Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/17/2006
Publication Date: 6/26/2006
Publication URL: http://jn.nutrition.org/cgi/reprint/136/9/2427
Citation: Olney, D.K., Pollitt, E., Kariger, P.K., Khalfan, S.S., Ali, N.S., Tielsch, J.M., Sazawal, S., Black, R., Allen, L.H., Stoltzfus, R.J. 2006. Combined iron and folic acid supplementation with or without zinc reduces time to walking unassisted among Zanzibari infants 5-11 months old. Journal of Nutrition. 136:2427-2432, 2006. Interpretive Summary: Zanzibari children aged 5-11 months benefited from iron+folic acid supplementation with or without zinc. Children who received iron+folic acid were able to walk unassisted about two weeks earlier than children who did not receive the supplement. This effect was stronger in children who were iron deficient anemic at the beginning of the study. Iron deficient anemic children who received iron+folic acid with or without zinc walked unassisted about one month earlier than those who did not receive the supplement. These results are based on a one-year supplementation trial conducted in Pemba, Zanzibar, Tanzania which included 354 children.
Technical Abstract: Iron and zinc deficiencies have been associated with delayed motor development in nutritionally at-risk children, albeit inconsistently. In this community-based, randomized double-blind trial, iron+folic acid (FeFA) (12.5 mg Fe + 50 'g folic acid), zinc (Zn) (10 mg), and iron+folic acid+zinc (FeFA+Zn) supplements or a placebo were given daily for 1 y to nutritionally at risk children in Pemba, Zanzibar. The effects of these treatments on attaining walking unassisted were evaluated using survival analysis for 354 children aged 5-11 mo at the start of supplementation. Treatment effects on changes in hemoglobin (Hb) and zinc protoporphyrin (ZPP) and height-for-age (HAZ) and weight-for-age (WAZ) Z scores were evaluated using linear regression. Attained motor milestone was recorded every 2 wk for 1 y. Hb, ZPP, HAZ and WAZ were measured at baseline and after 6 mo of treatment. FeFA with or without Zn reduced the time it took for children to walk unassisted. Children who received any iron walked unassisted sooner than those who received no iron (median difference ~ 15 d, P=0.035, risk ratio (RR)=1.28, 95% CI=1.02, 1.61) and this effect was stronger in those who had iron deficiency anemia (IDA) at baseline (median difference ~30 d, P=0.002, RR=1.68, 95% CI=1.21, 2.32). FeFA alone and Zn alone improved Hb and ZPP compared with placebo. There were no significant treatment effects on changes in HAZ or WAZ. The effects of treatment on time to walking may have been mediated by improvements in iron status or hemoglobin, but were not mediated through improvements in growth.