Fortifying Milk with Ferrous Gluconate and Zinc Oxide in a Public Nutrition Program Reduced the Prevalence of Anemia in Toddlers

Abstract

We aimed to assess the efficacy of whole cow's milk fortified with ferrous gluconate and zinc oxide, along with ascorbic acid, in reducing the prevalence of anemia and improving iron status of low income children 10-30 mo of age. Healthy children were randomly assigned to drink 400 mL/d of cow's whole milk, either fortified milk (FM) with 5.8 mg/400 mL of iron as ferrous gluconate, 5.28 mg/400 mL of zinc as zinc oxide, and 48 mg/400 mL of ascorbic acid, or nonfortified milk (NFM) with 0.2 mg iron/400 mL, 1.9 mg zinc/400 mL, and 6.8 mg ascorbic acid/400 mL. Hemoglobin, serum ferritin, soluble transferrin receptors (TfR), and C-reactive protein concentrations were measured at baseline and 6 mo after intervention. The prevalence of anemia declined from 41.4 to 12.1% (P < 0.001), or 29 percentage points, in the FM group; there was no change in the NFM group. Hemoglobin (coefficient = 0.22, P < 0.01) was positively and TfR (coefficient = -0.29, P < 0.001) negatively associated with treatment, controlling for their respective baseline values, age, and gender. Treatment with FM was negatively associated with the likelihood of being anemic (pseudo R(2) = 0.085, P < 0.03) after 6 mo of intervention. Ferrous gluconate added to whole cow's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status of Mexican toddlers. The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1-11 y of age in Mexico.

Clinical Profile of Anemia in Children

“…Iron deficiency anemia is most common in our study followed by dimorphic anemia and megaloblastic anemia, which is in accordance to previous studies [1,2,3,4,8,10,12,13,14,15]. There are several causes of iron deficiency anemia.…”

“…It is observed from our study that all three types of anemia were more in 1-2 years age group, which is in accordance to previous studies [1,2,3,4,5,7,9,10,13,14]. It may be due to poverty, maternal anemia, continued exclusive breast feeding beyond 6 months and improper complimentary diet.…”

Effects of zinc-fortified drinking skim milk (as functional food) on cytokine release and thymic hormone activity in very old persons: a pilot study

“…A particular attention needs also to be addressed to the age of the old subjects that need zinc supplementation because of the extreme cellular frailty present in older individuals (Collerton et al 2012) that can lead to no significant biochemical modifications even with low doses of zinc in tablets (Hininger-Favier et al 2007) with also adverse effects and toxicity (Hsu and Guo 2002). In this context, fortified foods (functional foods) are an emerging field in food science with the intention of increasing the life expectancy and improving human health conditions (Villalpando et al 2006;Sazawal et al 2010;Vinodkumar et al 2009). Food fortification holds promise, because it does not require changes in dietary patterns, the cost is low and, as such, it can reach a large portion of the elderly population, including very old subjects.…”

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

“…[3][4][5][6] Iron defi ciency alone among children and adolescence with and/or without anemia is strongly related to learning ability and school achievement, besides of its closed relation to growth and loss of appetite. [6][7][8][9] Zinc, it is involved in metabolic processes, and it was stated from several studies that zinc defi ciency greatly affecting body growth, development, and immunity. 4 Thus, the combination of iron and zinc enriched in milk powder might have a strategic role in the prevention of child growth and development impairment.…”

“…And, in general, this combination has no negative effect, biochemically. 4,[8][9][10] Unfortunately, iron and zinc are mostly found in meat and seafood which are classifi ed as expensive foods. Poor socio-economic status is affecting to the poor quality of poor iron and zinc intake from daily foods, especially of those of hem-iron sources.…”