Introduction
Methodology
Inclusion and exclusion criteria
Criteria | Inclusion | Exclusion |
---|---|---|
Population (P) | Vietnamese infants, young children, and adolescents aged 0–18 years old | Those who have been diagnosed with any chronic or congenital diseases that potentially affect the child’s nutritional status |
Exposure (E) and intervention (I) | Any studies that reported the prevalence, determinants of childhood malnutrition, and interventions (including both nutrition specific and sensitive programmes) aiming to address childhood malnutrition | Studies assessing the genetic effects on malnutrition indicators; interventions targeted at mothers or pregnant women with no child outcomes; interventions that only reported the protocol with no outcomes |
Comparison (C) | Those who were exposed to the risk factors or interventions related to malnutrition | Not applicable |
Outcome (O) | Malnutrition indicators including undernutrition (stunting, wasting, underweight, and thinness), overnutrition (overweight and obesity) and micronutrient deficiencies, assessed by blood biomarkers such as iron (or ferritin, transferrin), vitamin A (or retinol), vitamin B9 (or folate/folic acid), anaemia (haemoglobin (Hb)), zinc, and iodine | Studies that do not assess malnutrition indicators as the primary outcomes or focused on the consequences of malnutrition |
Search strategy
Study selection
Data extraction
Data synthesis
Quality criteria checklist for risk of bias
Results
Risk of bias assessment
General characteristics of the studies included
Undernutrition | Overnutrition | MNDs | Undernutrition, overnutrition, and MNDs | Total | |
---|---|---|---|---|---|
< 5 years old | 18 | 2 | 8 | 6 | 34 |
5–11 years old | 9 | 2 | 6 | 8 | 25 |
12–18 years old | 0 | 7 | 1 | 5 | 13 |
Total | 27 | 11 | 15 | 19 | 72 |
Prevalence of different forms of malnutrition
Authors and year | Study design & duration | Sample age | Sample size | Measurements | Key findings—prevalence | Risk of bias |
---|---|---|---|---|---|---|
< 5 years old | ||||||
Smuts et al. 2005 [2] | Baseline data of a double blinded, RCT | 6–11 months | 257 | Weight, height, WAZ, HAZ, and WHZ Blood: serum levels of Hb, ferritin, retinol, and zinc | 12.7% underweight 8.0% stunted 3.0% wasted 89.9% anaemic 20.2% retinol deficient 22.5% zinc deficient | Low |
Khan et al. 2007 [23] | Repeat cross-sectional 1990–2005 (14 years) | 0–5 years | 357,396 1990 = 37,972 1994 = 37,654 2000 = 94,469 2002 = 91,921 2004 = 95,380 | Weight, height, and BMI | Underweight decreased by 18.4% (from 45% to 26.6%) Stunting decreased by 25.8% (from 56.5% to 30.7%) Wasting decreased by 1.7% (from 9.4% to 7.7%) | Low |
Nguyen et al. 2007 [24] | Cross-sectional | 0–5 years | 1,657 | Blood: serum retinol and Hb Retinol deficiency = retinol < 0.70 μmol/L Anaemia: Hb < 110 g/L | 12.0% retinol deficient 28.4% anaemic < 6 months old: 35.1% retinol deficient 61.7% anaemic | Low |
Nhien et al. 2008 [25] | Cross sectional | 1–6 years | 243 | Serum blood: copper, zinc, selenium, magnesium, retinol and Hb | 86.9% zinc deficient 55.6% anaemic 11.3% retinol deficient 50.2% underweight 36.2% stunted 14.4% wasted | Low |
Dieu et al. 2009 [20] | Repeated cross sectional study 2002–2005 (3 years) | 4–5 years | 1,162 2002 = 492 2005 = 670 | Weight, height, BMI Underweight = WAZ < 5th percentile Overweight/ obesity BMI > 23 kg/m2 | 36.8% obese (2005) 21.4% overweight 7.5% underweight Overweight/ obesity increased by 52.9% (p < 0.001) | Low |
Vaktskjold et al. 2010 [26] | Prospective cohort study 2005–2006 (1 year) | 0–1 year | 237 | Weight, HAZ, WLZ, and BMI-Z compared to WHO standards Blood: Hb (n = 189) | 79% below median for weight-for-length 18.0% in 5th percentile for length-for-age 9.6% in 5th percentile for weight-for age 9.6% in 5th percentile for weight-for-length 20.3% in 5th percentile for BMI-for age 11.1% anaemic | Low |
Laillou et al. 2013 [27] | Cross-sectional | 0–5 years | 532 | Weight, height Blood: plasma calcium and vitamin D | 21% vitamin D deficient 37% vitamin D insufficient 97% mild calcium deficient | Low |
Nguyen et al. 2014 [28] | Cross-sectional | 0–5 years | 4,029 | Weight and height | 16.8% stunted 13.2% underweight 4.8% wasting | Medium |
Lundeen et al. 2014 [29] | Longitudinal 8 years | 1–8 years | 1,830 | Weight, height and HAZ | 1 year: 21% stunted 5 years: 24% stunted 8 years: 19.2% stunted | Low |
Giao et al. 2019 [22] | Prospective cross-sectional | 1–2 years | 768 (receiving vaccinations) | Weight, height, HAZ and BMI-Z | 8.2% stunted 10.7% overweight/ obese | Medium |
Kim et al. 2022 [30] | Cross-sectional | 3–4 years | 103 | Weight, height, and BMI | 22.3% overweight/ obese | Low |
5–11 years old | ||||||
