Efficacy of a multi micronutrient-fortified drink in improving iron and micronutrient status among schoolchildren with low iron stores in India: a randomised, double-masked placebo-controlled trial

Background/Objectives: A multiple micronutrient-fortified drink could be an effective strategy to combating micronutrient deficiencies in school going children. To assess the efficacy of a multiple micronutrient-fortified drink in reducing iron deficiency (ID), ID anemia (IDA), anemia and improving...

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Published in:	European journal of clinical nutrition Vol. 67; no. 1; pp. 36 - 41
Main Authors:	Thankachan, P, Selvam, S, Surendran, D, Chellan, S, Pauline, M, Abrams, S A, Kurpad, A V
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 01-01-2013 Nature Publishing Group
Subjects:	692/699/1702/295 692/700/1720 692/700/459/1994 Anemia Anemia, Iron-Deficiency - blood Anemia, Iron-Deficiency - diet therapy Anemia, Iron-Deficiency - epidemiology Anemia, Iron-Deficiency - physiopathology Anemias. Hemoglobinopathies Ascorbic Acid Deficiency - blood Ascorbic Acid Deficiency - diet therapy Ascorbic Acid Deficiency - epidemiology Beverages Beverages - adverse effects Beverages - analysis Biological and medical sciences Child Child Development Children & youth Clinical Nutrition Diet therapy Diseases of red blood cells Double-Blind Method Enriched foods Epidemiology Feeding. Feeding behavior Female Food Services Food, Fortified - adverse effects Food, Fortified - analysis Fundamental and applied biological sciences. Psychology Health aspects Hematologic and hematopoietic diseases Humans India - epidemiology Internal Medicine Intervention Iron Iron deficiency anemia Lost to Follow-Up Male Medical sciences Medicine Medicine & Public Health Metabolic Diseases Metals (hemochromatosis...) Micronutrients - analysis Micronutrients - blood Micronutrients - deficiency Micronutrients - therapeutic use Nutrient deficiency Nutrition Nutritional Status original-article Other metabolic disorders Patient Compliance Patient outcomes Prevalence Public Health Schools Severity of Illness Index Vertebrates: anatomy and physiology, studies on body, several organs or systems Vitamin B 12 Deficiency - blood Vitamin B 12 Deficiency - diet therapy Vitamin B 12 Deficiency - epidemiology Asia India micronutrients iron deficiency children fortification iron deficiency anemia anemia Human Iron deficiency anemia Mask Metabolic diseases Hemopathy Iron Inorganic element Micronutrient Randomization School age Storage Clinical trial Sideropenia Child
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Summary:	Background/Objectives: A multiple micronutrient-fortified drink could be an effective strategy to combating micronutrient deficiencies in school going children. To assess the efficacy of a multiple micronutrient-fortified drink in reducing iron deficiency (ID), ID anemia (IDA), anemia and improving micronutrient status among schoolchildren with low iron stores. The study employed a school-based, randomized, double-blind, placebo-controlled design. Subjects/Methods: Schoolchildren with low serum ferritin (SF <20 μg/l) ( n =246), aged 6–12 years were randomly assigned to receive either a multi-micronutrient fortified or an unfortified identical control drink. The drinks were provided 6 days/week for 8 weeks. Anthropometric and biochemical assessments were taken at baseline and endline. Results: Study groups at baseline were comparable, and compliance to the intervention was similar. The overall prevalence of ID, IDA and anemia was 64%, 19% and 24%, respectively. The prevalence of ID, IDA, vitamin C and vitamin B 12 deficiencies significantly reduced by 42%, 18%, 21% and 5%, respectively, in the intervention arm ( P <0.01) as compared with the control arm at the end of the study. Similarly, the concentration of hemoglobin, SF, vitamin A, vitamin B 12 , vitamin C and body iron stores were significantly higher in the intervention arm in comparison to the control arm ( P <0.001). Red cell folate levels also improved significantly in the intervention arm ( P =0.04), however, serum zinc status did not change in either of the study arms. Children who had received the fortified drink had significantly lower odds of being ID (0.15; 95% confidence interval (CI): 0.09–0.27), IDA (0.14; 95% CI: 0.04–0.52), vitamin B 12 deficient (0.36; 95% CI: 0.18–0.73) and vitamin C deficient (0.24; 95% CI: 0.13–0.46), after adjusting for baseline age, gender and weight. Conclusions: The multi micronutrient-fortified drink was efficacious in reducing the prevalence of ID, IDA, vitamin C and vitamin B 12 deficiency and improved micronutrient status in schoolchildren.
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ISSN:	0954-3007 1476-5640
DOI:	10.1038/ejcn.2012.188