Malnutrition and health in developing countries

MALNUTRITION, WITH ITS 2 CONSTITUENTS of protein–energy malnutrition and micronutrient deficiencies, continues to be a major health burden in developing countries. It is globally the most important risk factor for illness and death, with hundreds of millions of pregnant women and young children particularly affected. Apart from marasmus and kwashiorkor (the 2 forms of protein– energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the main manifestations of malnutrition in developing countries. In these communities, a high prevalence of poor diet and infectious disease regularly unites into a vicious circle. Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients (especially in rural areas) have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein– energy malnutrition range from promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock. The fortification of salt with iodine has been a global success story, but other micronutrient supplementation schemes have yet to reach vulnerable populations sufficiently. To be effective, all such interventions require accompanying nutrition-education campaigns and health interventions. To achieve the hunger- and malnutrition-related Millennium Development Goals, we need to address poverty, which is clearly associated with the insecure supply of food and nutrition.     

Role of vitamin A supplementation in the treatment of tuberculosis

Vitamin A deficiency has been commonly observed in patients with tuberculosis. Low serum retinol levels return to normal after antituberculosis treatment even when no supplements are provided. The deficiency of vitamin A observed in patients with tuberculosis might have contributed to the development of tuberculous disease in them. Alternatively, deficiency could be the result of loss of appetite, poor intestinal absorption, increased urinary loss of vitamin A or acute phase reaction in TB. Vitamin A deficiency lowers immunity while vitamin A supplementation reduces morbidity and mortality, particularly from measles and diarrhoea. Vitamin A supplementation also decreases the mortality rate in HIV-infected children and delays the progression of HIV disease in infected subjects. A higher incidence of lung cancer and increased mortality have been observed in smokers after beta-carotene supplementation. Zinc deficiency is also common in tuberculosis, which may impose a secondary vitamin A deficiency. Clinical trials have shown conflicting results regarding the effect of supplementation of vitamin A, alone or with other micronutrients, on time taken to sputum conversion in patients with pulmonary tuberculosis. Supplementation with multiple micronutrients (including zinc) rather than vitamin A alone may be more beneficial in patients with tuberculosis, but clinical trials on such a combination are lacking.     

Micronutrient malnutrition--present status and future remedies

Micronutrient deficiency is a serious public health concern in most of the developing countries which leads to malnutrition syndromes. The micronutient deficiencies which are of greatest public health significance include iron deficiency, vitamin A deficiency and iodine deficiency disorder. National Pilot Programme on Control of Micronutrient Malnutrition was launched in 1995 and the department of biochemistry and nutrition of the All India Institute of Hygiene and Public Health, Calcutta was entrusted to co-ordinate the activities. It presently covers five eastern and north-eastern states. Baseline situation analysis was conducted mainly on iron deficiency anaemia, iodine deficiency disorder and vitamin A deficiency. Comparing with WHO cut off figures, point prevalence of anaemia in various age groups was found to be high. Bitot's spot was mainly noted in the age group of 6-71 months. Nightblindness was found in the children of the age group of 24-71 months. High prevalence of nightblindness in pregnant women is a point of concern. Action needed to control micronutrient deficiency includes: Intervention strategies, extensive nutrition and health education, to support the problem specific programmes, to stregthen various state government programmes and strengthen role of NGOs.     

Combining vitamin A and vaccines: convenience or conflict?