Hop et al. 1997 [31] | Longitudinal 1981–1994 (14 years) | 0–10 years | 212 | Weight, height and feeding practices | Stunting at 21 months: 59.4% (male) & 58.3% (female) | Low |
Hall et al. 2001 [32] | Cross-sectional 1998 | 7–11 years | 588 | Blood: Hb levels | 13% anaemic | Medium |
Mai et al. 2003 [33] | Cross-sectional 1999 | 7–9 years | 348 Girls | Weight, height, LMAC, body fat and blood pressure | Rural: 21.8% underweight 13.5% stunted 11.5% wasted 0.0% obese Urban: 5.8% underweight 1.9% stunted 5.2% wasted 5.3% obese | Low |
Tuan et al. 2008 [34] | Repeated cross sectional study 1992 – 2002 (10 years) | 2–17 years | 70,331 | Weight, height, and BMI | Overweight/ obesity increased from 1.4% to 1.8% (p = 0.07) Underweight increased from 32.1% to 33.5% (p = 0.11) | Low |
Nguyen et al. 2013 [8] | Cross-sectional SEANUTS | 0.2–11.9 years | 2,872 | Weight, height, MUAC, waist and hip circumferences Blood: Hb, ferritin, vitamin A and D | 14% stunted (< 5 years) 8.6% underweight (< 5 years) 4.4% thin (< 5 years) 15.6% stunted (5–11.9 years) 22.2% underweight (5–11.9 years) ~ 5% of overweight/obese children also stunted 38.65% anaemic (0.5–1.0 years) 18.25% anaemic (2–4.9 years) 12.47% anaemic (5–11 years) 7.75% retinol deficient (6–11.9 years) | Low |
Huong et al. 2014 [35] | Cross-sectional | 6 months-18 years | 108 | Weight, height and MUAC | 19% wasted 13.9% stunted 0% obese 7% severe wasting at 6–59 months | Low |
Le Nguyen et al. 2016 [36] | Cross-sectional 2011 SEANUTS | 6–11 years | 385 | Blood: Hb, ferritin and red blood cell count | 11.4% anaemic 5.6% iron deficient 0.4% ID anaemia | Low |
Poh et al. 2016 [37] | Cross-sectional SEANUTS | 2–15 years | 2,016 | Blood: serum vitamin D | 11.1% vitamin D deficient 37.1% vitamin D insufficient 29.4% inadequate vitamin D | Low |
Do et al. 2017 [19] | Longitudinal 2013–2016 (3 years) | 3–9 years | 2,602 | Weight and height | Overweight increased from 9.1% to 16.7% Obesity decreased from 6.4% to 4.5% | Low |
Thuc et al. 2019 [38] | Cross-sectional | 6–11 years | 155 | Vitamin D deficiency: 25(OH)D < 50 nmol/L | 23.9% vitamin D deficient | Medium |
Le and Dinh 2022 [39] | Cross-sectional 2021 | 6–11 years | 782 | Height, weight and BMI-Z | 14.32% obese 21.61% overweight | Low |
12–18 years old | ||||||
Hong et al. 2007 [40] | Repeat cross- sectional study 2002 & 2004 | 11–16 years | 3,687 2002 = 1,003 2004 = 2,684 | Height, weight, and BMI-Z | Overweight significantly increased, 6.7% (p < 0.001) Obesity significantly increased, 1.4% (p < 0.001) Underweight decreased, 6.4% (insignificant) BMI significantly greater in 2004 than 2002 (p < 0.001) | Low |
Van Nhien et al. 2009 [41] | Cross-sectional | 11–17 years | 245 girls | Weight, height and BMI Blood: Hb and trace element levels | 20.7% undernourished 20.4% anaemic 26.5% zinc deficient | Low |
Trang et al. 2012 [42] | Prospective cohort study 2004–2009 (5 years) | 11–14 years | 585 | Weight and height | Overweight/ obesity increased by 7.6% (from 14.2% to 21.8%) | Low |
Phan et al. 2020 [43] | Cross-sectional 2018 | 11–14 years | 2,788 | Weight and height using WHO and IOTF classification | 17.4% overweight (WHO) 8.6% obese (WHO) 17.1% overweight (IOTF) 5.4% obese (IOTF) | Medium |
Mai et al. 2020 [21] | Cross-sectional 2014–2015 | 6–18 years | 10,949 | Weight, height, BMI-Z and HAZ | Primary school children (6–13 years): 2.4% stunted 2.2% thin 24.3% overweight 26.9% obese Secondary school children (10–17 years): 3.8% stunted 4.6% thin 23.5% overweight 12.1% obese High school children (14–18 years): 7.9% stunted 6.0% thin 14% overweight 5.2% obese | Low |
Determinants of different forms of malnutrition
Authors and year | Study duration & design | Sample age | Sample size | Measurements | Key findings – risk factors / determinants | Risk of bias |
---|---|---|---|---|---|---|
Hanieh et al. 2015 [44] | Prospective longitudinal | 6 months | 1,046 | Length, weight, and LAZ | Positive association between infant LAZ scores at 6 months and maternal BMI (coefficient 0.04 kg/m2, CI = 0.01–0.07), weight gain during pregnancy (0.04/kg, CI = 0.01–0.06) and maternal ferritin concentration (− 41.5 g/twofold increase in ferritin, CI = − 78 to − 5.0) Inverse association between maternal 25-(OH)D concentration and infant LAZ scores (coefficient − 0.06 per 20 nmol/L, CI = -0.11 to -0.01) No association between maternal iodine status & infant LAZ | Low |
Vaktskjold et al. 2010 [26] | Prospective cohort 2005–2006 (1 year) | 0–1 year | 237 | Weight, height, LAZ, WHZ, and BMI-Z | Lower LAZ (β = -2.2, CI = -4.0 to -0.5) and WAZ (-0.5, CI = -1.0 to -0.1) were statistically associated with living rurally | Low |
