Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36–66 mo

Abstract

Background: Children participating in the Integrated Child Development Service (ICDS) in India have high rates of iron and vitamin A deficiency. Objective: The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi, a rice and dal mixture, in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency, anemia, and vitamin A deficiency. Design: This cluster, randomized, double-blind, controlled trial was initiated in 30 Anganwadi centers (daycare centers) in West Bengal state, India. Children aged 36 -66 mo (n ҃ 516) attending villagebased ICDS centers were randomly assigned to receive either a fortified or a nonfortified premix for 24 wk. Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin, serum ferritin, and serum retinol. Results: The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups (P 0.001). Prevalence rates of anemia, iron deficiency, and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group (P 0.001). There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified-and nonfortified-khichdi groups. Conclusion: A premix fortified with iron, vitamin A, and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia.

International Experiences in Assessing Vitamin A Status and Applying the Vitamin A-Labeled Isotope Dilution Method

“…In the same study, SR concentrations increased from baseline only in the supplemented group, but fi nal SR concentrations did not signifi cantly differ from the control group [37]. In a cluster randomized, controlled study by Varma et al [38], there were unfortunate baseline differences between groups in SR, but not VAD prevalence, and no change was observed in either SR or VAD prevalence after an intervention with iron and VA (500 ug) premix. In a randomized controlled trial of children aged 5 -18 y with mean SR close to 0.7 μmol / L, a micronutrient fortifi ed salt including VA reduced the prevalence of VAD in children 5 -18 years from 57 % to 16 %, based on SR < 0.7 μmol / L [39].…”

The Influence of Vitamin A Supplementation on Iron Status

“…In a randomized, double-blind, controlled trial study carried out by Varma et al [10], 516 Indian children aged 3–5.5 year participating in the Integrated Child Development Service (ICDS) received for 6 months either a non-fortified or a fortified “premix” with VA (500 IU as retinyl acetate), Fe (14 mg as ferrous fumarate), and folic acid (50 μg) added to prepare khichdi (rice and lentils mixture), to decrease the prevalence of Fe and VA deficiencies. There were significant differences in the prevalence of anemia, iron deficiency anemia, mean serum retinol concentration, and C-reactive protein (CRP) in both groups of children at baseline.…”

Acceptance and Effect of Ferrous Fumarate Containing Micronutrient Sprinkles on Anemia, Iron Deficiency and Anthropometrics in Honduran Children

“…When determining the cost effectiveness of home-fortification programs in a low income country with a high infant mortality rate and high prevalence of anemia, it is estimated that cost per DALY saved is $12.2 and the present value of the gain in earnings is $37 for each dollar spent on the micronutrient sprinkles program . Iron fortification continues to be evaluated in a variety of food stuffs for efficacy and acceptance (Karn et al, 2011;Angeles-Agdeppa et al, 2011;Varma et al, 2007;Andersson et al, 2008;Adu-Afarwuah et al, 2008;Wegmuller et al, 2006;Hurrell et al, 2010;Faber et al, 2005;Torrejon et al, 2004); however, it is essential that the fortification efforts are supported politically, adequately marketed, cost effective and have long-term commercial commitment (Angeles-Agdeppa et al, 2011). Iron supplementation and fortification are effective in controlling iron deficiency in populations and bioavailability of the iron is an important factor, iron status should be used and monitored to assess fortification requirements and efficacy (Zimmermann & Hurrell, 2007).…”