The present thesis is based on 11 papers from 1995-2010. The studies have mainly taken place at the Bandim Health Project in Guinea-Bissau, West Africa, but a reanalysis of a randomised trial from Ghana is also included. My research has explored the consequences of combining high-dose vitamin A supplementation and childhood vaccines. Vitamin A deficiency is associated with increased mortality. To protect against the consequences of vitamin A deficiency the World Health Organization recommends that high-dose vitamin A supplements be given together with routine vaccines to children between 6 months and 5 years of age in more than 100 low-income countries. The recommendation is based on logistical considerations. The consequences of combining vitamin A and vaccines were not investigated in randomised trials prior to the implementation of this policy - it was assumed that the interventions were independent. My first project aimed to study the effect on the immune response to measles of providing vitamin A together with measles vaccine. We found that the two interventions were not independent. Vitamin A enhanced the antibody response to measles vaccine given at 9 months of age significantly, especially in boys. The effects were sustained over time; the children who had received vitamin A with their measles vaccine were more protected against measles at 6-8 years of age. Though vitamin A supplementation had a beneficial effect on the immune response to measles vaccine, it intrigued me that the effect of vitamin A supplementation on overall mortality was not always beneficial. While vitamin A was beneficial when given after 6 months of age, and two studies had shown a beneficial effect when given at birth, all studies testing the effect between 1-5 months of age had found no effect. These time windows are dominated by three different childhood vaccines: BCG vaccine given at birth, diphtheria-tetanus-pertussis (DTP) vaccine given between 1-5 months of age, and measles vaccine given at 9 months of age. These vaccines have been shown to have strong effects on mortality from infectious diseases in general, so-called non-specific effects. The live BCG and measles vaccine protects against more mortality than can be ascribed to the prevention of tuberculosis and measles, respectively. The inactivated DTP vaccine worryingly has been associated with increased mortality from other infectious diseases. Both positive and negative effects are strongest for girls. I proposed the hypothesis that vitamin A amplifies not only the specific vaccine effects, as we saw for measles vaccine, but also the non-specific effects of vaccines on mortality from other infectious diseases. According to my hypothesis, vitamin A would enhance the non-specific beneficial effects on mortality of BCG and measles vaccine, but also the negative effects of DTP vaccine. Hence, the hypothesis offered an explanation for the mortality-age pattern after vitamin A supplementation. Since it was formulated, I have aimed to test this hypothesis. Since it is associated with ethical problems to randomise children above 6 months of age to vitamin A supplementation, and to randomise children in general to recommended vaccines, we have had to be pragmatic when designing the trials. Hence, our studies have taken many different forms. We conducted an observational study during a vitamin A campaign in which missing vaccines were also provided, and a randomised trial testing the effect of two different doses of vitamin A during another campaign; we tested the effect of providing vitamin A with BCG at birth in two randomised trials, and we reanalysed data from one of the original randomised trials of vitamin A supplementation from the perspective of vaccination status. In all studies the main outcome was mortality. The results document that vitamin A supplements do more than protect against vitamin A deficiency. They support the hypothesis that vitamin A supplements interact with vaccines with important consequences for mortality. First, a smaller dose of vitamin A was more beneficial than a larger dose for girls. Second, the effect of vitamin A given with DTP vaccine was significantly different from the effect of vitamin A given with measles vaccine, and children, who received vitamin A with DTP vaccine, had higher mortality than children, who had received vitamin A alone, or who did not receive anything. Third, vitamin A given with BCG at birth interacted negatively with subsequent DTP vaccines in girls. Fourth, the effect of vitamin A to older children in Ghana depended on vaccination status, being beneficial in boys, but harmful in girls who received DTP vaccine during follow-up. The results also show that boys and girls respond differently to vitamin A and vaccines. It is a common assumption within public health in low-income countries that interventions can be combined without producing unexpected consequences. The work presented in this thesis confronts this assumption; the results show that vitamin A and vaccines should be seen not only as specific interventions with specific and independent effects, but as immuno-modulators, which can interact with important consequences for overall mortality. Combining interventions can be convenient and lead to synergistic health benefits, but we documented several examples, where it also leads to unexpectedly increased mortality. Thus, to optimise the child health intervention policy in low-income countries a shift in paradigm is needed. Health interventions should no longer be seen as merely specific and independent, and the policy should probably not be the same for boys and girls. Though more complex, it is necessary to evaluate all health interventions in terms of their effect on overall mortality - and their potential interactions with other health interventions and potential sex-differential effects should always be investigated. Only in this way can we assure that the children in the poorest countries get the best possible treatment and avoid using large amounts of money and resources on interventions which may, in worst case, kill them.     

Acute diarrhoeal diseases--an approach to management

Acute diarrhoeal diseases rank second amongst all infectious diseases as a killer in children below 5 years of age worldwide. Globally, 1.3 billion episodes occur annually, with an average of 2-3 episodes per child per year. The important aetiologic agents of diarrhoea and the guidelines for management are discussed. Management of acute diarrhoea is entirely based on clinical presentation of the cases. It includes assessment of the degree of dehydration clinically, rehydration therapy, feeding during diarrhoea, use of antibiotic(s) in selected cases, micronutrient supplementation and use of probiotics. Assessment of the degree of dehydration should be done following the WHO guidelines. Dehydration can be managed with oral rehydration salt (ORS) solution or intravenous fluids. Recently WHO has recommended a hypo-osmolar ORS solution for the treatment of all cases of acute diarrhoea including cholera. Feeding during and after diarrhoea (for at least 2-3 weeks) prevents malnutrition and growth retardation. Antibiotic therapy is not recommended for the treatmentof diarrhoea routinely. Only cases of severe cholera and bloody diarrhoea (presumably shigellosis) should be treated with a suitable antibiotic. Pilot studies in several countries have shown that zinc supplementation during diarrhoea reduces the severity and duration of the disease as well as antidiarrhoeal and antimicrobial use rate. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.     

