补充铁对0～5岁儿童生长发育影响的随机对照试验的Meta分析

EFFECT OF IRON SUPPLEMENTATION ON THE GROWTH OF CHILDREN UNDER FIVE YEARS OLD:A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

目的采用Meta分析系统定量地评价单纯补铁、铁和叶酸联合补充以及含铁的多种微量营养素补充对0～5岁儿童生长发育的影响,探讨铁在儿童生长发育中的作用,为儿童合理补铁提供科学依据。方法以"iron"、"folic acid"、"micronutrient"、"growth"、"growth and development"、"child"、"children"和"infant"为主题词和关键词联合检索PubMed、Medline、Embase、SinoMed、CNKI和万方数据库的相关文献,对符合纳入排除标准的文献进行质量评价及摘录所需数据,以年龄别身高(height for age z-score,HAZ)、年龄别体重(weight for age Z-score,WAZ)和身高别体重(weight for height Z-score,WHZ)干预前后变化值的标准均数差作为效应值,分为单纯补充、铁和叶酸联合补充以及含铁的多种微量营养素补充三部分,运用Revman5.2软件进行Meta分析。结果共纳入18篇合格文献。Meta分析显示,单纯补充铁对儿童HAZ影响的标准均数差(standard mean difference,SMD)=-0.07(95%CI:-0.32,0.18),对WAZ影响的SMD=0.05(95%CI:-0.03,0.13),对WHZ影响的SMD=0.09(95%CI:-0.06,0.25);铁和叶酸联合补充对儿童HAZ影响的SMD=0.46(95%CI:-0.06,0.99),对WAZ影响的SMD=0.18(95%CI:-0.00,0.37);含铁的多种微量营养素补充对儿童HAZ影响的SMD=0.40(95%CI:-0.13,0.92),对WAZ影响的SMD=0.25(95%CI:-0.08,0.59),对WHZ影响的SMD=0.01(95%CI:-0.15,0.16)。结论以10～30 mg/d的剂量补充铁对0～5岁儿童HAZ、WAZ和WHZ未起到促进作用。

Objective To evaluate the association between iron supplementation and growth of children and provide scientific basis for iron supplementation in children. Methods We searched articles through the PubMed, Medline, Embase, SinoMed, CNKI and Wanfang database using key words of iron, folic acid, micronutrient, growth, growth and development, child, children and infant. The quality of the included articles was evaluated and the required data was extracted. The changes of heights for age z-score（HAZ）,weight for age z-score（WAZ） and weight for height z-score（WHZ） were employed as the effect values. Eligible articles were analyzed using Review Manager 5.2. Results Among eighteen randomized controlled trials, the combined standard mean difference（SMD）（95% CI） of iron supplementation was-0.07（-0.32,0.18） for HAZ, 0.05（-0.03,0.13） for WAZ, and 0.09（-0.06,0.25） for WHZ, respectively. Similarly, the combined SMD（95% CI） of iron-folate supplementation was 0.46（-0.06,0.99） for HAZ and 0.18（-0.00,0.37） for WAZ. The combined SMD（95% CI） of multi-micronutrients supplementation was 0.40（-0.13,0.92） for HAZ, 0.25（-0.08,0.59） for WAZ, and 0.01（-0.15,0.16） for WHZ, respectively. Conclusion From this meta-analysis iron supplementation did not affect significantly the growth of children.