Micronutrient 8 year follow up

Project Summary 

This research project is a follow-up of children at approximately eight years of age who were born in a randomised controlled trial of multiple micronutrient (MMN) supplementation in pregnancy. The research is conducted in partnership with the Mother and Infant Research Activities (MIRA) non-governmental organisation.

The research will investigate whether an antenatal nutritional intervention can lead to a difference in growth and lung function of children, and whether this difference is influenced by environmental air pollution. The project ranges from field epidemiology and environmental health to laboratory-based epigenetic research.

The main aims of the study are:

• to investigate the long-term effects in children born after maternal antenatal MMN supplementation.
• to explore the relationship between air pollution and lung function.

The study will be the second follow-up of a randomised controlled trial (RCT) in Dhanusha district, Nepal, in which pregnant women received either daily MMN supplements containing 15 vitamins and minerals or a control supplement of iron and folic acid.

The original trial formed one of twelve similar RCTs in which a MMN supplement was given. In the initial trial the babies born in the MMN group were found to be 77g heavier (95% CI: 24-130 g) at birth [1]. The follow-up study showed that the MMN group were 204g heavier (95% CI: 27-381 g) at 2.5 years. The systolic blood pressure was also 2.5 mmHg (95% CI: 0.5-4.6) lower [2].

The study aims to investigate the role of an antenatal MMN intervention in the programming of future health and disease risk factors and will explore its potential role in protecting against an environmental stressor. It performs the important function of following up the children born in a RCT to look at the long-term effects of the intervention, and has policy implications regarding the diet of pregnant women.

We aim to repeat the anthropometric measurements made in the previous follow-up, providing longitudinal information on the growth of the children. The study is powered to detect a 0.2 Z score difference in weight. The research will then go further by assessing body composition, using bioelectrical impedance, to see if differences in weight are related to a difference in fat or lean mass.

To calibrate the bioelectrical impedance measurements, a measure of total body water in a sub-sample of children will be made using deuterium-labelled water. We will also repeat the blood pressure measurement to see if a previous reduction in the supplemented group is sustained. We will perform the spirometry using ultrasound sensor technology.

We will estimate personal exposure to air pollution using gravimetric analysis of air samples in a subsample of children, from which a model will be constructed to give 24-hour time-weighted averages that can be applied to all the children. We will then be able to explore the association between the antenatal nutritional intervention and a current environmental stressor. In addition we are taking saliva samples from the children to look for epigenetic changes that may have been caused by changing the micronutrient supply to the fetus.

References

1. Osrin D, Vaidya A, Shrestha Y, Baniya RB, Manandhar DS, Adhikari RK, et al. Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial. Lancet 2005;365(9463):955-62.
2. Vaidya A, Saville N, Shrestha BP, Costello AM, Manandhar DS, Osrin D. Effects of antenatal multiple micronutrient supplementation on children's weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial. Lancet 2008;371(9611):492-9

Key Project Information

Dates: Dec 2010 - June 2014

Principal Investigator: Dr Delan Devakumar

Partners: Mother and Infant Research Activities (MIRA) - Nepal |  UCL Institute of Child Health |  Institute of Occupational and Environmental Medicine, University of Birmingham |  Great Ormond Street Hospital

Location: Nepal

Funding: Wellcome Trust

Contact: d.devakumar@ucl.ac.uk

Resources

Project film (YouTube)

Public engagement art project (YouTube)

Publications

Previous trial and follow-up:

Osrin D, Vaidya A, Shrestha Y, Baniya RB, Manandhar DS, Adhikari RK, et al. Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial. Lancet 2005;365(9463):955-62.

Vaidya A, Saville N, Shrestha BP, Costello AM, Manandhar DS, Osrin D. Effects of antenatal multiple micronutrient supplementation on children's weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial. Lancet 2008;371(9611):492-9.