5岁以下儿童补充维生素A对预防死亡、疾病及失明的系统回顾和荟萃分析

目的研究补充维生素A与6个月至5岁儿童死亡率和发病率的减少是否相关。方法系统回顾和荟萃分析,由2名研究者独立筛选文献,数据经双方提取,不同点通过讨论解决,主要进行死亡、疾病、视力及副作用的荟萃分析。数据来源于Cochrane中心注册的对照研究,包括Cochrane图书馆、Medline、Embase、GlobalHealth、Latin American和Caribbean HealthSciences,metaRegister of Controlled Trials和African Index Medicus。数据检索至2010年4月前已发表或待发表的各种语言的文献。入选标准为对口服合成维生素A的6个月至5岁儿童的随机对照研究,研究儿童患有疾病（包括腹泻、麻疹及HIV）,排除住院以及食物强化或B胡萝卜素儿童。结果包括215633名儿童的43项研究人选。其中17项研究（194483名儿童）显示全因死亡率减少了24％,其比值比为0．76,95％可信区间（95％CI）0．69～0．83。7项研究报道与腹泻相关的死亡率减少了28％,其比值比为0．72（95％C10．57—0．91）。维生素A的补充与腹泻减少的比值比为0．85（95％C10．82—0．87）、与麻疹、视力问题包括夜盲和眼球干燥症减少的比值比分别为0．50（95％C10．37—0．67）、0．32（95％C10．21～0．50）和0．31（95％C10．22—0．45）。3项研究报道在补充维生素A的48小时内呕吐增加的风险为2．75（95％CI1．81～4．19）。结论补充维生素A在一定范围内与儿童的死亡率、发病率及视力问题的大幅减少有关,且这一结论不能由偏倚来解释。在6个月至59个月的儿童中已无需进行补充维生素A的安慰剂对照研究,但是有必要进一步比较不同剂量和不同给药方式（如强化）的区别。就目前得到的数据而言,所有可能缺乏维生素A的儿童均应得到补充,尤其是中低收入的国家。     

Zinc and vitamin A supplementation in Indigenous Australian children hospitalised with lower respiratory tract infection: a randomised controlled trial

OBJECTIVE: To evaluate the efficacy of supplementation with zinc and vitamin A in Indigenous children hospitalised with acute lower respiratory infection (ALRI). DESIGN: Randomised controlled, 2-by-2 factorial trial of supplementation with zinc and vitamin A. SETTING AND PARTICIPANTS: 187 Indigenous children aged < 11 years hospitalised with 215 ALRI episodes at Alice Springs Hospital (April 2001 to July 2002). INTERVENTIONS: Vitamin A was administered on Days 1 and 5 of admission at a dose of 50 000 IU (infants under 12 months), or 100 000 IU; and zinc sulfate was administered daily for 5 days at a daily dose of 20 mg (infants under 12 months) or 40 mg. MAIN OUTCOME MEASURE: Time to clinical recovery from fever and tachypnoea, duration of hospitalisation, and readmission for ALRI within 120 days. RESULTS: There was no clinical benefit of supplementation with vitamin A, zinc or the two combined, with no significant difference between zinc and no-zinc, vitamin A and no-vitamin A or zinc + vitamin A and placebo groups in time to resolution of fever or tachypnoea, or duration of hospitalisation. Instead, we found increased morbidity; children given zinc had increased risk of readmission for ALRI within 120 days (relative risk, 2.4; 95% CI, 1.003-6.1). CONCLUSION: This study does not support the use of vitamin A or zinc supplementation in the management of ALRI requiring hospitalisation in Indigenous children living in remote areas. Even in populations with high rates of ALRI and poor living conditions, vitamin A and zinc therapy may not be useful. The effect of supplementation may depend on the prevalence of deficiency of these micronutrients in the population.     

