal iron-folic acid supplementation improved aspects of intellectual, executive, and fine motor function among school-age children. We examined the impact of added zinc to the maternal antenatal supplement (M-IFAZn) and preschool supplementation from 12 to 36 mo with iron-folic acid (C-IFA) ± zinc (C-IFAZn) on cognitive outcomes compared to maternal iron-folic acid (M-IFA) alone. Children 7-9 y old (n = 780) who participated in early childhood micronutrient supplementation trial during 2001-2004 and whose mothers participated in an antenatal micronutrient supplementation between 1999 and 2001 were followed for cognitive assessments in 2007-2009. Usingmultivariate analysis of variance and adjusting for confounders, M-IFAwith child supplementation (either C-IFA or C-IFAZn) did not impact scores on the tests of general intelligence (Universal Nonverbal Intelligence Test), and executive function (Stroop and go/no go tests) relative to theM-IFA alone. However, children in the C-IFAZn group had slightly lower scores on the backward digit span (20.29, 95% CI: -0.55, 20.04) and Movement Assessment Battery for Children (1.33, 95% CI: 0.26, 2.40) relative to the referent group, whereas both C-IFA (-1.92, 95% CI: -3.12, -0.71) and C-IFAZn (-1.78, 95% CI: 22.63, -0.92) produced somewhat lower finger tapping test scores (fine motor skills). The combination of M-IFAZn and C-IFA or C-IFAZn did not lead to any outcome differences relative to M-IFA alone. Preschool iron-folic acid ± zinc to children exposed to iron-folic acid in utero or addition of zinc to maternal iron-folic acid conferred no additional benefit to cognitive outcomes assessed in early school age. The late timing of supplementation during preschool may explain the lack of impact of iron and/or zinc.

Original languageEnglish (US)
Pages (from-to)2042-2048
Number of pages7
JournalJournal of Nutrition
Volume141
Issue number11
DOIs
StatePublished - Jan 1 2011

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Folic Acid
Zinc
Iron
Mothers
Intelligence Tests
Micronutrients
Nepal
Motor Skills
Executive Function
Fingers
Analysis of Variance

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Christian, Parul ; Morgan, Mary E. ; Murray-Kolb, Laura E. ; LeClerq, Steven C. ; Khatry, Subarna K. ; Schaefer, Barbara ; Cole, Pamela Marie ; Katz, Joanne ; Tielsch, James M. / Preschool iron-folic acid and zinc supplementation in children exposed to iron-folic acid in utero confers no added cognitive benefit in early school-age. In: Journal of Nutrition. 2011 ; Vol. 141, No. 11. pp. 2042-2048.
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abstract = "In Nepal, antenatal iron-folic acid supplementation improved aspects of intellectual, executive, and fine motor function among school-age children. We examined the impact of added zinc to the maternal antenatal supplement (M-IFAZn) and preschool supplementation from 12 to 36 mo with iron-folic acid (C-IFA) ± zinc (C-IFAZn) on cognitive outcomes compared to maternal iron-folic acid (M-IFA) alone. Children 7-9 y old (n = 780) who participated in early childhood micronutrient supplementation trial during 2001-2004 and whose mothers participated in an antenatal micronutrient supplementation between 1999 and 2001 were followed for cognitive assessments in 2007-2009. Usingmultivariate analysis of variance and adjusting for confounders, M-IFAwith child supplementation (either C-IFA or C-IFAZn) did not impact scores on the tests of general intelligence (Universal Nonverbal Intelligence Test), and executive function (Stroop and go/no go tests) relative to theM-IFA alone. However, children in the C-IFAZn group had slightly lower scores on the backward digit span (20.29, 95{\%} CI: -0.55, 20.04) and Movement Assessment Battery for Children (1.33, 95{\%} CI: 0.26, 2.40) relative to the referent group, whereas both C-IFA (-1.92, 95{\%} CI: -3.12, -0.71) and C-IFAZn (-1.78, 95{\%} CI: 22.63, -0.92) produced somewhat lower finger tapping test scores (fine motor skills). The combination of M-IFAZn and C-IFA or C-IFAZn did not lead to any outcome differences relative to M-IFA alone. Preschool iron-folic acid ± zinc to children exposed to iron-folic acid in utero or addition of zinc to maternal iron-folic acid conferred no additional benefit to cognitive outcomes assessed in early school age. The late timing of supplementation during preschool may explain the lack of impact of iron and/or zinc.",
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Preschool iron-folic acid and zinc supplementation in children exposed to iron-folic acid in utero confers no added cognitive benefit in early school-age. / Christian, Parul; Morgan, Mary E.; Murray-Kolb, Laura E.; LeClerq, Steven C.; Khatry, Subarna K.; Schaefer, Barbara; Cole, Pamela Marie; Katz, Joanne; Tielsch, James M.

