11 Four studies that reported respiratory outcomes did not distinguish upper and lower respiratory tract infections. The overall benefits of breastfeeding promotion are now widely accepted, and it seems doubtful that future similar trials will be deemed ethical or be more rigorously conducted than PROBIT, even the respiratory tract in children of early age the magnitude of the effect might differ across populations or alternative behaviour-change strategies.
A recent prospective study in India found serum folate status to be independently associated with the risk of ALRI,33 but we did not identify any trials assessing the effect of folic acid supplementation alone on ALRI outcomes. ALRI in hospitalized children in some settings. Several studies not included in the published meta-analysis have shown null or non-significant effects of routine zinc on ALRI incidence in Latin America,47,48 South Africa49 and Nepal. In summary, routine zinc supplementation to young children prevents about one-quarter of ALRI cases, which likely translates into a modest reduction in ALRI-related mortality. In contrast to its prophylactic effect, there is no strong evidence of a benefit of zinc supplementation in the treatment context. IFA supplementation is currently recommended by WHO for regions with a high prevalence of iron-deficiency anaemia,57 so it is of primary interest to know whether including zinc in a daily IFA regimen would reduce ALRI-associated morbidity or mortality.
In summary, the only multiple micronutrient intervention with a clear benefit on ALRI incidence or mortality was a milk powder fortified with zinc and six other micronutrients, but the effect size was comparable to that achieved by supplementation with zinc alone. LBW: birth weight 5 In the LUS analysis,3 an estimated 17. 66 and the association of fetal growth restriction with structural alterations that may affect lung anatomy and function. Based on a critical review of the literature, we were able to reach conclusions about only a few of the potential nutritional interventions. 6 months of age was the only intervention for which high-quality trial evidence has demonstrated a significant reduction in childhood ALRI incidence and a trend towards a reduction in mortality.
Second, despite the limited available trial data, there should be little hesitation in including ALRI risk reduction in the list of benefits of exclusive breastfeeding, given the strength and consistency of observational findings and the evidence of a modest reduction in ALRI-related hospitalizations in the only rigorous trial of breastfeeding promotion. We found insufficient evidence of efficacy of other specific nutritional interventions for ALRI risk reduction. LBW, underweight or stunting79 would be expected to consequentially diminish the burden of ALRI. Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Fishman SM, Caulfield LE, de Onis M, Blossner M, Hyder AA, Mullany L, et al.
In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, eds. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Rice AL, Sacco L, Hyder A, Black RE.