Effect of Micronutrient Supplementation on the Growth of Preschool Children in China

Objective To study the relationship between micronutrient supplementation and children growth. Methods A double-blind, placebo-controlled trial was conducted in 156 growth retarded preschool children. They were randomly assigned to five groups: supplemental control (S-control,n=28), zinc supplementation(+Zn, 3.5mg Zn/day, n=34), zinc and calcium supplementation (+ZnCa,3.5mg Zn+250mg Ca/day, n=37), zinc and calcium and vitamin A supplementation (+ZnCaVA,3.5mgZn +250mgCa+200gVA/day, n=28), Calcium and vitamin A supplementation (+CaVA,250mgCa + 200gVA/day, n=29). Another 34 children with normal height were selected as normal control (N-control). Supplementation continued for twelve months. Results The height gain in +Zn group (7.84cm per year) and +ZnCa group (7.70 cm per year) was significantly higher than that in S-control group (6.74 cm per year, P＜0.05); The weight gain in +ZnCaVA group (2.55kg per year)and +CaVA group (2.57 kg per year) was also significantly higher than that in S-control group (2.19kg per year, P＜0.05); The average days of illness in each supplementation group were lower than that in S-control (13 days per year compared with 23 days per year). No significant difference was observed on bone age. Conclusion Zinc and Zinc+Calcium supplementation can improve the height gain,and vitamin A can improve weight gain in growth retarded preschool children, but do not affect the maturity of bone. Micronutrient supplementation can lower the morbidity of these children.     

Zinc and vitamin A supplementation in Australian Indigenous children with acute diarrhoea: a randomised controlled trial

OBJECTIVE: To evaluate the role of zinc and vitamin A supplementation in the recovery of Indigenous children hospitalised for acute diarrhoea. DESIGN: A randomised controlled 2 by 2 factorial trial of supplementation with zinc and vitamin A. SETTING AND PARTICIPANTS: Aboriginal children (aged < 11 years) hospitalised for acute diarrhoea at Alice Springs Hospital, Northern Territory, April 2001-July 2002. MAIN OUTCOME MEASURES: Duration of diarrhoeal illness; re-admission for diarrhoeal illness within 120 days. RESULTS: Our study involved 392 Aboriginal children with 436 episodes of diarrhoea. Supplementation with zinc, vitamin A, or combined zinc and vitamin A had no significant effect on duration of diarrhoea or rate of re-admission compared with placebo. Median diarrhoea duration after starting supplementation was 3.0 days for the vitamin A and zinc supplemented and placebo groups (P values 0.25 and 0.69, respectively). The number of re-admissions did not differ significantly between those receiving vitamin A or zinc and the relevant placebo groups (relative risk [95% CI], 1.2 [0.7-2.1] and 1.3 [0.8-2.1], respectively). CONCLUSION: Vitamin A and zinc supplementation may not be indicated for in-hospital management of acute diarrhoeal disease in Aboriginal children living in remote areas. This finding may not apply to children with malnutrition, for whom other studies suggest a benefit. Larger trials incorporating more comprehensive data on the vitamin A and zinc status as well as nutritional status of study populations might help to explain the different results in different populations.     

小儿反复呼吸道感染的临床病因分析

目的探讨小儿反复呼吸道感染的临床病因。方法选取2009年6月～2010年6月间我院收治的100例反复呼吸道感染的患儿及在儿童保健科体检的健康儿童100例为研究对象,对两组儿童可能导致免疫功能缺陷的16项因素进行检查,并对两组检查结果进行比较。结果两组儿童在蛋白质营养不良、缺铁性贫血和铁、锌、钙元素缺乏及佝偻病、维生素A缺乏、哮喘、先天性心脏病、长期应用免疫制剂方面存在显著性差异（P〈0．05）。结论加强对儿童的合理营养,提高抵抗力,有助于预防儿童反复呼吸道感染。     

泰安市100户城乡居民营养状况评价

泰安市城乡居民营养状况调查表明,营养状况基本合理,但蛋白质、钙、视黄醇和VB_2摄入不足,尤以乡村居民显著。17.8％居民存在缺铁性贫血。本市城乡居民应从以上几个方面改进膳食,达到平衡膳食及合理营养。     

血清锌与小儿肺炎的关系

３９例肺炎，４３例支气管炎，４３例上呼吸道感染，３０例非呼吸道感染患儿血清锌水平测定，发现肺炎组平均锌含量低于其它３组（Ｐ＜０．０５）及正常组（Ｐ＜０．０１），肺炎组低锌率（５９．０％）高于其它３组（Ｐ＜０．０５）．且婴幼儿比例最大（７８．３％）．本文探讨了锌在小儿肺炎中的作用，提示防治缺锌有助于降低肺炎发病率。     

