Micronutrient fortified milk improves iron status, anemia and growth among children 1-4 years: a double masked, randomized, controlled trial

• Published in: PloS one Vol. 5; no. 8; p. e12167
• Main Authors: Sazawal, Sunil, Dhingra, Usha, Dhingra, Pratibha, Hiremath, Girish, Sarkar, Archana, Dutta, Arup, Menon, Venugopal P, Black, Robert E
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13-08-2010; Public Library of Science (PLoS)
• Subjects: Anemia; Anemia - diet therapy; Animals; Anthropometry; Ascorbic acid; Biochemistry; Body measurements; Child development; Child, Preschool; Children; Children & youth; Confidence intervals; Consent; Copper; Dairy products industry; Double-Blind Method; Ferritin; Food; Food fortification; Food, Fortified; Fuel consumption; Growth; Growth and Development - drug effects; Health Behavior; Hematology; Hemoglobin; Hemoglobins; Humans; Infant; Intervention; Iron; Iron - metabolism; Iron deficiency; Iron deficiency anemia; Manganese; Micronutrients; Milk; Nutrient deficiency; Nutrition; Nutrition/Deficiencies; Nutrition/Malnutrition; Parameter estimation; Pediatrics and Child Health; Pediatrics and Child Health/Child Development; Physical growth; Plasma; Preschool children; Public health; Public Health and Epidemiology; Public Health and Epidemiology/Global Health; Randomization; Selenium; Supplementation; Time Factors; Tocopherol; Trace elements; Vitamin A; Vitamin C; Vitamin E; Zinc; United States > US; Maryland; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0012167

Multiple micronutrient deficiencies are highly prevalent among preschool children and often lead to anemia and growth faltering. Given the limited success of supplementation and health education programs, fortification of foods could be a viable and sustainable option. We report results from a community based double-masked, randomized trial among children 1-4 years evaluating the effects of micronutrients (especially of zinc and iron) delivered through fortified milk on growth, anemia and iron status markers as part of a four group study design, running two studies simultaneously.
Enrolled children (n = 633) were randomly allocated to receive either micronutrients fortified milk (MN = 316) or control milk (Co = 317). Intervention of MN milk provided additional 7.8 mg zinc, 9.6 mg iron, 4.2 microg selenium, 0.27 mg copper, 156 microg vitamin A, 40.2 mg vitamin C, and 7.5 mg vitamin E per day (three serves) for one year. Anthropometry was recorded at baseline, mid- and end-study. Hematological parameters were estimated at baseline and end-study. Both groups were comparable at baseline. Compliance was over 85% and did not vary between groups. Compared to children consuming Co milk, children consuming MN milk showed significant improvement in weight gain (difference of mean: 0.21 kg/year; 95% confidence interval [CI] 0.12 to 0.31, p<0.001) and height gain (difference of mean: 0.51 cm/year; 95% CI 0.27 to 0.75, p<0.001). Mean hemoglobin (Hb) (difference of 13.6 g/L; 95% CI 11.1 to 16.0, p<0.001) and serum ferritin levels (difference of 7.9 microg/L; 95% CI 5.4 to 10.5, p<0.001) also improved. Children in MN group had 88% (odds ratio = 0.12, 95% CI 0.08 to 0.20, p<0.001) lower risk of iron deficiency anemia.
Milk provides an acceptable and effective vehicle for delivery of specific micronutrients, especially zinc and iron. Micronutrient bundle improved growth and iron status and reduced anemia in children 1-4 years old.