Hien and Hoa 2009 [11] | Cross-sectional | 0–3 years | 383 | Weight and height | Positive association between being underweight and rural living region (OR = 2.22), minority ethnicity (OR = 1.74), mother’s occupation-housewife (OR = 7.91), household size ≤ 4 (OR = 3.07), underweight mother (OR = 1.95), number of children in the family ≥ 3 (OR = 3.35), low birth weight < 2500 g (OR = 7.99), exclusive breastfeeding duration < 6 months (OR = 4.41) and initiation of breastfeeding after 1 hour (OR = 2.54) | Medium |
Tran 2008 [45] | Cross-sectional | 0–3 years | 547 | Height, weight and questionnaire | Positive association between fathers not taking children to a medical facility for immunisation and being underweight or stunted (OR = 1.75, CI = 1.07–2.87) | Low |
Khan et al. 2007 [23] | Repeat cross-sectional 1990–2005 (14 years) | 0–5 years | 357,396 | Weight, height and BMI | Higher prevalence of underweight, stunting and wasting in rural and mountainous areas than urban areas. Larger rates of reduction of underweight, stunting and wasting in urban areas, than rural and mountainous areas Household size and being a male are all both positively associated with being stunted (β = -0.1543, p = 0.0001) | Low |
Nguyen et al. 2014 [28] | Cross-sectional | 0–5 years | 4,029 | Weight and height Maternal CMD | Maternal CMD was positively associated with underweight children (OR = 1.27, CI = 1.01–1.61). Low birth weight was positively associated with stunting (OR = 3.71, p < 0.001), underweight (OR = 3.96, p < 0.001), and wasting (OR = 3.61, p < 0.001). Poor household wealth was positively associated with underweight (OR = 1.99, p < 0.01) | Low |
Huong et al. 2014 [35] | Repeat cross–-sectional—seasons | 2–4.9 years | 853 | Weight, height and BMI | Summertime is positively associated with being underweight (p < 0.05) and stunted (p < 0.05) | Low |
Chen 2021 [51] | Young Lives Study Longitudinal 2002–2006 (4 years) | 1–6 years | 2,000 | Weight, height, WAZ, HAZ and WHZ | Negative association between malnutrition and family size; having one additional child is associated with declines of the first child’s HAZ (0.49 SD) and WAZ (0.57 SD) | Medium |
Kim et al. 2022 [30] | Cross-sectional | 3–4 years | 103 | Weight, height, physical activity and sedentary behaviour | Children not meeting screen time guidelines were at a higher risk of being overweight/ obese but was not significant (OR = 0.94, p = 0.904) | Low |
Lavin et al. 2017 [49] | Longitudinal cohort study 8 years | 0–8.5 years | 1,812 | Weight, height and HAZ | Positive associations with moderate/severe stunting were found in low birth weight (OR = 0.114, p = 0.001), food shortages (OR = 0.048, p < 0.001), rural location (OR = 0.068, p < 0.001), decreasing wealth (OR = 0.080, p = 0.008) and ethnic minority (OR = 0.077, p < 0.001) | Low |
Bennett et al. 2015 [46] | Young Lives Longitudinal Cohort study 2001–06 | 1–8 years | 1,961 | Weight, height, questionnaire and risk of maternal CMD | Maternal CMD is positively associated with stunting at age 1 (ARR = 1.24, CI = 1.03–1.62), age 8 (1.22, CI = 1.03–1.45) | Low |
Dearden et al. 2017 [48] | Longitudinal | 1–8 years | 1,905 | Height, weight and BMI-Z | Improved access to water at 1 year old was negatively associated with stunting at 1 (RR = 0.27–1.20), 5 (RR = 0.25–1.17) and 8 (RR = 0.25–1.42) years old | Low |
Huynh et al. 2011 [63] | Cohort study 2005–2006 | 4–5 years | 526 | Weight, height, SSF: SSFT, TSFT and suprailia Questionnaire: physical activity level | BMI and SSF were negatively associated with neighbourhood safety for boys (β = -0.80, CI = –1.53 to –0.08) and girls (β = -0.59, CI = -1.16 to -0.01) Boys increasing BMI was positively associated with both parents being overweight (β = 1.18, CI = 0.21–2.16) Availability of food at home was associated with increased BMI in girls (β = 1.23, CI = 1.91–0.55) but not boys | Medium |
Nguyen et al. 2013 [8] | SEANUTS multi-stage cluster-randomised sampling | 0.2–11.9 years | 2,872 | Weight, height, mid-upper arm circumference, waist and hip circumferences Blood: Hb, serum ferritin, vitamin A and D | Positive association between undernutrition and rural habitation (p < 0.05) Positive association between overnutrition and urban habitation (p < 0.05) Ferritin: significantly higher levels in urban girls than urban boys (p < 0.05) and significantly higher levels in urban children than rural children (p < 0.05) aged 6–11.9 years | Low |
Nguyen et al. 2021 [52] | Cross-sectional, follow up | 6–7 years | 1,579 | Weight, height and BMI Maternal weight, height and BMI | Preconception maternal nutritional status is positively associated with child attained size at age 6–7. Child HAZ was positively associated with maternal height (+ 0.28 SD) and BMI (+ 0.13 SD), and faster linear growth at age 6–25 months (β = 0.39–0.42) | Low |