小儿感染性疾病红细胞内锌原卟啉测定及其临床意义

目的：了解小儿感染性疾病红细胞内锌原卟啉（ZPP）值及其临床意义。方法：对61例小儿感染性疾病进行ZPP及血红蛋白（Hb)、红细胞计数（RBC）及平均红细胞体积（MCV）的测定，以健康体检儿童作为对照。结果：感染组儿童ZPP值明显高于对照组（P＜0．05），Hb、MCV值明显低于对照组（P＜0．05），RBC值差异无显性（P＞0.05)。不同性别之间ZPP、Hb、RBC、MCV值无统计学差异（P＞0．05））。肺炎、肺结核、肠炎的ZPP值较上呼吸道感染及皮肤感染患儿高，败血症患儿ZPP值最高，Hb、RBC、MCV值较低，但无统计学差异（P＞0．05）。结论：小儿感染性疾病存在在铁代谢紊乱。应用ZPP筛查铁缺乏症时，应避免感染因素的干扰，ZPP也可作为儿童感染及感染严重程度的观察指标。     

Marginal vitamin and mineral intake of Costa Rican adolescents

BACKGROUND: Although a great deal of attention is given to macronutrient and energy intake in the diet, elements essential to dietary metabolic balance include important micronutrients. Very little information exists on vitamin and mineral intake during adolescence, especially in developing countries. METHODS: The micronutrient intake of urban and rural adolescents aged 12-19 years from the Costa Rican capital city, San José, was evaluated. Prospective 3-day diet records including 2 weekdays and 1 weekend day were used for dietary data. We evaluated the micronutrient intake to determine the nutrient adequacy ratio. RESULTS: Approximately 30% of adolescents did not meet the 70% level of the daily recommended intake (DRI) for vitamin Bl2. Additionally, 40% of the Costa Rican youngsters presented a vitamin A, E, and iron intake of between 30 and 69% of the DRI or recommended daily dose (RDA) for these nutrients. Likewise, approximately 15% of adolescents did not meet 30% of the DRI or RDA indicators for these nutrients. The micronutrients most at risk for inadequate intake were zinc, calcium, magnesium, and folate: more than 25% of the adolescents did not meet 50% of DRI or RDA indications for these micronutrients. Contrariwise, vitamin C, vitamin B6, thiamin, riboflavin, and niacin were the nutrients less at risk for inadequate intake. Fast foods prepared in school cafeterias provided approximately 15-30% of the DRI for vitamins B1, B2, B6, Bl2, and niacin, approximately 18% of the RDA for iron, and over 40% of the RDA for vitamin E. CONCLUSIONS: Nutritional interventions and educational strategies are needed to promote the adoption of healthful eating habits among adolescents.     

Nutrition scenario in India--implications for clinical practice

India has the highest prevalence (and largest share) of malnourished children, low birth weight babies and anaemia levels amongst children and women in the world. Other micronutrient deficiencies (vitamin A and iodine) also constitute serious public health problems. Various government schemes set up to combat these problems have not had the expected impact in reducing malnutrtion or micronutrient deficiencies. This is not only due to low utilisation or inadequacy of the schemes but also due to the population not adopting appropriate behaviours to improve their health and nutrition. Providing correct and timely technical advice on nutrition to their patients and their families is often given inadequate emphasis by medical practitioners. But when we know that malnutrition contributes to 55% of child mortality which has been stagnating in most states, medical practitioners, whose advice on health matters is very much heeded by the population, can play an important role in reversing this trend.     

透析患者补充维生素C的作用

透析患者存在维生素C缺乏,因为各种原因导致的摄入不足、透析丢失。心血管疾病是透析患者主要死亡原因,微炎症是主要危险因素。低血浆水平维生素C伴随炎症状态和心血管疾病发病率、死亡率增高,在维持性血液透析及腹膜透析患者中均存在。现就透析患者补充维生素C的作用做一简单综述。     

Diet and nutrition in urologic cancer

Cancer is a major cause of mortality and morbidity throughout the world and is projected to become the leading cause of death in the United States and other developed countries in the next few years. There is a large body of evidence linking diet and nutrition with the development of urologic cancers. This is an area where intervention and education can have a major preventive effect on the occurrence of cancer on a worldwide basis. With bladder cancer, a significant protective effect is conferred by a combination of high doses of vitamins A, B6, C and E plus zinc. For prostate cancer, reduced fat intake has a protective effect. A lesser benefit is also suggested with intake of vitamins D and C. Evidence for chemoprevention against renal cell cancer is supported mainly by epidemiologic studies with animal studies indicating possible benefit of vitamin D supplementation. Further research is needed before vitamins and other nutritional supplements can be advocated as standard therapy. Current data support increased intake of vitamins A, B6, C, D and E, reduction of animal fat and increased intake of fruits and vegetables.     

