Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

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Soluble Serum Transferrin Receptor (STFR) Levels in Hemodialysis Patients

Annals of King Edward Medical University ◽

10.21649/akemu.v22i4.1463 ◽

2016 ◽

Vol 22 (4) ◽

Author(s):

Ayesha Majeed ◽

Aisha Hameed ◽

Iram Aftab ◽

Muhammad Anees ◽

Shahida Mohsin ◽

...

Keyword(s):

Iron Deficiency ◽

Renal Disease ◽

Serum Ferritin ◽

Transferrin Receptor ◽

Hemodialysis Patients ◽

Serum Transferrin ◽

Soluble Transferrin Receptor ◽

Serum Transferrin Receptor ◽

Iron Deficient ◽

Stage Renal Disease

Objectives: Anemia is a frequent disorder in patients with end stage renal disease. Erythropoietin is advised in these patients; however, this therapy is not effective in patients who are iron deficient. So, diagnosis of iron deficiency which is traditionally based on ferritin and other iron parameters becomes difficult in these patients, as chronic kidney disease is a chronic inflammatory condition which affects these markers and masks the iron deficiency. In present study, we assessed the reliability of another indicator of body iron supply; serum transferrin receptor, in hemodialysis patients. It is not affected in case of inflammation unlike other markers of iron status.Patients and Methods: Eighty Patients with endstage renal disease, 20 to 60 years of age and both sexes were included. All cases were examined for complete blood count, serum iron, serum ferritin, serum total iron binding capacity, transferrin saturation and serum soluble transferrin receptor. Data was analysed by using independent sample t test and Pearson’ correlation. A p value of ≤ 0.05 was considered as significant.Results: The results of our research showed that mean values of serum soluble transferrin receptor and serum ferritin were 3.28 ± 0.83 µg/ml and 286.31 ± 165 ng/ml respectively which were significantly higher than the upper normal limit (p < 0.001). Levels of sTfR were statistically different (p = 0.002) between iron replete group (SF > 100 ng/ml) and iron deplete group (SF < 100 ng/ml). Additionally, there was negative and significant correlation between sTfR and Hemoglobin.Conclusions: Levels of serum soluble transferrin receptor can be used as a reliable marker of iron defi-ciency in hemodialysis patients.

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Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes

European Journal of Clinical Nutrition ◽

10.1038/ejcn.2015.157 ◽

2015 ◽

Vol 70 (3) ◽

pp. 358-363 ◽

Cited By ~ 22

Author(s):

A Z Khambalia ◽

C E Collins ◽

C L Roberts ◽

J M Morris ◽

K L Powell ◽

...

Keyword(s):

Iron Deficiency ◽

Birth Outcomes ◽

Serum Ferritin ◽

Early Pregnancy ◽

Transferrin Receptor ◽

Soluble Transferrin Receptor ◽

Pregnancy And Birth Outcomes ◽

Pregnancy And Birth

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Correlations between hemoglobin, serum ferritin, and soluble transferrin receptor levels in children aged 6-59 months

Paediatrica Indonesiana ◽

10.14238/pi54.2.2014.122-6 ◽

2014 ◽

Vol 54 (2) ◽

pp. 122

Author(s):

Fajar Diah Tri Kusumastuti ◽

Sutaryo Sutaryo ◽

Sri Mulatsih

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Transferrin Receptor ◽

Cross Sectional Study ◽

Deficiency Anemia ◽

Soluble Transferrin Receptor ◽

Cross Sectional ◽

Infection And Inflammation ◽

Blood Specimens ◽

Sensitive Marker

Background Early detection of iron deficiency is important in young children to prevent iron deficiency anemia, which may cause permanent neurocognitive development disorders. Hemoglobin level is an insensitive tool for detecting iron deficiency without anemia, while serum ferritin levels may be influenced by infection and inflammation. However, soluble transferrin receptor (sTfR) is a sensitive marker for detecting iron deficiency, yet not widely used in daily practice.Objective To assess for correlations between hemoglobin, serum ferritin, and soluble transferrin receptor levels in children aged 6-59 months.Methods We performed a cross-sectional study in the Yogyakarta and Bantul Districts involving 85 children aged 6-59 months who visited integrated health posts (posyandu) and who met the inclusion criteria. Subjects were chosen by cluster random sampling. Blood specimens were collected to examine hemoglobin, serum ferritin, and sTfR levels.Results Spearman’s correlation test revealed weak negative correlations between hemoglobin and serum ferritin levels, as well as between hemoglobin and sTfR levels, with coefficient correlations of r = -0.220, (P=0.043) and r = -0.317, (P=0.003), respectively. There was no correlation between serum ferritin and sTfR levels (r = -0.033; P=0.767).Conclusion Hemoglobin levels has weak negative correlations with serum ferritin and sTfR, but serum ferritin does not correlate with sTfR. [Paediatr Indones. 2014;54:122-6.]

