Elsevier

Advances in Nutrition

Volume 8, Issue 2, March 2017, Pages 323-336
Advances in Nutrition

The Impact of Nutritional Interventions beyond the First 2 Years of Life on Linear Growth: A Systematic Review and Meta-Analysis

https://doi.org/10.3945/an.116.013938Get rights and content
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Abstract

A large body of evidence suggests that the first 1000 d from conception is a critical window in which interventions to address malnutrition will be most effective, but little is known about the impact on linear growth of nutritional interventions in children ≥2 y of age. The aim of this analysis was to evaluate the effectiveness of several nutrition-based interventions, specifically iron, zinc, calcium, iodine, vitamin A, multiple (≥2) micronutrients, protein, and food, at improving growth in children ≥2 y of age. A systematic search of MEDLINE and EMBASE retrieved 7794 articles. A total of 69 studies met prespecified inclusion criteria. Baseline height-for-age z score, age, nutrient dose, and study duration were examined as potential sources of heterogeneity. Zinc (mean effect size: 0.15; 95% CI: 0.06, 0.24), vitamin A (0.05; 95% CI: 0.01, 0.09), multiple micronutrients (0.26; 95% CI: 0.13, 0.39), and protein (0.68; 95% CI: 0.30, 1.05) had significant positive effects on linear growth, with baseline height-for-age z score as a significant inverse predictor of the effect size. Iron, calcium, iodine, and food-based interventions had no significant effect on growth. Age at baseline, study duration, and dose were not related to effect size for any nutrient examined. These findings suggest that zinc, vitamin A, multiple micronutrients, and protein interventions delivered after 24 mo of age can have a positive effect on linear growth, especially in populations that have experienced growth failure.

zinc
iron
calcium
vitamin A
protein
multiple micronutrient
stunting
1000 days

Abbreviations used

HAZ
height-for-age z score
LMICs
low- and middle-income countries
MM
multiple micronutrient

Cited by (0)

Supported by NIH award T32 DK007734.

Supplemental Figures 1–5 and Supplemental Table 1 are available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://advances.nutrition.org.

Author disclosures: JL Roberts and AD Stein, no conflicts of interest.