Micronutrient Powders Improve At-Risk Infants’ Language Development
Malnutrition can have long term effects on health and development, especially when it occurs during the first thousand days of a child’s life, from before conception to the age of two. From a nutrition stand-point, the best outcomes for children occur when their mothers are well-nourished from the pre-pregnancy period up until birth, and they receive appropriate and adequate nutrition that is tied to their age and development throughout infancy and childhood. Unfortunately, this is not always possible. The prevalence of children who are negatively affected by malnutrition is high in low- and middle-income, and probably limits the health and cognitive ability of populations, to the extent that overall national development is impaired.
Treating the root causes of malnutrition require attention to a host of different areas such food security, education, dietary diversification and the prevention and treatment of disease. Multiple micronutrients have a part to play here. While international organizations tend to focus on overall energy intake and the “big three” micronutrients (iron, vitamin A and iodine), many people with poor diets likely lack others. For example, Allen concludes that vitamin B12 deficiency is very common in developing countries and persists across the life span. Northrop-Clewes and Thurnham also report that riboflavin deficiency is likely prevalent in many countries, but is not noticed as it is concurrent with poor general nutrient intakes and has non-specific symptoms. Many micronutrients are important for the normal physical and cognitive development of infants and children. Therefore, nutritional interventions that attempt to provide the full range of micronutrients required for health may be more effective than those that only target the most pressing or noticeable deficiencies.
To test this, Singla and co-workers tested the effect of a multiple micronutrient powder formulation containing 22 vitamins and minerals on cognitive and language development of 186 small-for-gestational-age term infants living in Bangladesh. As part of a larger study, infants were randomized first to nutrition-, hygiene- and health-related educational messages, then around half of these received micronutrient powder sachets that provided around 100% of requirements for all vitamins and 9 important minerals. Sachets are were added directly to food before consumption. Infants received the supplements between 7 and 12 months of age. Toddlers’ cognitive and language development were assessed 4 to 10 months after completing the intervention via use of the Bayley III Scales of Infant Development.
The authors found that expressive language skills were more developed in the intervention group. In addition, cognitive development showed a non-significant increase in infants who were given the multiple micronutrients. Another interesting finding was that although receptive language scores were lower in stunted children in the control group, there was no difference found in the intervention group by stunting status. This suggests that the intervention was able to reduce the negative effects of stunting on language development.
To grow and reach their potential, infants must be given more than just micronutrients. However this study suggests that they are an important part of helping children from low-resource backgrounds improve their cognitive potential.
Daisy R. Singla, Sohana Shafique, Stanley H. Zlotkin, and Frances E. Aboud. A 22-Element Micronutrient Powder Benefits Language but Not Cognition in Bangladeshi Full-Term Low-Birth-Weight Children. J. Nutr. jn.114.193094; first published online August 20, 2014. doi:10.3945/jn.114.193094
Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009 Feb;89(2):693S-6S. doi: 10.3945/ajcn.2008.26947A. Epub 2008 Dec 30.
Northrop-Clewes CA, Thurnham DI. The discovery and characterization of riboflavin. Ann Nutr Metab 2012;61(3):224-30. doi: 10.1159/000343111