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.

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

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.

Dietary Inadequacy, Micronutrient Deficiencies, and Approaches to Preventing Poor Nutrition in the Gaza Strip

Palestine refugees comprise the largest refugee population in the world, most of whom are encamped in Middle Eastern countries. In the Gaza Strip, where ∼1.4 million Palestinians reside, there are high prevalences of anemia and multiple micronutrient deficiencies (MNDs), including those of iron, zinc, vitamins A, B12, D, and E, ranging from 11.4% to 84.7% among pregnant women and 2.9% to 70.9% among preschool children. Dietary diversification and adequate food fortification are framed in policies but remain aspirational goals. Alternative, effective, targeted preventive approaches include, for women, replacement of antenatal iron-folic acid with multiple micronutrient supplementation, and for young children, point-of-use multiple micronutrient powder fortification to prevent anemia, both of which can reduce other MNDs and may bring additional health benefits. These interventions coupled with monitoring of dietary intakes, periodic assessment of MNDs, and implementation research to improve existing nutrition interventions are warranted to protect the health of the Middle East Palestinian diaspora.

Predictors of Multiple Micronutrient Powder Intake Adherence among Children Aged 6-23 Months in Rasuwa District, Nepal: A Cross-sectional Study

Introduction Breastfeeding would not be sufficient to meet the micronutrient requirement of children after six months and more prone to iron deficiency anemia. Micronutrient powder (MNP) can be mixed with semi-solid food to feed the children aged 6-23 months, contains 12 different micronutrients, one of the appropriate strategies. The study’s objective was to assess adherence to MNP and its predictors among children aged 6-23 months in Rasuwa district of Nepal. MethodsA cross-sectional study was conducted in the Uttargaya rural and the Kalika rural municipality of Rasuwa district among 200 mothers of children aged 6-23 months who were fed MNP. Proportionate random sampling was used to select eligible mothers for interviews, and a semi-structured questionnaire was employed for data collection. Multivariate logistic regression was used to obtain adjusted odds ratio with 95% C.I. ResultsSample mean was calculated among 155 mothers who received 60 sachets of MNPs;41.3% had adhered to 60 sachets intake of MNP. The mean age of the mother was 25. 29±5.3 years and the mean age of children was 14. 66±5.2 months. In bivariate analysis, the mother having one child less than five years (COR=0.5, 95% CI: 0.24-1.0) and MNP received from the health facility (COR=1.96, 95% CI: 1.02-3.76) were statically significant. Further, multivariate analysis, a mother who accepted the properties of MNP (AOR=2.52, 95% CI: 1.27-5.00), was associated with high adherence. ConclusionAcceptability of MNP by the mother is the key to increase adherence to MNP. The distribution of MNP from a health facility, tailored with nutrition education is essential to improve adherence to MNP.

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

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.

Multiple Micronutrient Powder Reduces Vitamin E Deficiency in Brazilian Children: A Pragmatic, Controlled Clinical Trial

Multiple micronutrient powder supplementation is a health promotion strategy, but data on its effectiveness regarding vitamin E are rare. The objective was to evaluate the impact of home fortification with powdered micronutrients on α-tocopherol concentrations, growth, and inflammation in Brazilian children aged 6–15 months. This is a pragmatic, controlled clinical trial, in which the intervention group received micronutrient powder sachets for up to 3 months. Vitamin E deficiency was considered when α-tocopherol was less than 11.6 µmol/L. The Poisson regression model was used to estimate adjusted values for prevalence ratios (PR) for the outcome variable. A total of 224 children participated in the study. The intervention group had a higher median α-tocopherol level (17.2 versus 3.6 µmol/L; p < 0.001) and an 82.0% reduction in the prevalence of vitamin deficiency (PR = 0.18; 95% CI 0.11–0.30) when compared with the control group. Consumption of multiple micronutrients in powder increases serum α-tocopherol concentrations, promotes better linear growth, and reduces morbidity in children.