Trinh et al. 2021 [53] | Longitudinal | 5 months – 13 years | 2,000 | Rainfall data (flooding, drought), weight, height, BMI, HAZ and WAZ | Positive association between flooding and being stunted (RR = 0.122, p < 0.01) and underweight (RR = 0.067 p < 0.01). Positive association between droughts and stunting (RR = 0.127, p < 0.01) Rainfall shocks can impact parental mental health, increasing the probability of child being underweight by 0.976 (p < 0.001) | Medium |
Hoang et al. 2019 [67] | Cross-sectional | 6–9 years | 839 | Weight and height Blood: Hb and mean corpuscular volume | Underweight, stunting and wasting were all positively associated with anaemia (p < 0.004), specifically normocytic anaemia (p < 0.006) No significant association between anaemia and demographic indicators or socio-economic indicators | Low |
Nguyen 2022 [50] | Cross-sectional | 0–15 years | 158,019 | Height, weight, HAZ and WAZ | Preschool attendance is negatively associated with prevalence of underweight (p = 0.079) and stunting (p = 0.079) at 2–15 years | Medium |
Krishna et al. 2015 [47] | Longitudinal– | 6 months—15 years | 2,489 | Weight, height and HAZ | Wealth index is positively associated with growth in children | Low |
Mai et al. 2003 [33] | Cross-sectional 1999 | 7–9 years | 348 girls | Weight, height, WAZ, HAZ, WHZ and LMAC | Positive association between rural living and being underweight (OR = 4.5, p < 0.001), stunted (OR = 7.9, P < 0.001), wasted (OR = 2.4, p = 0.039) or undernourished (OR = 3.0, p = 0.045) | Low |
Van Lierop et al. 2008 [62] | Cross-sectional | 6–10 years | 2,631 | Weight, height and waist circumference | 21.4% were stunted, and higher prevalence was found in rural regions (23.8% vs 17.3%, p < 0.001) Living in urban areas is positively associated with being overweight (4.6% vs 1.6%, p < 0.001) | Low |
Le and Dinh 2022 [39] | Cross-sectional, two-stage cluster random sampling | 6–11 years | 782 | Questionnaire, weight, height, and BMI-Z | Significant positive association between male and childhood obesity (OR = 2.48, p < 0.0001) Positive association between overweight/ obesity and children who live with only their father (OR = 11.96, p = 0.0219), transport to school being inactive (motorbike/car/bus) (OR = 1.58, p = 0.0096) and mother’s occupation being white collar (OR = 1.56, p = 0.004) | Low |
Hung et al. 2005 [65] | Longitudinal 1997–2000 (3 years) | 0–17 years | 2,767 | Blood: Hb and ferritin Malaria and intestinal helminth infection (worms) | Malaria is significantly positively associated with anaemia (OR = 2.408, p = 0.0006) No significant association between intestinal helminth & anaemia | Medium |
Hall et al. 2001 [32] | Cross-sectional | 7–11 years | 588 | Blood: Hb levels | Anaemia is positively associated with boys: Aged 7–11 years (RR = 1:07, CI = 1.10–1.13) Aged 12–14 years (1.18, CI = 1.12–1.24) Aged ≥ 15 years (1.30, CI = 1.16–1.46) | Medium |
Mai et al. 2020 [21] | Cross-sectional 2014–2015 | 6–18 years | 10,949 | Weight and height | Positive association between overweight status, urban living (p < 0.001), and male (p < 0.001) Positive association between underweight status and rural living (p < 0.001) | Low |
Trang et al. 2012 [56] | Longitudinal study 2004–2009 (5 years) | 11–14 years | 759 | Weight, height, BMI, questionnaire: level of physical activity and socio-economic status | Levels of ‘moderate-to-vigorous physical activity’ are negatively associated with overweight/ obesity (RR = 0.60, CI = 0.53–0.67) | Low |
Tang and Dibley 2022 [59] | Longitudinal | 10–15 years | 482 | Weight, height and BMI SSF: SSFT and TSFT | Male at higher risk for higher BMI than girls (p = 0.006) Inactive adolescents at higher risk of gaining weight than active adolescents; TSFT (RR = 1.43, CI = 1.22–1.67), SSFT (1.09, CI = 1.00–1.18) and BMI (1.06, CI = 1.02–1.10) | Low |
Tang et al. 2020 [57] | Cross-sectional | 10–15 years | 2,660 | Weight, height and BMI SSF: SSFT and TSFT | Overweight status was positively associated with boys (p < 0.0001) TSFT & SSSF significantly higher in girls than boys (p < 0.0001) | Low |
Nguyen et al. 2022 [58] | Cross-sectional | 11–15 years | 2,660 | Weight, height and consumption of sugar-sweetened beverages (SSBs) | Negative association between overweight/ obese status and consumption of milk based SSBs. Every kcal more of fresh milk with sugar & condensed milk, can reduce the obesity odds of 0.005 (CI = 0.002–0.008) | Low |
Hong et al. 2007 [40] | Repeated cross-sectional 2002–2004 | 11–16 years | 3,687 | Weight, height and BMI | Positive association between increase in overweight/ obesity and male: 113% increase (p < 0.001) Significant difference in the increase in prevalence by gender: obesity and overweight in males increased by 113%, with only a 39% increase in girls Poorer households showed smaller increase in obesity/overweight at 33%, compared to wealthier households at 77–124% | Low |
