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

• 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
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/ejcn.2012.188

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.