Daily supplementation of a multiple micronutrient powder improves folate but not thiamine, riboflavin, or vitamin B12 status among young Laotian children: A randomized controlled trial

Authors: HINNOUHO, GUY-MARINO - University Of California, Davis; HAMPEL, DANIELA - University Of California, Davis; Shahab-Ferdows, Setti; BARFFOUR, MAXWELL - University Of California, Davis; MCANENA, L - University Of Ulster; ARNOLD, CHARLES - University Of California, Davis; WESSELLS, K. RYAN - University Of California, Davis; KOUNNAVONG, SENGCHANH - National Institute Of Public Health (INSP); Allen, Lindsay - A; HESS, SONJA - University Of California, Davis

Submitted to: European Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/7/2022
Publication Date: 5/9/2022
Citation: Hinnouho, G., Hampel, D., Shahab-Ferdows, S., Barffour, M.A., McAnena, L., Arnold, C.D., Wessells, K., Kounnavong, S., Allen, L.H., Hess, S.Y. 2022. Daily supplementation of a multiple micronutrient powder improves folate but not thiamine, riboflavin, or vitamin B12 status among young Laotian children: A randomized controlled trial. European Journal of Nutrition. https://doi.org/10.1007/s00394-022-02890-3.
DOI: https://doi.org/10.1007/s00394-022-02890-3

Interpretive Summary: In this study, we examined the effects of a daily multiple micronutrient powder (MNP) on thiamine (vitamin B1), riboflavin (vitamin B2), folate, and B12 status among young Laotian children (n=1704) aged 6-23 mo. The participating children were randomly assigned to receive either MNP (0.5 mg of thiamine, 0.5 mg riboflavin, 150 µg folic acid, and 0.9 µg vitamin B12 along with 11 other micronutrients), or placebo, and followed for ~36 weeks. In a sub-sample of 260 children, erythrocyte thiamine diphosphate (eTDP), plasma folate and B12 concentrations and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin biomarker) were measured at baseline and endline. The MNP did not improve eTDP (110.6 ± 8.9 nmol/L in MNP vs. 109.4 ± 8.9 nmol/L in placebo; p=0.924), EGRac (1.46 ± 3.0 vs. 1.49 ± 3.0; p=0.184), or B12 concentrations (523.3 ± 24.6 pmol/L vs. 515.9 ± 24.8 pmol/L; p=0.678). However, endline folate concentration was significantly higher in the MNP (28.2 ± 0.8 nmol/L vs 19.9 ± 0.8 nmol/L; p<0.001). Thus, daily MNP for 9 months increased only folate but not thiamine, riboflavin or B12 status in young Laotian children.

Technical Abstract: Objective: To assess the effects of intervention with a daily multiple micronutrient powder (MNP) on thiamine, riboflavin, folate and B12 status among young Laotian children. Methods: Children (n=1704) aged 6-23 mo, participating in a double-blind placebo-controlled randomized trial were individually randomized to receive daily either MNP (containing 0.5 mg of thiamine, 0.5 mg riboflavin, 150 µg folic acid, and 0.9 µg vitamin B12 along with 11 other micronutrients) or placebo and followed for ~36 weeks. In a randomly selected sub-sample of 260 children, erythrocyte thiamine diphosphate (eTDP), plasma folate and B12 concentrations and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin biomarker) were assessed at baseline and endline. Results: There was no treatment effect on endline eTDP concentrations (110.6 ± 8.9 nmol/L in MNP vs. 109.4 ± 8.9 nmol/L in placebo group; p=0.924), EGRac (1.46 ± 3.0 vs. 1.49 ± 3.0; p=0.184) and B12 concentrations (523.3 ± 24.6 pmol/L vs. 515.9 ± 24.8 pmol/L; p=0.678). Likewise, the prevalence of thiamine, riboflavin and B12 deficiencies did not differ significantly between the two groups. However, endline folate concentration was significantly higher in the MNP compared to the placebo group (28.2 ± 0.8 nmol/L vs 19.9 ± 0.8 nmol/L, respectively; p<0.001), and correspondingly, the prevalence of folate deficiency was significantly lower in the MNP group (1.6% vs 17.4%; p=0.015). Conclusions: Compared to a placebo, daily MNP for 9 months increased only folate but not thiamine, riboflavin or B12 status in young Laotian children.