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

Abstract

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 o20 mg/l) (n ¼ 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 (Po0.01) 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 (Po0.001). Red cell folate levels also improved significantly in the intervention arm (P ¼ 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.

Meeting iron needs for infants and children

“…The first three also reported an absolute risk reduction of IDA (China: 45-33%, India: 28-13% and Brazil: 75-20%) [39][40][41][42]. All four populations had a high prevalence of anaemia at baseline and all found a significant positive effect on haemoglobin.…”

Contribution of food sources to the vitamin B12 status of South Indian children from a birth cohort recruited in the city of Mysore

“…There are currently no standard criteria for defining B 12 deficiency in children, but 2·5 % were deficient according to the adult definition and a further 14 % had 'marginal' status. Given that rates of deficiency in India have been measured at 1-44 %, the prevalence in our cohort could be considered low (10)(11)(12)(13)(14) . However the 150 pmol/l cut-off was derived for adults and may not be a valid measure of deficiency for children.…”

“…There is no standard definition of deficiency among children and there is a paucity of data on B 12 status among Indian children. However, recent studies using adult cut-offs have reported that 2-44 % of infants and school-age children are deficient (10)(11)(12)(13)(14) . A study in Pune, India showed normal B 12 absorption in the majority (90 %) of individuals studied (15) .…”

Multi-micronutrient Fortified Beverage Delivered through the School-Based System Improved Iron Status and Test Scores of Children

“…In the same manner, studies on multiple micronutrient-fortified beverages [18][19][20], iron-fortified candies [21], biscuits [22] and drinking water [23] showed positive response to intervention by increased hemoglobin levels, serum ferritin or decreased prevalence of anemia among subjects after the intervention period. The multiple micronutrient intervention was effective in reducing the prevalence of anemia in children [24][25][26][27][28][29].…”