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Iron Deficiency and Vitamin B12/Folate Levels. A Case-Control Study.

Blood ◽

10.1182/blood.v106.11.3709.3709 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3709-3709

Author(s):

Angel F. Remacha ◽

Pilar Sardà ◽

Teresa Royo ◽

Nieves Fernández ◽

Ester Rojas ◽

...

Keyword(s):

Iron Deficiency ◽

Vitamin B12 ◽

Serum Ferritin ◽

Transferrin Receptor ◽

Case Control Study ◽

Case Control ◽

Deficiency Anemia ◽

Control Group ◽

Soluble Transferrin Receptor ◽

Control Study

Abstract A number of cases with iron deficiency anemia (IDA) are associated with low vitamin B12 (LB12). However, LB12 is not synonymous with B12 deficiency. An increase in homocysteine (Hcy) or methylmalonic acid can differentiate cases with a real deficiency from those with apparently innocuous LB12. Our aim was to study LB12 and low red cell folate (LRCF) prevalence in IDA cases and to determine the existence of B12/folate deficiency. A prospective case-control study was carried out in patients with anemia consecutively admitted to our Hospital. The case group included 506 IDA patients (Hb <115g/l, MCV <98fl, serum ferritin <20microg/l or soluble transferrin receptor >5mg/l). The control group was made up of 117 patients with anemia of chronic disorders (ACD) (Hb <115g/l, MCV 80-98fl, iron <10micromol/l, total iron binding capacity <40micromol/l, serum ferritin >100microg/l and soluble transferrin receptor <4mg/l). Serum B12 and RCF were evaluated in all cases and controls. Serum homocysteine was determined in those with B12 and/or RCF below percentile 10 (B12 <200pmol/l, RCF <590nmol/l). HyperHcy was considered when Hcy exceeded >17micromol/l. Several variables were included in a multiple regression analysis to build a predictive model for IDA with LB12 and hyperHcy. LB12 was observed in 17.8% of IDA cases (87 cases), including 8.2% with B12<150pmol/l (percentile 2.5). Interestingly, 60% of patients with B12 <150pmol/l had hyperHcy and 48% of those with B12 between 150 and 200pmol/l. Low RCF was found in 6.3% (13 cases). All cases with RCF <500nmol/l (percentile 2.5) showed hyperHcy and 50% of cases with RCF between 500 and 590nmol/l. LB12 was observed in 7 patients in the control group (5.4%) and LRCF in 10%. LB12 was more frequent in IDA than in ACD (p<0.0001). The best predictive variable for IDA and LB12 with hyperHcy was age and the cut-off was 60 years (sensitivity: 91%). In summary, in our study 18% of cases with IDA showed LB12, and a high percentage had a real vitamin deficiency. Age was the main predictive factor. Thus, serum B12 should be determined in IDA patients over 60 years

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A Randomized Multiple Micronutrient Powder Point-of-Use Fortification Trial Implemented in Indian Preschools Increases Expressive Language and Reduces Anemia and Iron Deficiency

Journal of Nutrition ◽

10.1093/jn/nxab066 ◽

2021 ◽

Author(s):

Maureen M Black ◽

Sylvia Fernandez-Rao ◽

Krishnapillai Madhavan Nair ◽

Nagalla Balakrishna ◽

Nicholas Tilton ◽

...

Keyword(s):

