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Community and International Nutrition

Antenatal Micronutrient Supplementation Reduces Metabolic Syndrome in 6- to 8-Year-Old Children in Rural Nepal^1,2

³ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 and ⁴ The Nepal Nutrition Intervention Project-Sarlahi, Nepal Netra Jyoti Sangh, Tripureswor, Kathmandu, Nepal

Previously, we showed that antenatal micronutrient supplementation increases birth weight in a malnourished rural South Asian setting, but the long-term effects are unknown. Between 1999 and 2001, pregnant women were sector-randomized to receive from early pregnancy through 3 mo postpartum daily micronutrient supplements containing either vitamin A alone as the control or with folic acid; folic acid+iron; folic acid+iron+zinc; or a multiple micronutrient supplement that included the above nutrients plus 11 others. From 2006 to 2008, 3524 children (93% of surviving children) were revisited between the ages of 6 and 8 y. Blood pressure, BMI, waist circumference, glycated hemoglobin, cholesterol, triglycerides, glucose, insulin, and the urinary microalbumin:creatinine ratio were assessed among children. Insulin resistance was estimated using the homeostasis model assessment (HOMA) and metabolic syndrome was defined using a modified National Cholesterol Education Program definition. None of the micronutrient supplement combinations affected blood pressure, cholesterol, triglycerides, glucose, insulin, or HOMA. There was a reduced risk of microalbuminuria (3.40 mg/mmol creatinine) in the folic acid [odds ratio (OR), 0.56; 95%CI, 0.33–0.93; P = 0.02) and folic acid+iron+zinc (OR, 0.53; CI, 0.32–0.89; P = 0.02) groups and a reduced risk of metabolic syndrome in the folic acid group (OR, 0.63; CI, 0.41–0.97; P = 0.03). Maternal supplementation with folic acid or folic acid+iron+zinc reduced the risk of kidney dysfunction and, to some extent, metabolic syndrome among children at 6–8 y of age. Supplementation with multiple micronutrients had no such affect. Future follow-up studies are needed to examine long-term supplementation effects on risk of chronic diseases in adults.

^* To whom correspondence should be addressed. E-mail: email: pchristi{at}jhsph.edu.

Manuscript received 5 March 2009. Initial review completed 26 April 2009. Revision accepted 30 May 2009.

Published online 23 June 2009.