Air pollution:

Devakumar D, Semple S, Osrin D, Yadav SK, Kurmi OP, Saville NM, Shrestha BP, Manandhar DS, Costello A, Ayres JG. Biomass fuel use and the exposure of children to particulate air pollution in southern Nepal. Environment International. 2014 Feb 14; 66C: 79-87

Devakumar D, Qureshi Z, Mannell J, Baruwal M, Sharma N, Rehfuess E, Saville NM, Manandhar DS, Osrin D. Using focus groups to understand women’s perceptions of household air pollution and generation of artwork to raise awareness of key issues identified in Nepal. Int J of Environ Research and Public Health. 2018, 15 (2), 248

Bartington SE, Bakolis I, Devakumar D, Kurmi OP, Gulliver J, Chaube G, Manandhar DS, Saville NM, Costello A, Osrin D, Hansell AL, Ayres JG. Domestic exposure to Carbon Monoxide and Particulate Matter in households using biomass fuel in Janakpur, Nepal. Environmental Pollution. 2017; 220: 38-45

Devakumar D, Ayres JG, Bartington S, Stocks J, Chaube SS, Saville NM, Manandhar DS, Costello A, Osrin D. Cross-sectional study of asthma and rhinitis symptoms in the context of exposure to air pollution in Nepal. European Respiratory Journal Open research. 2015. 1: 0004-2015

Devakumar D, Semple S, Osrin D, Yadav SK, Kurmi OP, Saville N, Shrestha BP, Manandhar DS, Costello A, Ayres JG. Biomass fuel use and the exposure of children to particulate air pollution in southern Nepal. Environment International. 2014;66: 79-87

Devakumar D. Fires and strikes: the politics of power. The Lancet Respiratory Medicine. 2013; 1: 19-20

Micronutrient supplementation:

Marphatia AA, Wells JCK, Reid AM, Cortina-Borja M, Manandhar DS, Sen A, Saville N, Devakumar D, Osrin D, Prost A, Dulal S. Early-life factors and pre-primary experience predict over-age attendance in secondary school: evidence from lowland Nepal. International Journal of Educational Research. In press

Wells JCKW, Devakumar D, Manandhar DSM, Saville N, Chaube S, Costello A, Osrin O. Associations of stunting at 2 years with body composition and blood pressure at 8 years of age: longitudinal cohort analysis from lowland Nepal. Eur J Clin Nut. 2019; 73: 302-10

Devakumar D, Kular D, Shrestha BP, Grijalva-Eternod C, Daniel RM, Saville NM, Manandhar DS, Costello A, Osrin D, Wells JCK. Socioeconomic determinants of growth in a longitudinal study in Nepal. Maternal and Child Nutrition. 2018, 14: e12462

Devakumar D, Fall CHD, Sachdev HS, Margetts BM, Osmond C, Wells JCK, Costello A, Osrin D. Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis. BMC Medicine. 2016; 14: 90

Marphatia AA, Devakumar D, Wells JCK, Saville NM, Manandhar DS, Costello A, Osrin D. Maternal phenotype, independent of family economic capital, predicts educational attainment in lowland Nepalese children. Am J Hum Biol. 2016; 28(5): 687–698

Wells JCK, Devakumar D, Grijalva-Eternod CS, Manandhar DS, Costello A, Osrin D. Blood pressure and the capacity-load model in 8 year-old children from Nepal: testing the contributions of kidney size and intergenerational effects. Am J Hum Biol. 2016; 28:555–565 

Devakumar D, Stocks J, Ayres JG, Kirkby J, Yadav SK, Saville NM, Devereux G, Wells JCK, Manandhar DS, Costello A, Osrin D. Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal. European Respiratory Journal. 2015. 45(6), 1566-1575

Devakumar D, Grijvala C, Roberts S, Chaube SS, Saville NM, Manandhar DS, Costello A, Osrin D, Wells JCK. Body composition in Nepalese children using isotope dilution: the production of ethnic-specific calibration equations and an exploration of methodological issues. PeerJ. 2015; 3: e785

Devakumar D, Chaube SS, Wells JCK, Saville NM, Ayres JG, Manandhar DS, Costello A, Osrin D. The effects of antenatal multiple micronutrient supplementation on anthropometry and blood pressure in mid-childhood in Nepal: follow-up of a double-blind randomized controlled trial. Lancet Global Health. 2014; 2: e654-63.

Related project: Smokescreen

Following the main data collection, Dr Delan Devakumar ran a public engagement project focusing on air pollution. Air pollution in the region is mostly caused by the indoor burning of biomass fuels and is disproportionately experienced by the women of the household who do the cooking.

To help both them and us gain further understanding of the research Dr Devakumar subsequently designed a public engagement project where women from research project met with local artists to explore the issues around indoor air pollution from cooking.

Watch a film about Smokescreen on YouTube