Zinc, Iron, Vitamin A and Psychosocial Care for Child Growth and Development

NCT ID: NCT02319499

Last Updated: 2014-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

800 participants

Study Classification

INTERVENTIONAL

Study Start Date

1998-08-31

Brief Summary

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Many Indonesian infants are already iron deficient before they reach the age of six months, which also determines the high prevalence of anemia among under-five children. Iron deficiency ultimately leads to anemia, and there is clear evidence that iron deficiency anemia during early childhood has a marked negative effect on child development and cognitive function (Lozoff et al.1991; Idjradinata \& Pollitt, 1993). This negative impact on childhood development is one of the main reasons why iron deficiency during infancy should be prevented or treated.

Since diets low in iron is usually also low in zinc, zinc deficiency --which has negative consequence on growth-- is common in iron deficiency area. In Southeast Asia, the condition is exacerbated by the rich phytate content in the complementary foods which inhibits the absorption of iron as well as zinc (Gibson, 1994). Thus, combining both iron and zinc, hence, is expected to decrease both iron and zinc deficiencies and hence improve growth and development of the children.

Recently, there has been an emerging view which looks at the two-way relationship between nutrition, health, and psychosocial well-being. This concept is supported by studies on "positive deviance", a term used to refer to children who grow and develop well in impoverished environments where most children are victims of malnutrition and chronic illness (Zeitlin et al., 1990). The mechanism which helps to explain how psychosocial factors, such as the affect between mother and child, are associated with adequate growth and development: 'Psychological stress has a negative effect on the use of nutrients whereas psychological well-being stimulates the secretion of growth-promoting hormones. Pleasantly stimulating interactions can enhance the child's tendency to exercise its developing organ systems and hence to utilize nutrients for growth and development'.

Understanding how the psychosocial environment can promote or inhibit the benefit of supplementation intervention is necessary in order to have a better way of setting about providing supplements. In fact, many supplementation programs do not incorporate complementary program elements that would help to improve the health and psychosocial development of children at the same time that they improve nutritional status' (Myers, 1995). Looking from this perspective, not only will supplementation benefit the psychosocial development but also the psychosocial environment can promote the benefit of the supplementation on the nutritional status and developmental outcomes of infants.

The purpose of the study is to investigate whether multi-micronutrient supplementations (zinc+iron, zinc+iron+vit.A) have positive effect on infants' growth and developmental outcomes, and whether the effect is modified by psychosocial care.

Detailed Description

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Conditions

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Development Iron Deficiency Zinc Deficiency

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Zinc Alone

Zinc Sulphate (10 mg Zn/day)

Group Type EXPERIMENTAL

Zinc Alone

Intervention Type DIETARY_SUPPLEMENT

Zn-alone group received 10 mg/day of elemental zinc (as zinc sulphate)

Iron and Zinc

Ferrous Sulphate and Zinc Sulphate (10 mg/day of each zinc and iron)

Group Type EXPERIMENTAL

Iron and Zinc

Intervention Type DIETARY_SUPPLEMENT

Zn+Fe group received 10 mg/day of elemental zinc (as zinc sulphate) and 10 mg/day of elemental iron (as ferrous sulphate)

Iron, Zinc and Vitamin A

Ferrous Sulphate, Zinc Sulphate and Vitamin A (10 mg/day of each zinc and iron, plus 1,000 IU vitamin A/day)

Group Type EXPERIMENTAL

Iron, Zinc and Vitamin A

Intervention Type DIETARY_SUPPLEMENT

Zn+Fe+vit.A group received 10 mg/day of elemental zinc (as zinc sulphate) and 10 mg/day of elemental iron (as ferrous sulphate), plus 1,000 IU/day of vitamin A

Placebo

No minerals/vitamin

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

Placebo group received no minerals/vitamin

Interventions

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Zinc Alone

Zn-alone group received 10 mg/day of elemental zinc (as zinc sulphate)

Intervention Type DIETARY_SUPPLEMENT

Iron and Zinc

Zn+Fe group received 10 mg/day of elemental zinc (as zinc sulphate) and 10 mg/day of elemental iron (as ferrous sulphate)

Intervention Type DIETARY_SUPPLEMENT

Iron, Zinc and Vitamin A

Zn+Fe+vit.A group received 10 mg/day of elemental zinc (as zinc sulphate) and 10 mg/day of elemental iron (as ferrous sulphate), plus 1,000 IU/day of vitamin A

Intervention Type DIETARY_SUPPLEMENT

Placebo

Placebo group received no minerals/vitamin

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* 3 to 6 month old
* predominantly breast-fed children (assuming the infants were already introduced complementary feedings as early as 4 months)
* parental consent

Exclusion Criteria

* apparent congenital abnormalities
Minimum Eligible Age

3 Months

Maximum Eligible Age

6 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Indonesia University

OTHER

Sponsor Role lead

Responsible Party

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Umi Fahmida

Dr

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Umi Fahmida, PhD

Role: PRINCIPAL_INVESTIGATOR

South East Asian Ministers of Education Organization, Regional Center for Food and Nutrition (SEAMEO-RECFON)

Locations

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South East Asian Ministers of Education Organization, Regional Center for Food and Nutrition (SEAMEO-RECFON)

Jakarta, Java, Indonesia

Site Status

Countries

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Indonesia

References

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Schultink W, Gross R. Iron deficiency alleviation in developing countries. Nutr Res Rev. 1996 Jan;9(1):281-93. doi: 10.1079/NRR19960015. No abstract available.