Effects of Zinc Alone versus Zinc-Containing Multiple Micronutrient Powder on Insulin-Like Growth Factor 1 (IGF1) and IGF Binding Protein-3 (IGFBP3) in Laotian Children (OR07-05-19)

Objectives To assess a) the impact of daily preventive zinc tablets (7 mg; PZ), multiple micronutrient powder (10 mg zinc, 6 mg iron and 13 other micronutrients; MNP) or placebo on Insulin-like Growth Factor 1 (IGF1), IGF Binding Protein 3 (IGFBP3) and IGF1 bioavailability (indexed by molar IGF1: IGFBP3 ratio), among Laotian children aged 6–23 mo; b) potential effect modification by baseline physical growth status. Methods Plasma samples from 419 children participating in the parent trial (n = 3407) were collected at baseline and after ∼9 mo (endline). Determination of IGF1 and IGFBP3 were done via an automated chemiluminescent assay. Linear regression models were used to assess main and modifying effects of PZ and MNP on IGF1 and IGFBP3, controlling for age, sex, district and baseline values of each biomarker. Results The parent trial found no overall treatment effects on physical growth. In this subgroup, mean age at baseline was 14.2 ± 5.1 mo and ∼38% were stunted. IGF1 and IGFBP3 at baseline were 45.9 ng/ml and 2143.0 ng/ml, respectively. At endline, geometric mean IGF1 (∼39.0–39.2 ng/ml; P = 0.99), IGFBP3 (2038–2076 ng/ml; P = 0.83) and molar IGF1: IGFBP3 ratio (0.071–0.073; P = 0.74) did not differ by group. Baseline weight-for-age z-score (WAZ) modified the treatment effect on IGFBP3 (p for interaction = 0.05) and molar IGF1: IGFBP3 (p for interaction = 0.04). In non-underweight children (WAZ ≥ -2), mean IGFBP3 in the PZ group (2000 ng/ml) was significantly lower than in the placebo (2148 ng/ml; P = 0.03) and MNP (2157 ng/ml; P = 0.03) groups. In underweight children, however, the IGFBP3 in the PZ group (2039 ng/ml) was higher than the placebo (1774 ng/ml; P = 0.05) but not the MNP (1881 ng/ml; P = 0.15) group. PZ (relative to placebo and MNP) appeared to reduce the bioavailability of IGF1 in underweight children, while increasing IGF1 bioavailability in non-underweight children (p interaction = 0.04). Conclusions IGF1 in this population did not respond to PZ or MNP. PZ (relative to placebo and MNP) was associated with higher endline IGFBP3 concentrations in underweight children but lower values in non-underweight children. These results suggest that PZ affected activity in the GH-IGF axis in these children, but additional evidence is needed to understand long term implications for growth in this population. Funding Sources By The Thrasher Research Fund, with support from the Mathile Institute for the Advancement of Human Nutrition, Nutrition International and the Bill & Melinda Gates Foundation.

Pengaruh Multiple Micronutrient Powder Terhadap Kejadian Infeksi Saluran Pernapasan Akut Pada Anak Usia 6-59 Bulan Dengan Anemia

Anak Balita merupakan kelompok usia yang rentan terhadap gizi dan kesehatan. Pada masa ini daya tahan tubuh anak masih belum kuat, sehingga risiko anak menderita penyakit infeksi lebih tinggi. Salah satu penyakit infeksi yang sering terjadi pada Anak balita adalah Infeksi Saluran Pernafasan Akut (ISPA). Multiple Micronutrient Powder merupakan multimineral yang diberikan pada balita untuk membantu tumbuh kembang balita secara optimal, meningkatkan daya tahan tubuh, meningkatkan nafsu makan, mencegah anemia dan mencegah kekurangan zat gizi. Penelitian ini bertujuan untuk menganalisis pengaruh Multiple Micronutrient Powder Terhadap Kejadian ISPA Anak Dengan Anemia Usia 6-59 Bulan. Metode penelitian adalah Randomized Control Trial dengan sampel Anak dengan anemia usia 6-59 bulan dipilih secara random. Sampel dikelompokkan menjadi dua kelompok yaitu kelompok yang diberi Multiple Micronutrient Powder dan kelompok lain diberi plasebo. Keduanya diberi perlakuan selama 12 minggu. Kejadian ISPA diobservasi sebelum dan sesudah perlakuan. Berdasarkan analisis regresi linier ganda didapatkan hasil bahwa balita yang diberi Multiple Micronutrient Powder menurun kejadian ISPA sebesar 0,076 dibandingkan yang diberi plasebo, walaupun secara statistik tidak signifikan (p=0,455). Pemberian Multiple Micronutrient Powder pada balita dengan anemia menurunkan kejadian ISPA, meskipun secara statistik tidak signifikan.