Efficacy of Multiple Micronutrient Supplementation for Improving Anemia, Micronutrient Status, and Growth in South African Infants1

Abstract

Growth faltering, anemia, and multiple micronutrient deficiency are common during infancy in developing countries. This South African trial was part of a multicenter study aimed at testing the efficacy of multiple micronutrient supplementation on growth, anemia, micronutrient status, and morbidity during infancy across 4 countries. A total of 265 infants aged 6-12 mo were individually randomized to 1 of 4 intervention groups: a daily multiple micronutrient supplement (DMM), a daily placebo supplement (P); a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week (WMM), and a daily iron supplement (DI). For 6 mo, the blinded supplements were provided to mothers at monthly health clinic sessions, and consumption was verified during weekly household visits by community health workers, when morbidity was also checked. Weight and height of the infants were measured monthly, and blood samples were taken at the beginning and at the end for assessing the infants micronutrient status. There were no significant differences in nutritional status of the groups at baseline with 40% of infants with anemia (hemoglobin < 110 g/L), 16% vitamin A deficiency (plasma retinol < 0.7 micromol/L), 47% zinc deficiency (plasma zinc < 10.7 micromol/L), 2% underweight, and 11% stunting. There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study. The DMM was the most effective intervention tested, not only for improving anemia but also for improving iron, zinc, riboflavin, and tocopherol status.

Effects of bovine serum concentrate, with or without supplemental micronutrients, on the growth, morbidity, and micronutrient status of young children in a low-income, peri-urban Guatemalan community

“…Other studies of multiple micronutrients (MMN) found positive effects of supplementation on growth among Mexican (Rivera et al, 2001) and Vietnamese (Thu et al, 1999;Hop and Berger, 2005) infants and among older children in Tanzania (Ash et al, 2003), suggesting that deficiency of one or more these micronutrients was limiting their physical development. Contrary to these results, multiple micronutrient (MMN) supplements did not affect the growth of children in other settings (Penny et al, 2004;Ló pez de Romaña et al, 2005;Smuts et al, 2005;Untoro et al, 2005), possibly because the study subjects were less growth restricted initially, they were not lacking in any of the specific micronutrients that are critical for growth, or the supplements that were provided were poorly absorbed.…”

“…Among Tanzanian school children 6-11 years of age, an MMN-fortified drink increased rates of both linear growth and weight gain (Ash et al, 2003). By contrast, there was no growth impact of MMN supplementation in a recent trial in Peru (Penny et al, 2004) or in three sites included in a recently completed multi-center trial (Ló pez de Romaña et al, 2005;Smuts et al, 2005;Untoro et al, 2005). The inconsistent results across these different sets of studies may relate to the age of the study subjects, their underlying nutritional status, the duration of supplementation, the composition of the supplements, or their mode of delivery (e.g., with or without meals).…”

“…While the benefit of zinc supplementation for reducing morbidity has been demonstrated in a considerable number of studies (Zinc Investigators' Collaborative Group, 1999), the effect of multiple micronutrient supplements on morbidity outcomes is still unclear. The few results available to date have been disappointing (Penny et al, 2004;Ló pez de Romaña et al, 2005;Smuts et al, 2005;Untoro et al, 2005).…”

Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic

“…These findings are similar to those of three other studies of home fortification products in which there was no significant impact of the intervention on vitamin A status. 3,9,17,18 In our population, the lack of impact might be partially attributable to concurrent vitamin A capsule distribution, the insensitivity of current indicators to assess vitamin A status, 19 and the relatively low prevalence of vitamin A deficiency in the population without inflammation.…”

Efetividade da suplementação diária ou semanal com ferro na prevenção da anemia em lactentes

“…The results of four subsequent studies adopting the IRIS (The International Research on Infant Supplementation Initiative) protocol, 6 in which daily and weekly supplementation were compared among infants, indicate that only daily supplementation is effi cacious in controlling anemia. 8,9,16,21 Prior to the present clinical trial, there was no record of a study comparing the effectiveness of daily and weekly iron supplementation in preventing anemia among infants.…”