Reference Type BACKGROUND
PMID: 19094274 (View on PubMed)

Colomer J, Colomer C, Gutierrez D, Jubert A, Nolasco A, Donat J, Fernandez-Delgado R, Donat F, Alvarez-Dardet C. Anaemia during pregnancy as a risk factor for infant iron deficiency: report from the Valencia Infant Anaemia Cohort (VIAC) study. Paediatr Perinat Epidemiol. 1990 Apr;4(2):196-204. doi: 10.1111/j.1365-3016.1990.tb00638.x.

Reference Type BACKGROUND
PMID: 2362876 (View on PubMed)

Lozoff B, Brittenham GM, Wolf AW, McClish DK, Kuhnert PM, Jimenez E, Jimenez R, Mora LA, Gomez I, Krauskoph D. Iron deficiency anemia and iron therapy effects on infant developmental test performance. Pediatrics. 1987 Jun;79(6):981-95.

Reference Type BACKGROUND
PMID: 2438638 (View on PubMed)

Idjradinata P, Pollitt E. Reversal of developmental delays in iron-deficient anaemic infants treated with iron. Lancet. 1993 Jan 2;341(8836):1-4. doi: 10.1016/0140-6736(93)92477-b.

Reference Type BACKGROUND
PMID: 7678046 (View on PubMed)

Brown KH, Wuehler SE and Peerson JM (2001). The importance of zinc in human nutrition and estimation of the global prevalence of zinc deficiency. Food Nutr Bull 22 (2):113-25

Reference Type BACKGROUND

Gibson RS and Ferguson EL (1999). An Interactive 24-hour Recall for Assessing the Adequacy of Iron and Zinc Intakes in Developing Countries. ILSI Press, Washington DC

Reference Type BACKGROUND

Ronaghy HA, Reinhold JG, Mahloudji M, Ghavami P, Fox MR, Halsted JA. Zinc supplementation of malnourished schoolboys in Iran: increased growth and other effects. Am J Clin Nutr. 1974 Feb;27(2):112-21. doi: 10.1093/ajcn/27.2.112. No abstract available.

Reference Type BACKGROUND
PMID: 4591425 (View on PubMed)

Walravens PA, Chakar A, Mokni R, Denise J, Lemonnier D. Zinc supplements in breastfed infants. Lancet. 1992 Sep 19;340(8821):683-5. doi: 10.1016/0140-6736(92)92229-9.

Reference Type BACKGROUND
PMID: 1355797 (View on PubMed)

Umeta M, West CE, Haidar J, Deurenberg P, Hautvast JG. Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial. Lancet. 2000 Jun 10;355(9220):2021-6. doi: 10.1016/S0140-6736(00)02348-5.

Reference Type BACKGROUND
PMID: 10885352 (View on PubMed)

Rosado JL, Lopez P, Munoz E, Martinez H, Allen LH. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. Am J Clin Nutr. 1997 Jan;65(1):13-9. doi: 10.1093/ajcn/65.1.13.

Reference Type BACKGROUND
PMID: 8988907 (View on PubMed)

Cavan KR, Gibson RS, Grazioso CF, Isalgue AM, Ruz M, Solomons NW. Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial. Am J Clin Nutr. 1993 Mar;57(3):344-52. doi: 10.1093/ajcn/57.3.344.

Reference Type BACKGROUND
PMID: 8438768 (View on PubMed)

Bates CJ, Evans PH, Dardenne M, Prentice A, Lunn PG, Northrop-Clewes CA, Hoare S, Cole TJ, Horan SJ, Longman SC, et al. A trial of zinc supplementation in young rural Gambian children. Br J Nutr. 1993 Jan;69(1):243-55. doi: 10.1079/bjn19930026.

Reference Type BACKGROUND
PMID: 8457531 (View on PubMed)

Engle P and Ricciuti HN (1995). Psychosocial aspects of care and nutrition. Food Nutr Bull 16(4):356-77

Reference Type BACKGROUND

Myers R (1995). The Twelve Who Survive: Strengthening Programmes of Early Childhood Development in the Thirld World. High/Scope Press, Michigan

Reference Type BACKGROUND

Bayley (1993). Bayley Scales of Infant Development: Manual, 2nd ed. Harcourt Brace & Co., San Antonio

Reference Type BACKGROUND

Caldwell BM and Bradley RH (1984). Home Observation for Measurement of the Environment. University of Arkansas, Little Rock - Arkansas

Reference Type BACKGROUND

Other Identifiers

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ZIAP

Identifier Type: -

Identifier Source: org_study_id