强化糕点改善学前儿童营养状况的研究

目的：观察强化钙、锌、维生素Ａ、维生素Ｄ的糕点对改善学前儿童营养状况及生长发育的效果。方法：以５４名５￣６岁健康儿童为对象,分为强化组和对照组,于午睡后加餐,连续观察７０ｄ,比较两组儿童的身高、体重、维生素Ａ缺乏症检出率及血清中总蛋白、白蛋白、钙、锌、维生素Ａ水平。结果：强化组儿童的身高增长值高于对照组;血钙、血锌、血清维生素Ａ的水平较加餐前明显提高;维生素Ａ缺乏症检出率明显下降。结论：强化钙、锌     

学龄前肺炎儿童患维生素A缺乏疾病相关状况及最新检测手段

目的:主要目标是进一步明确肺炎患儿体内维生素A的状况,次要目的是研究个体化、营养等因素对VAD儿童的影响。方法:对北京3所医院中患社区获得性肺炎的患儿进行抽样研究,患儿的相关信息通过患儿母亲详述而获得,体内维生素A含量测定通过相关剂量反应实验(RDR)得到结果。结果:100例社区获得性肺炎患儿,其中17.8%确诊为VAD,50.3%的患儿为正常结果,24.6%的患儿有肝脏储备功能的下降,7.3%的患儿结果与感染过程相关。得出与VAD相关的变量数值:年龄<2个月(OR 3.43,94%CI:1.83～9.23);年龄>6个月并给予配方食品的儿童(OR 0.37,95%CI:0.15～0.91)。结论:社区获得性肺炎的患儿VAD发生率在北京仍然存在,而且对有维生素A缺乏高危患儿进行维生素A补充是必要的。     

不同孕期微量元素水平对胎儿生长受限的预测作用

背景　胎儿生长受限（FGR）是围生期较严重的并发症之一，可导致胎儿多个系统发育不良，甚至死亡，近年来研究发现，微量元素缺乏可能与FGR相关。目的　评估不同孕期微量元素铁、锌、铜和碘水平对FGR发生风险的预测作用。方法　选取2016年7月-2018年6月在湖北民族大学附属民大医院进行产前检查且妊娠8周内的326例孕妇作为研究对象。分别于孕早期（妊娠≤13周）、孕中期（妊娠14~27周）和孕晚期（妊娠≥28周）检测孕妇血液样本中铁、锌、铜水平和尿液样本中碘水平并计算微量元素缺乏率。参照《妇产科学》的诊断标准评估是否为FGR。比较不同孕期铁、锌、铜、碘水平及缺乏率，比较FGR孕妇与非FGR孕妇铁、锌、铜、碘水平；绘制微量元素水平预测FGR的受试者工作特征（ROC）曲线，并计算ROC曲线下面积（AUC）。结果　孕中期和孕晚期孕妇铁、碘水平低于孕早期（P<0.05）；孕晚期锌、铜水平低于孕早期（P<0.05）；孕中期的铁、锌、铜、碘水平均高于孕晚期（P<0.05）。孕中期和孕晚期铁、碘缺乏率高于孕早期（P<0.05）；孕中期和孕晚期锌缺乏率低于孕早期（P<0.05）；孕中期的铁、锌、碘缺乏率均低于孕晚期（P<0.05）。FGR孕妇不同孕期铁、碘水平低于非FGR孕妇（P<0.05）；FGR孕妇孕晚期铜水平低于非FGR孕妇（P<0.05）。孕晚期铁、锌、铜、碘联合预测FGR的效能较好，AUC（95%CI）为0.829（0.753，0.905），截断值为0.094，灵敏度84.4%，特异度72.1%。结论　孕晚期微量元素铁、锌、铜、碘联合检测对FGR发生风险具有较好的预测作用。