Child Development ◽

Iron Deficiency ◽

Inhibitory Control ◽

Expressive Language ◽

Childhood Development ◽

Social Emotional ◽

Point Of Use ◽

Micronutrient Powder ◽

Multiple Micronutrient ◽

Multiple Micronutrient Powder

ABSTRACT Background Anemia is a global public health problem that undermines childhood development. India provides government-sponsored integrated nutrition/child development preschools. Objectives This double-masked, cluster-randomized controlled trial examines whether point-of-use multiple micronutrient powder (MNP) compared with placebo fortification of preschool meals impacts child development and whether effects vary by preschool quality (primary outcome) and biomarkers of anemia and micronutrients (secondary outcomes). We also measured growth and morbidity. Methods We randomly assigned 22 preschools in rural India to receive MNP/placebo fortification. We administered baseline and endline blood sampling and measures of childhood development (Mullen Scales of Early Learning, inhibitory control, social–emotional), anthropometry, and morbidity to preschoolers (aged 29–49 mo). Preschools added MNP/placebo to meals 6 d/wk for 8 mo. We conducted linear mixed-effects regression models accounting for preschool clustering and repeated measures. We evaluated child development, examining effects in high- compared with low-quality preschools using the Early Childhood Environment Rating Scale–Revised and the Home Observation for the Measurement of the Environment Inventory, modified for preschools. Results At baseline, mean age ± SD was 36.6 ± 5.7 mo, with 47.8% anemic, 41.9% stunted, and 20.0% wasted. Baseline expressive/receptive language scores were higher in high-quality compared with low-quality preschools (P = 0.02 and P = 0.03, respectively). At endline (91% retention, n = 293/321), we found MNP compared with placebo effects in expressive language (Cohen's standardized effect d = 0.4), inhibitory control (d = 0.2), and social–emotional (d = 0.3) in low-quality, not high-quality, preschools. MNP had significantly greater reduction of anemia and iron deficiency compared with placebo (37% compared with 13.5% and 41% compared with 1.2%, respectively). There were no effects on growth or morbidity. Conclusions Providing multiple micronutrient-fortified meals in government-sponsored preschools is feasible; reduced anemia and iron deficiency; and, in low-quality preschools, increased preschoolers’ expressive language and inhibitory control and reduced developmental disparities. Improving overall preschool quality by incorporating multiple components of nurturing care (responsive care, learning, and nutrition) may be necessary to enhance preschoolers’ development. This trial was registered at clinicaltrials.gov as NCT01660958.

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The value of soluble transferrin receptor and Tfr-Ferritin index in the differential diagnosis of iron deficiency anemia

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2008.09.076 ◽

2009 ◽

Vol 42 (4-5) ◽

pp. 343-344

Author(s):

Tulay Keskin ◽

Ozlem Hurmeydan ◽

Yalcin Onder ◽

Lale Dagdelen ◽

Nazli Caner ◽

...

Keyword(s):

Differential Diagnosis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Transferrin Receptor ◽

Deficiency Anemia ◽

Soluble Transferrin Receptor

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PENGARUH MULTIPLE MICRONUTRIENT POWDER TERHADAP PERTUMBUHAN ANAK DENGAN ANEMIA USIA 6-59 BULAN

JURNAL KESEHATAN MASYARAKAT ◽

10.47317/jkm.v9i2.4 ◽

2020 ◽

Vol 9 (2) ◽

Author(s):

Prastiwi Putri Basuki

Keyword(s):

Randomized Control Trial ◽

Z Score ◽

Trace Mineral ◽

Micronutrient Powder ◽

Multiple Micronutrient ◽

Randomized Control ◽

Multiple Micronutrient Powder

Latar belakang: Kesehatan anak tergantung interaksi antara genetika danfaktor eksogenous seperti kecukupan gizi, kesehatan lingkungan, interaksi sosial dan stimulasi. Hampir dua pertiga kematian anak di dunia secara langsung dan tidak langsung berhubungan dengan defisiensi gizi. Kurang energi protein dan defisiensi mikronutrien meningkatkan risiko kematian karena penyakit seperti anemia, gastroenteritis, pneumonia dan campak. Vitamin dan trace mineral dibutuhkan untuk produksi berbagai macam enzim, hormon, dan mediator biokimiawi untuk mengatur proses biologi. Mikronutrien juga dibutuhkan untuk meningkatkan pertumbuhan fisik, kematangan seksual dan perkembangan syaraf.Tujuan: Penelitian ini bertujuan untuk menganalisis pengaruh MultipleMicronutrient Powder Terhadap Pertumbuhan Anak Dengan Anemia Usia 6-59 Bulan.Metode: Metode penelitian adalah Randomized Control Trial yang dilakukan pada bulan Maret – Mei 2013 di Kecamatan Polanharjo Kabupaten Klaten. Anak dengan anemia usia 6-59 bulan dipilih secara random , dikelompokkan menjadi dua kelompok yaitu kelompok yang diberi Multiple Micronutrient Powder dan kelompok lain diberi plasebo. Keduanya diberi perlakuan selama 12 minggu. Berat Badan dan tinggi badan diukur sebelum dan sesudah perlakuan. Hasil dianalisis dengan menggunakan analisis t-test.Hasil: Anak dengan anemia yang diberi Multiple Micronutrient Powder terjadipeningkatan rata-rata z-score pada indeks TB/U (p=0.829), BB/U (p=0.906), dan BB/TB (p=0.996) walaupun secara statistik tidak signifikan.

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