Tang et al. 2007 [61] | Cross-sectional | 11–16 years | 1,504 | Weight, height and BMI-Z | Being male is positively associated with being underweight (p = 0.001) Non-significant association between being male and being overweight or obese (p = 0.074) Positive association between living in wealthy urban districts and being overweight/ obese (p < 0.001) | Low |
Trang et al. 2009 [55] | Cross-sectional | 11–16 years | 2,684 | Weight, height, questionnaire: physical activity levels, and family characteristics | Being overweight is positively associated with physical inactivity (OR = 2.5, CI = 1.9–3.2), passive transport to school (OR = 4.2, CI = 3.3–5.2), no recess exercise (OR = 1.3, CI = 1.1–5.6), time spent playing video games (OR = 2.3, CI = 1.7–3.1), or watching television (OR = 1.5, CI = 1.2–1.9) | Low |
Van Nhien et al. 2009 [41] | Cross-sectional | 11–17 years | 245 girls | Weight and height Blood: serum Hb and selenium | Anaemia is positively associated with selenium deficiency (OR = 5.36, CI = 2.57–11.18), being underweight (2.72, CI = 1.37–5.37) and years of age (1.35, CI = 1.14–1.59) in girls | Low |
Tran et al. 2017 [64] | Cross-sectional | 12–17 years | 1,851 | Weight, height and memory tests | No significant association between child maltreatment and overweight or underweight status Underweight status is negatively correlated with working memory (r = -0.07, p < 0.01) and academic performance (r = -0.08, p < 0.01) Overweight status is positively associated with male (OR = 1.39, p = 0.00) and negatively associated with rurality OR = 0.66, p = 0.04) | Low |
Malnutrition Type | Rurality | Socioeconomic status: poorer | Food availability | Maternal nutrition | Gender (Male) | Physical Activity | Low birth weight | Ethnic minority | Household size | Maternal CMD |
---|---|---|---|---|---|---|---|---|---|---|
Undernutrition | + + + + + + + + | + + + | – | – | + + | + + + | + + | + + + | + + | |
Overnutrition | - - - - - | - | +/- | + | + + + + + + | - - - - | ||||
Iron deficiency | + |
Interventions and its impacts on addressing different forms of malnutrition
Authors and year | Study design & duration | Sample age | Sample size | Inclusion criteria | Intervention group Control group | Measurements | Key findings – results and effectiveness | Risk of bias |
---|---|---|---|---|---|---|---|---|
Nutrition sensitive intervention studies | ||||||||
Hop and Khan 2002 [3] | Follow-up of national nutrition strategy 1995–2000 | 0–5 years | National | Child living in included area | National Plan of Action for Nutrition (NPAN), poverty reduction, infrastructure improvement, financial support, agriculture and aquaculture extension, health care, credit & education | Weight and height | Stunting decreased from 58% to 37.3% Underweight decreased from 51.5% to 25% | Medium |
Mackintosh et al. 2002 [69] | Follow-up study to assess effectiveness of PANP (1993–1995) after 3 4 years (1998–1999) | 4–6 years (older) 1–3 years (younger group) | 55 | Families who previously participated in the PANP study and 1 younger child who had not received any PANP exposure Control group: no previous exposure to PANP | Poverty alleviation and nutrition program (PANP): growth monitoring and promotion, positive deviance inquiry, nutrition education and rehabilitation programme, and revolving loan program (n = 46 household, 142 children) Control group: no intervention (n = 25 household) | Weight, height and WAZ | After 24 months: severe malnutrition (using WAZ) had reduced from 23 to 6% No significant difference in WAZ between the groups Intervention group were ‘nutritionally better off’, had better feeding habits and weaning practices | Medium |
Watanabe et al. 2005 [70] | Uncontrolled trial and follow up (2004) 5 years total | Intervention: 4–5 years Follow up: 6.5–8.5 years | 313 | Living in a commune with a high prevalence of malnutrition, poor socioeconomic conditions, no prior intervention programme, and leaders being interested in the project | Nutrition intervention group: including growth monitoring, nutrition education rehabilitation programme, nutrition-seeking and health-seeking behaviours, feeding children locally available nutritious foods, antenatal care, home gardening, savings & credit programme (n = 172) Nutrition programme (as above) & early childhood development (ECD) group: follow up to the prior intervention Parental training: care and development. (n = 141) | Height, weight, HAZ, WAZ, WHZ, maternal and household characteristics | No statistically significant differences between intervention groups for anthropometric measures, or levels of stunting, wasting or underweight status Longitudinal results: significant decrease in stunting prevalence in both the nutrition intervention group (13.4%, p < 0.01) and ECD & nutrition group (16.3%, p < 0.01). Severe stunting was only reduced in the ECD & nutrition group by 7.8% (p < 0.01) | Medium |
