Effect of a six-month iron-zinc fortified milk supplementation on nutritional status, physical capacity and speed learning process in Indonesian underweight schoolchildren: randomized, placebo-controlled

Abstract

AbstrakTujuan mengevaluasi efek suplementasi susu yang diperkaya dengan zat besi dan zink terhadap indikator pertumbuhan, kapasitas fi sik dan kecepatan berpikir anak sekolah yang kurang berat (underweight (12,74 + 11,76) dibandingkan dengan kelompok susu biasa (8.31 + 9,60), namun tidak ada perbedaan yang bermakna untuk perbaikan skor kapasitas fi sik antara kedua kelompok (berturut-turut 10323,77 + 9253,83 dan 8435,94 + 8824,55). AbstractAim to evaluated the effect of milk supplementation enriched with iron and zinc on indicators of growth, physical capacity and cognitive performance in underweight school-children.Method Two-armed, randomized controlled double-blind trial was performed in several primary schools in Jakarta and Surakarta, Indonesia. A total of 245 underweight schoolchildren aged 7-9 years living in urban poor areas of Jakarta and Solo were randomly allocated to receive two cups of iron-zinc fortifi ed-milk (n = 121) or non-iron-zinc fortifi ed milk (n= 124) supplementation daily for six months. Biochemical indicators, anthropometric indices, physical capacity and cognitive performance were measured at before and after the supplementation. ResultsThe study shows that between the fortifi ed and non-fortifi ed milk group, there was no signifi cant different in haemoglobin increase (0.01 + 0.96 mg/dL versus 0.17 + 0.81 mg/dL) nor serum ferritin increase (12.77 + 25.50 mcg/dL versus 14.99 + 29.56 mcg/dL). Unexpectedly, decreased in serum zinc was found in both groups (3.01 + 3.24 mMol/dL and 3.12 + 3.71 mMol/dL). There was signifi cant higher increment (P=0.045) in body weight among the fortifi ed milk group (1.31 + 0.69 kg) as compared to the non-fortifi ed group (1.13 + 0.69 kg). Consistently, there was signifi cant increase (P=0.025) in the indicator of underweight (WAZ) among the fortifi ed milk group (1.47 + 0.50) as compared to the non-fortifi ed group (1.33 + 0.47). There was signifi cant improvement (P=0.001) of cognitive performance, i.e. coding test-score among the fortifi ed group (12.74 + 11.76) as compared to the non-fortifi ed group (8.31 + 9.60), but there was no signifi cant difference found in the improvement of physical capacity score in both groups (10323.77 + 9253.83 versus 8435.94 + 8824.55).Conclusion Among underweight schoolchildren aged 7-9 y, supplementation of milk fortified with iron and zinc can provide better growth, and better speed processing of learning ability.

Health effects of micronutrient fortified dairy products and cereal food for children and adolescents: A systematic review

“…Our searches retrieved 2048 potentially relevant studies (PRISMA flow diagram: Fig 1). Twenty-four RCTs (n = 11 fortified dairy products [27, 35–44]; n = 13 fortified cereals [24–26, 28, 29, 31, 45–51]) fulfilled the inclusion criteria, provided suitable data and were included in our main analysis (studies included: Table 2; examples of excluded studies with reasons for exclusion: S3 Table). Seven of the 24 trials were cluster-randomised trials [31, 35–38, 42, 44].…”

“…Twenty-four RCTs (n = 11 fortified dairy products [27, 35–44]; n = 13 fortified cereals [24–26, 28, 29, 31, 45–51]) fulfilled the inclusion criteria, provided suitable data and were included in our main analysis (studies included: Table 2; examples of excluded studies with reasons for exclusion: S3 Table). Seven of the 24 trials were cluster-randomised trials [31, 35–38, 42, 44]. The 24 RCTs reported about 9,367 children and adolescents, mostly from low- and middle-income countries (17 studies from Asia [27, 28, 31, 35–42, 44, 46, 48–51], six from Africa [24–26, 29, 45, 47]; and one from Australia, which provided only height and weight change data [43].…”

“…Seven of the 24 trials were cluster-randomised trials [31, 35–38, 42, 44]. The 24 RCTs reported about 9,367 children and adolescents, mostly from low- and middle-income countries (17 studies from Asia [27, 28, 31, 35–42, 44, 46, 48–51], six from Africa [24–26, 29, 45, 47]; and one from Australia, which provided only height and weight change data [43]. 15 of 24 RCTs were industry funded [24–27, 29, 35–37, 39, 41, 43, 45, 47, 49, 50], six of which in combination with public funding [24, 37, 39, 47, 49, 50].…”

“…The effect of fortification on haematological outcomes (haemoglobin levels, anaemia, iron deficiency anaemia, iron deficiency) was assessed in the meta-analysis with 14 studies reporting iron fortification, applied as single [28, 45, 47, 49, 51], dual (i.e. with zinc) [35] or MMN strategy (e.g. with zinc, iodine, vitamin A [24, 25, 27, 31, 39, 41, 50].…”

Zinc level in children with short stature

“…Energy and micronutrient deficiency remain prevalent among children. The fortified juice drink was effective in reducing the prevalence of growth deficit and improved the zinc status of children [27,28]. Zinc is an important nutrient which is critical for normal immune function and physical growth.…”