In: Journal of Nutrition, Vol. 141, No. 11, 01.01.2011, p. 2042-2048.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preschool iron-folic acid and zinc supplementation in children exposed to iron-folic acid in utero confers no added cognitive benefit in early school-age

AU - Christian, Parul

AU - Morgan, Mary E.

AU - Murray-Kolb, Laura E.

AU - LeClerq, Steven C.

AU - Khatry, Subarna K.

AU - Schaefer, Barbara

AU - Cole, Pamela Marie

AU - Katz, Joanne

AU - Tielsch, James M.

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N2 - In Nepal, antenatal iron-folic acid supplementation improved aspects of intellectual, executive, and fine motor function among school-age children. We examined the impact of added zinc to the maternal antenatal supplement (M-IFAZn) and preschool supplementation from 12 to 36 mo with iron-folic acid (C-IFA) ± zinc (C-IFAZn) on cognitive outcomes compared to maternal iron-folic acid (M-IFA) alone. Children 7-9 y old (n = 780) who participated in early childhood micronutrient supplementation trial during 2001-2004 and whose mothers participated in an antenatal micronutrient supplementation between 1999 and 2001 were followed for cognitive assessments in 2007-2009. Usingmultivariate analysis of variance and adjusting for confounders, M-IFAwith child supplementation (either C-IFA or C-IFAZn) did not impact scores on the tests of general intelligence (Universal Nonverbal Intelligence Test), and executive function (Stroop and go/no go tests) relative to theM-IFA alone. However, children in the C-IFAZn group had slightly lower scores on the backward digit span (20.29, 95% CI: -0.55, 20.04) and Movement Assessment Battery for Children (1.33, 95% CI: 0.26, 2.40) relative to the referent group, whereas both C-IFA (-1.92, 95% CI: -3.12, -0.71) and C-IFAZn (-1.78, 95% CI: 22.63, -0.92) produced somewhat lower finger tapping test scores (fine motor skills). The combination of M-IFAZn and C-IFA or C-IFAZn did not lead to any outcome differences relative to M-IFA alone. Preschool iron-folic acid ± zinc to children exposed to iron-folic acid in utero or addition of zinc to maternal iron-folic acid conferred no additional benefit to cognitive outcomes assessed in early school age. The late timing of supplementation during preschool may explain the lack of impact of iron and/or zinc.

AB - In Nepal, antenatal iron-folic acid supplementation improved aspects of intellectual, executive, and fine motor function among school-age children. We examined the impact of added zinc to the maternal antenatal supplement (M-IFAZn) and preschool supplementation from 12 to 36 mo with iron-folic acid (C-IFA) ± zinc (C-IFAZn) on cognitive outcomes compared to maternal iron-folic acid (M-IFA) alone. Children 7-9 y old (n = 780) who participated in early childhood micronutrient supplementation trial during 2001-2004 and whose mothers participated in an antenatal micronutrient supplementation between 1999 and 2001 were followed for cognitive assessments in 2007-2009. Usingmultivariate analysis of variance and adjusting for confounders, M-IFAwith child supplementation (either C-IFA or C-IFAZn) did not impact scores on the tests of general intelligence (Universal Nonverbal Intelligence Test), and executive function (Stroop and go/no go tests) relative to theM-IFA alone. However, children in the C-IFAZn group had slightly lower scores on the backward digit span (20.29, 95% CI: -0.55, 20.04) and Movement Assessment Battery for Children (1.33, 95% CI: 0.26, 2.40) relative to the referent group, whereas both C-IFA (-1.92, 95% CI: -3.12, -0.71) and C-IFAZn (-1.78, 95% CI: 22.63, -0.92) produced somewhat lower finger tapping test scores (fine motor skills). The combination of M-IFAZn and C-IFA or C-IFAZn did not lead to any outcome differences relative to M-IFA alone. Preschool iron-folic acid ± zinc to children exposed to iron-folic acid in utero or addition of zinc to maternal iron-folic acid conferred no additional benefit to cognitive outcomes assessed in early school age. The late timing of supplementation during preschool may explain the lack of impact of iron and/or zinc.

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