Pachon et al. 2002 [71] | Longitudinal, RCT 2 years | 5–25 months | 239 | Malnourished children matched with healthy children | Save the Children: positive deviance children interviewed to find key ‘good foods’ & behaviours. This included bimonthly nutrition rehabilitation for 9 months to identify ‘good foods,’ increase food quantity, and promote breastfeeding; and monthly growth monitoring and promotion sessions for 2 years (n = 119) Control group: no intervention (n = 119) | Weight, height, BMI, WAZ, HAZ, WHZ and breastfeeding status | At 12 months, intervention children consumed 20% more food than control group (p < 0.01), and were fed more times a day than the control group (p < 0.01) No statistically significant results for WAZ at 12 months At months 2–6, for children < 15 months, 44.6% control group were undernourished compared to 68.8% (p < 0.05) However, children > 15 months, the intervention group (45.2%) had more well-nourished children than the control group (29.6%, p < 0.01) | Low |
Nutrition specific intervention studies | ||||||||
Wieringa et al. 2007 [72] | Double blinded, RCT 6 months | 4–6 months | 784 | No chronic or severe illness, severe clinical malnutrition, anaemia, congenital anomalies | Supplementations for 7 days/week: Zinc (Zn): 10 mg/day (n = 196) Iron (Fe): 10 mg/day (n = 196) Iron + zinc: 10 mg each/day (n = 196) Control group: unfortified syrup (n = 196) | Weight, height, BMI, WAZ, HAZ, WHZ Hb, SF and serum zinc | The Fe and Fe + Zn groups had significantly higher levels of Hb and SF, and lower prevalence of anaemia, than the Zn and placebo groups (p < 0.0001). Iron supplementation significantly increases Hb levels (p < 0.0001) The Zn and Fe + Zn groups had significantly higher levels of zinc than the placebo and Fe groups (p < 0.0001). After baseline value adjustment, Zn levels were significantly higher in the Zn group compared to the Fe + Zn group (p = 0.02) Zinc supplementation had a negative effect on Hb concentrations, independent of iron supplementation (-2.5 g/L, p < 0.001, p-interaction = 0.25) | Low |
Hall et al. 2007 [73] | Cluster randomised trial (CRT), 17 months | 6 years | 1,080 | Children in primary schools who had taken part in a school feeding programme (fortified biscuits & milk) | Intervention group: fortified biscuits and milk, total 300 kcal. Once a day, 5 times a week. Deworming. Nutrition and hygiene information (n = 360) Control group: no intervention (n = 720) | Weight, height, BMI, WHZ, WAZ and HAZ | The intervention group gained significantly more weight (3.19 kg vs 2.95 kg, p < 0.001) and height (8.15 cm vs 7.88 cm, p = 0.008) than the control group. After controlling for other limiting factors, the intervention programme was statistically significant for weight gain (p = 0.024), and the most undernourished children at baseline gained the least weight | Low |
Hanieh et al. 2014 [74] | Cluster randomised trial (CRT) & follow up, 1 year | 6 months | 1,175 | Pregnant women | IFA: Iron + folic acid supplement daily (60 mg iron + 0.4 mg folic acid) (n = 395) IFA: Iron + folic acid supplement twice weekly (60 mg iron + 1.5 mg folic acid) (n = 399) MMN: Multiple micronutrient supplement + Iron and folic acid, twice weekly (60 mg iron + 1.5 mg folic acid + 13 other micronutrients) (n = 381) | Birthweight, length, and weight | No difference in birth weight as well as infant LAZ at 6 months of age in the twice weekly IFA group compared to the daily IFA group (MD 20.14, CI = 20.29–0.02), nor in the twice weekly MMN group compared to the daily IFA group (MD 20.04, CI = 20.20–0.11) | Low |
Hanieh et al. 2013 [75] | CRT and follow up 1 year | 6 months | Follow up: 891 | Pregnant women | IFA: Iron + folic acid supplement daily (n = 395) (60 mg iron + 0.4 mg folic acid) (n = 395) IFA: Iron + folic acid supplement twice weekly (n = 399) (60 mg iron + 1.5 mg folic acid) (n = 399) MMN: Multiple micronutrient supplement + Iron and folic acid, twice weekly (n = 381) (60 mg iron + 1.5 mg folic acid + 13 other micronutrients) (n = 381) | LAZ, head circumference, and HAZ | Follow up: Inverse association between maternal 25-OHD status and infant HAZ at 6 months (OR = -0.09, CI = -0.12 to -0.02) | Low |
Hop and Berger 2005 [76] | Double blinded, RCT 6 months | 6–12 months | 306 | Not severely wasted, not born prematurely | DDM: daily multiple micronutrient supplement (15 micronutrients including iron) (n = 76) WMM: weekly multiple micronutrient supplement (15 micronutrients including iron) (n = 77) DI: daily iron supplement (Daily adequate intake) (n = 75) Control group (P): daily placebo (n = 73) | Weight, length, LAZ, WAZ, plasma Hb, ferritin, zinc, riboflavin, retinol, tocopherol, and homocysteine | LAZ and WAZ worsened significantly in all groups, apart from LAZ in the DDM group which was significantly less than in the P and WMM groups (p = 0.001) Hb levels increased significantly more in the DMM group (mean = 16.4 g/L, CI = 12.4–20.4) than the P group (mean = 8.6 g/L, CI = 5.0–12.2) PF levels increased significantly more in the DMM and DI groups than the P and WMM groups | Low |
