Micronutrient Supplementation and Fortification Interventions on Health and Development Outcomes among Children Under-Five in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract

Micronutrient deficiencies continue to be widespread among children under-five in low-and middle-income countries (LMICs), despite the fact that several effective strategies now exist to prevent them. This kind of malnutrition can have several immediate and long-term consequences, including stunted growth, a higher risk of acquiring infections, and poor development outcomes, all of which may lead to a child not achieving his or her full potential. This review systematically synthesizes the available evidence on the strategies used to prevent micronutrient malnutrition among children under-five in LMICs, including single and multiple micronutrient (MMN) supplementation, lipid-based nutrient supplementation (LNS), targeted and large-scale fortification, and point-of-use-fortification with micronutrient powders (MNPs). We searched relevant databases and grey literature, retrieving 35,924 papers. After application of eligibility criteria, we included 197 unique studies. Of note, we examined the efficacy and effectiveness of interventions. We found that certain outcomes, such as anemia, responded to several intervention types. The risk of anemia was reduced with iron alone, iron-folic acid, MMN supplementation, MNPs, targeted fortification, and large-scale fortification. Stunting and underweight, however, were improved only among children who were provided with LNS, though MMN supplementation also slightly increased length-for-age z-scores. Vitamin A supplementation likely reduced all-cause mortality, while zinc supplementation decreased the incidence of diarrhea. Importantly, many effects of LNS and MNPs held when pooling data from effectiveness studies. Taken together, this evidence further supports the importance of these strategies for reducing the burden of micronutrient malnutrition in children. Population and context should be considered when selecting one or more appropriate interventions for programming.

A review of micronutrient deficiencies and analysis of maize contribution to nutrient requirements of women and children in Eastern and Southern Africa

“…There are evidences of importance and efficiency of all these intervention strategies. However, when selecting one or more appropriate interventions, population and context should be taken into account: cost, feasibility of implementation, strategies for monitoring and evaluation, and population-specific factors including gender-related barriers to uptake and prevalence of deficiencies at a sub-national level (which are often masked by national-level estimates) (Tam et al 2020).…”

Minerals in Pregnancy and Their Impact on Child Growth and Development

“…In childhood, iodine deficiency showed to be a risk factor for delayed development [97]. There are studies that also associate the deficiency of this mineral with autism and attention deficit and hyperactivity disorder in children [98].…”

“…Anemia has been associated with poor motor development and with irreversible cognitive defects [97]. A greater concern arises because there is evidence that iron-deficient and obese children can develop neurodegenerative diseases due to elevation of hepcidin, a protein regulator of iron, that is required for the adequate functioning of neurons, and it is necessary for insulin and its receptor signal in the brain system [90].…”

Association of Dietary Micronutrient Intake with Pulmonary Tuberculosis Treatment Failure Rate: ACohort Study

“…However, no effective adjunctive nutritional therapy is available for the treatment of pulmonary tuberculosis treatment. Dietary micronutrients intake was shown to be important for human health [10,11]. Particularly, vitamin C has pleiotropic effects on human health, possibly due to its antioxidant properties and cofactor functions for numerous biosynthetic enzymes [12].…”