Title: Efficacy of a multi micronutrient-fortified drink in improving iron and micronutrient status among schoolchildren with low iron stores in India: A randomised, double-masked placebo-controlled trial Authors
|Thankachan, P -|
|Selvam, S -|
|Surendran, D -|
|Chellan, S -|
|Pauline, M -|
|Abrams, S -|
|Kurpad, A -|
Submitted to: European Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: October 17, 2012
Publication Date: February 1, 2013
Citation: Thankachan, P., Selvam, S., Surendran, D., Chellan, S., Pauline, M., Abrams, S.A., Kurpad, A.V. 2013. Efficacy of a multi micronutrient-fortified drink in improving iron and micronutrient status among schoolchildren with low iron stores in India: A randomised, double-masked placebo-controlled trial. European Journal of Clinical Nutrition. 67(1):36-41. Interpretive Summary: A drink with added minerals and vitamins could be an effective strategy for combating nutritional deficiencies in school children especially in resource-poor countries. Along with our colleagues in India, we conducted a school-based, randomized, double-blind, placebo-controlled study of such a beverage in school children age 612 years who received either a multi-micronutrient-fortified or an unfortified identical control drink 6 days/week for 8 weeks. The groups at baseline were comparable, and the overall prevalence of iron deficiency, was 64%. At the end of the study, the prevalence of iron deficiency significantly reduced by 42% in the children who received the fortified beverage as compared with the control. Benefits were also seen for other nutrients including vitamin C and B12. We concluded that a multi-micronutrient-fortified drink was successful in reducing the prevalence of malnutrition in school children in India.
Technical Abstract: A multiple micronutrient-fortified drink could be an effective strategy to combating micronutrient deficiencies in school-going children. Our objective was to assess the efficacy of a multiple micronutrient-fortified drink in reducing iron deficiency (ID), ID anemia (IDA), anemia and improving micronutrient status among school children with low iron stores. The study employed a school-based, randomized, double-blind, placebo-controlled design. School children with low serum ferritin (SF <20 ug/l) (n=246), aged 6–12 years were randomly assigned to receive either a multi-micronutrient-fortified or an unfortified identical control drink. The drinks were provided 6 days/week for 8 weeks. Anthropometric and biochemical assessments were taken at baseline and endline. Study groups at baseline were comparable, and compliance to the intervention was similar. The overall prevalence of ID, IDA, and anemia was 64%, 19%, and 24%, respectively. The prevalence of ID, IDA, vitamin C, and vitamin B12 deficiencies significantly reduced by 42%, 18%, 21%, and 5%, respectively, in the intervention arm (P<0.01) as compared with the control arm at the end of the study. Similarly, the concentration of hemoglobin, SF, vitamin A, vitamin B12, vitamin C, and body iron stores were significantly higher in the intervention arm in comparison to the control arm (P<0.001). Red cell folate levels also improved significantly in the intervention arm (P<0.04); however, serum zinc status did not change in either of the study arms. Children who had received the fortified drink had significantly lower odds of being ID (0.15; 95% confidence interval (CI): 0.09–0.27), IDA (0.14; 95% CI: 0.04–0.52), vitamin B12 deficient (0.36; 95% CI: 0.18–0.73), and vitamin C deficient (0.24; 95% CI: 0.13–0.46), after adjusting for baseline age, gender, and weight. The multi-micronutrient-fortified drink was efficacious in reducing the prevalence of ID, IDA, vitamin C, and vitamin B12 deficiency and improved micronutrient status in school children.