Huy et al. 2009 [77] | Non-random, non-controlled pragmatic trial 2 years | 0–2 years | 586 | Pregnant women | 1: Iron (60 mg) + folic acid supplement (400 µg) (n = 211) 2: Multiple-micronutrient supplement (n = 203) 3: Gender training – maternal care from the family and community during pregnancy, and multiple-micronutrient supplement (n = 172) All: nutrition education- encouraging more frequent eating during pregnancy | Baby birth weight (LBW < 2500 g) At 2 years: weight and height | Average birth weight was higher in the two groups receiving multiple-micronutrient supplements than the group receiving iron = folic acid (2: + 166 g 3: + 105 g) than those receiving iron + folic acid (p < 0.05) LBW prevalence was lower in groups 2 & 3 than in group 1 (4.0%, 5.8% and 10.6% respectively, p < 0.05) At 2 years: children were taller in groups 2 & 3 than group 1 (p < 0.05) and stunting rates were ~ 10% lower (p < 0.05). No statistical significance for weight indicators | Medium |
Le et al. 2007 [78] | RCT 6 months | 6–8 years | 425 | Anaemic children | Iron fortified noodles, 10.7 mg/day (n = 86) Iron fortified noodles (10.7 mg/day) + mebendazole (n = 79) Mebendazole (deworming drug) (n = 79) Iron tablet (dose not reported) + mebendazole (n = 83) Control group: Placebo (n = 82) | Iron status: Hb, SF, sTfR, and haemoglobinopathies analysis Inflammation: C-reactive protein Parasite infection status and immunoglobulin E (IgE) | Hb concentration improved, and anaemia prevalence reduced in all groups (p < 0.001). Iron fortification significantly increased levels of Hb, SF and body iron (p = 0.037, p < 0.001 and p < 0.01, respectively), compared to just deworming and the placebo. Deworming showed no increased effect on Hb, iron status or IgE level compared to iron fortification | Low |
Le et al. 2006 [79] | RCT 6 months | 6–8 years | 425 | Anaemic children | Iron fortified noodles, 10.7 mg/day (n = 86) Iron fortified noodles (10.7 mg/day) + mebendazole (n = 79) Mebendazole (deworming drug) (n = 79) Iron tablet (dose not reported) + mebendazole (n = 83) Control group: Placebo (n = 82) | Hb, SF, sTfR, and haemoglobinopathies analysis, CRP, parasite infection status, and immunoglobulin E (IgE) | Iron supplementation was more efficient than fortification to treat anaemia for all iron markers: Supplementation (Hb 6.19 g/L, p = 0.001; SF 117.3 μg/L, p = 0.001; and body iron 4.37 mg/kg, p = 0.001) compared to fortification (Hb 2.59 g/L, p = 0.07; SF 23.5 μg/L, p = 0.006; and body iron 1.37 mg/kg, p = 0.001) | Low |
Ninh et al. 1996 [80] | Double blinded, RCT 5 months | 4–36 months | 146 | Growth-retarded children, paired to healthy children | Zinc supplementation (10 mg) daily (n = 73) Control group: Placebo (n = 73) | Weight, height, WAZ, HAZ plasma circulating insulin-like growth factor (IGF-I) | Zinc supplementation increased weight by 0.5 kg (± 0.1 kg, p < 0.001) and height by 1.5 cm (± 0.2 cm, p < 0.001) | Low |
Pham et al. 2020 [81] | RCT 6-month intervention 18-month follow-up | 5 months | 426 | Singleton, breastfed infants Severe anaemia (Hb < 70 g/L) | FF: instant fortified flour, daily for 6 months containing 11 vitamins & 12 minerals (n = 157) FC: complementary fortified food, daily for 6 months containing 11 vitamins & 12 minerals (n = 135) Control group (C group): no intervention (n = 134) | Micronutrient status: Hb, PF sTfR, zinc, and retinol | Iron deficiency and iron deficiency anaemia were lower in the FF (13.4% and 6.7%) and FC (15.2% and 3.8%) groups compared to the C group (57.5 and 37.5%, p < 0.0001) | Low |
Phu et al. 2012 [82] | RCT 6-month intervention 18-month follow-up | 5 months | 377 | Severe anaemia (Hb < 70 g/L) | FF: instant fortified flour, daily for 6 months containing 11 vitamins & 12 minerals (n = 135) FC: complementary fortified food, daily for 6 months containing 11 vitamins & 12 minerals (n = 114) Control group: no intervention (n = 128) | Micronutrient status: Hb, PF, sTfR, zinc, and retinol | Retinol & zinc concentrations didn’t differ significantly among groups. Zinc deficiency was significantly lower in the FF group (36.1%) than C group (52.9%, p = 0.04) | Low |
