Research has shown a link between iron and zinc deficiencies and adverse cognitive and behavioral outcomes. However, data from randomized trials are inconclusive. Recent studies from the Sarlahi district of Nepal indicate that approximately 40% of children are iron deficient and over half have some degree of zinc deficiency. The main objective of our study is t 1) estimate the treatment effects of iron and zinc supplementation on temperament, feeding interactions, and language skills in Nepalese infants. Secondary  objectives are: 2) to identify socio-demographic risk factors for these developmental outcomes, and 3) to estimate associations between parental report versus in-person observations of temperament and feeding interactions in this population. Participants included 569 children ages 4 to 17 months. Infants were randomized to receive daily supplementation of (A) 10 mg zinc, (B) 12.5 mg iron and 50 ?g folic acid, (C) a combination of 10 mg zinc, 12.5 mg iron and 50 ?g folic acid, or (D) a sugar placebo. For our main objective, intention-to-treat and cumulative dose analyses will be performed to estimate the effects of iron and zinc supplementation on infant temperament, quality of feeding interactions, and language development. This study will provide preliminary results for a future R01 application that more carefully examines infant social and cognitive development in Sarlahi beyond the limited number of endpoints already currently available.

Joanne Katz, ScD, Public Health, International Health; James Tielsch, PhD, Public Health, International Health; Laura Murray-Kolb, PhD, Public Health, InternationalHealth