Thach et al. 2015 [83] | Cluster randomised trial (CRT) 9-month intervention 25-month follow-up | 6 months | 426 | Pregnant women | Daily iron-folic acid (IFA) (60 mg elemental iron and 0.4 mg folic acid) (n = 34 communes) Twice weekly IFA (60 mg elemental iron and 1.5 mg folic acid) (n = 35 communes) Twice weekly multiple-micronutrient, iron and folic acid (60 mg elemental iron, 1.5 mg folic acid and MMN) (n = 35 communes) | Weight, length, LAZ and WAZ | The OR of anaemia was significantly lower among infants in the daily IFA (OR = 0.31, CI = 0.22–0.43), weekly IFA (0.38, CI = 0.26–0.54) and MMN (0.33, CI = 0.23–0.48) compared to groups in the observational study | Low |
Berger et al. 2006 [84] | Double blinded, RCT 6 months | 4–7 months | 915 | Breastfed infants aged 4–7 months who free from chronic/ acute illness, severe malnutrition, or congenital abnormalities | Fe-group: daily dose of 10 mg of iron as ferrous sulfate (n = 201) Zn-group: daily dose of 10 mg zinc as zinc sulfate (n = 195) Fe–Zn group: a daily dose of 10 mg iron þ 10 mg zinc (n = 190) Control group: Placebo: a dose of 100 000 IU of vitamin A was given to all infants to avoid VAD (n = 198) | Stunting HAZ < -2 z-scores; wasting WHZ < -2 z-scores; underweight HAZ < -2 z-scores; anaemia = Hb < 110 g/l; low Fe stores = SF < 12 mg/l; low Zinc = Zinc < 9.9 mmol/l; IDA = simultaneous low SF and anaemia | Hb and SF levels significantly increased in both Fe and Fe + Zn groups (22.6 and 20.6 g/l for Hb; 36.0 and 24.8 mg/l for SF, respectively) compared to Zn and placebo groups (Hb: 6.4 and 9.8 g/l; SF: 18.2 and 16.9 mg/l, p < 0.0001). Zn increased more in Zn group (10.3 mmol/l) than in Fe + Zn group (8.0 mmol/l, p < 0.03), and Fe and placebo groups (1.6 and 1.2 mmol/l, p < 0.0001). Adding iron to zinc supplements negates the positive effect that sole zinc supplementation had on weight gain (WAZ) (p = 0.0004) and serum zinc (p = 0.02) showing a significant interaction between zinc and iron co-supplementation | Low |
Vuong et al. 2002 [85] | Controlled trial 30 days | 31–70 months | 185 | Children with low Hb concentration (100–120 g/L) | Vitamin A supplementation: using Momordica coincidences (gac) fruit (locally available) 1: fruit & rice = 3.5 mg β-carotene (n = 62) 2: powder & rice = 5.0 mg synthetic β-carotene (n = 60) 3: Plain rice, no fortification (n = 63) | Weight, height, HAZ, WAZ and plasma β-carotene and Hb concentration | β-carotene concentrations significantly higher in groups 1 & 2 than group 3 (p < 0.0001) Plasma retinol concentration significantly higher in group 1 (p = 0.0053) than group 2 and (p = 0.0053) group 3 Plasma retinol concentrations were significantly higher in group 1 than group 2 (p = 0.0053) and group 3 (p = 0.006) Hb concentrations increased in all 3 groups. In anaemic children, Hb levels were significantly lower in group 3 than group 1 (p = 0.017), but not than group 2 | Medium |
Xuan et al. 2013 [86] | RCT 5 months | 18–36 months | 334 | Not breastfed, no congenital or chronic diseases, and not consuming prebiotics or probiotics | Intervention group: GAU 1 + milk-isocaloric and isoprotic gum, containing synbiotics, and fortified with vitamins A, C and E, and minerals zinc and selenium, and docosahexaenoic acid (n = 150) Control group: Fortified gum of sufficient protein, carbohydrates, fats, vitamins, and minerals (n = 184) | Height and weight gain, anaemia, zinc, and vitamin A deficiencies | The growth parameters of the intervention group increased significantly more than the control group: Weight (+ 0.43, p < 0.01) Height (+ 1 cm, p < 0.01) and BMI Z-score (+ 0.015, p < 0.05) MNDs were reduced in both the intervention and control groups, more in the intervention groups, but non-statistically significant, anaemia by 14.9% (p = 0.63), vitamin A by 9.5% (p = 0.05) and zinc by 13.6% (p = 0.44) | Low |
Nguyen et al. 2021 [87] | Uncontrolled trial, 6 months | 6–14 years | 151 | Children from 5 schools in Can Tho with Vitamin D deficiency/ insufficiency/ low BMD | 6–9 years: daily 600 mg elemental calcium & 400 IU vitamin D3 10–14 years: daily 1350 mg elemental calcium & 460 IU vitamin D3 | BMD, bone turnover markers, vitamin D level, and PTH | Vitamin D concentration significantly improved (p 0.001) Prevalence of low BMD significantly reduced by 56.29% (p < 0.05) | Low |
Smuts et al. 2005 [2] | Double blinded, RCT 6 months | 6–11 months | 1,134 | Residents in study location, not born prematurely or low birth weight, not severely wasted nor severely anaemic, no fever | WMM: weekly multiple micronutrient supplements (n = 283) DMM: daily multiple micronutrient supplement (n = 280) DI: daily iron supplement (n = 288) Control group (P): placebo (n = 283) | CRP, Pb, retinol, Hb, and riboflavin level | The DMM group had a significantly greater weight gain, growing at an average rate of 207 g/mo compared with 192 g/mo for the WMM group, and 186 g/mo for the DI and P groups. DMM had significantly greater reduction in anaemia (-44% vs -35.1% and -29.9%), ID (-17.6% vs -13.7% and 9.3%) and VAD (-10.7% vs -4.3% and -11.4%) compared to DI and P groups (p < 0.05) |