Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial Efficacy of different strategies to treat anemia in children: a randomized clinical trial Multinutrient-fortified juices improve vitamin D and vitamin E status in children: a randomized controlled trial. A Micronutrient Fortified Beverage Given at Different Dosing Frequencies Had Limited Impact on Anemia and Micronutrient Status in Filipino Schoolchildren Fortified mineral water improves folate status and decreases plasma homocysteine concentration in pregnant women Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania. Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings. Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. Triple fortification of salt with microcapsules of iodine, iron, and vitamin A. Effect of a micronutrient fortificant mixture and 2 amounts of calcium on iron and zinc absorption from a processed food supplement. A multinutrient-fortified beverage enhances the nutritional status of children in Botswana. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. Fortifying milk with ferrous gluconate and zinc oxide in a public nutrition program reduced the prevalence of anemia in toddlers. Breakfast cereal fortified with folic acid, vitamin B-6, and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations: a randomized trial. Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico. A multiple-micronutrient-fortified beverage affects hemoglobin, iron, and vitamin A status and growth in adolescent girls in rural Bangladesh. Nutritional efficacy of a fortified weaning rusk in a rural area near Beijing. Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Randomized outcome trial of human milk fortification and developmental outcome in preterm infants. Growth and micronutrient status in children receiving a fortified complementary food. Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y. Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants. Effects of daily intake of yoghurt enriched with bioactive components on chronic stress responses: a double-blinded randomized controlled trial Multiple micronutrient-fortified rice affects physical performance and plasma vitamin B-12 and homocysteine concentrations of Indian school children. Micronutrient-Fortified Rice Can Increase Hookworm Infection Risk: A Cluster Randomized Trial An efficacy study on alleviating micronutrient deficiencies through a multiple micronutrient fortified salt in children in South India. Impact of a multiple-micronutrient fortified salt on the nutritional status and memory of schoolchildren. Effect of consumption of micronutrient fortified candies on the iron and vitamin A status of children aged 3-6 years in rural Haryana. Effect of micronutrient fortified beverage on nutritional anaemia during pregnancy. Long-term evaluation of a micronutrient-fortified biscuit used for addressing micronutrient deficiencies in primary school children. 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 Extruded rice grains fortified with zinc, iron, and vitamin A increase zinc status of Thai school children when incorporated into a school lunch program. A Blinded, Cluster-Randomized, Placebo-Controlled School FeedingTrial in Burundi Using Rice Fortified With Iron, Zinc, Thiamine, and Folic Acid Effects of supplemental dietary arginine, canola oil, and trace elements on cellular immune function in critically injured patients. Effect of multi-micronutrient-fortified rice on cognitive performance depends on premix composition and cognitive function tested: results of an effectiveness study in Cambodian schoolchildren. Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies: a randomized controlled trial. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. Impact of fortified versus unfortified lipid-based supplements on morbidity and nutritional status: A randomised double-blind placebo-controlled trial in ill Gambian children Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention. Effect of micronutrient supplement on health and nutritional status of schoolchildren: bone health and body composition. The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants Fortified Snack Reduced Anemia in Rural School-Aged Children of Haiti: A Cluster-Randomized, Controlled Trial Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population. Nutrition of Very Low Birth Weight Infants Fed Human Milk with or without Supplemental Trace Elements: A Randomized Controlled Trial A micronutrient powder with low doses of highly absorbable iron and zinc reduces iron and zinc deficiency and improves weight-for-age Z-scores in South African children. Micronutrient Fortification to Improve Growth and Health of Maternally HIV-Unexposed and Exposed Zambian Infants: A Randomised Controlled Trial Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women. Effects of fortified milk on morbidity in young children in north India: community based, randomised, double masked placebo controlled trial Micronutrient-Fortified Milk and Academic Performance among Chinese Middle School Students: A Cluster-Randomized Controlled Trial Impact of micronutrient fortification of yoghurt on micronutrient status markers and growth – a randomized double blind controlled trial among school children in Bangladesh Micronutrient Fortified Milk Improves Iron Status, Anemia and Growth among Children 1–4 Years: A Double Masked, Randomized, Controlled Trial Short-Term Evaluation of the Impact of a Fortified Food Aid Program on the Micronutrient Nutritional Status of Argentinian Pregnant Women Fortified breakfast cereal consumed daily for 12 wk leads to a significant improvement in micronutrient intake and micronutrient status in adolescent girls: a randomised controlled trial Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Mineral water fortified with folic acid, vitamins B6, B12, D and calcium improves folate status and decreases plasma homocysteine concentration in men and women Effect of multiple micronutrient-fortified food on mild morbidity and clinical symptoms in Zambian infants: results from a randomised controlled trial GLV supplements increased plasma β–carotene, vitamin C, zinc and hemoglobin in young healthy adults A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children Bioavailability of iron and zinc from a multiple micronutrient-fortified beverage. Fortified human milk in the small for gestational age neonate Prenatal Multiple Micronutrient Supplementation has Greater Impact on Birthweight than Supplementation with Iron and Folic Acid: A Cluster-Randomized, Double-Blind, Controlled Programmatic Study in Rural Niger A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. Micronutrient supplementation improves physical performance measures in Asian Indian school-age children. Iron, zinc, copper and selenium status of breast‐fed infants and infants fed trace element fortified milk‐based infant formula Antioxidant fortified margarine increases the antioxidant status Effects of a milk-based bioactive micronutrient beverage on pain symptoms and activity of adults with osteoarthritis: a double-blind, placebo-controlled clinical evaluation. Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Complementary foods fortified with micronutrients prevent iron deficiency and anemia in Vietnamese infants. Supplementary feeding with fortified spread among moderately underweight 6-18-month-old rural Malawian children. Effect of vitamin-enriched bread on the vitamin status of an isolated rural community--a controlled clinical trial. A multi-micronutrient beverage enhances the vitamin A and zinc status of Nigerian primary schoolchildren. Omega-3 fatty acid-, micronutrient-, and probiotic-enriched nutrition helps body weight stabilization in head and neck cancer cachexia. Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children's Health and Mental Performance Influenced by Optimal Nutrition) Study. The Oportunidades program's fortified food supplement, but not improvements in the home diet, increased the intake of key micronutrients in rural Mexican children aged 12-59 months. Bone Mineralization and Mineral Homeostasis in Very Low‐Birth-Weight Infants Fed Either Human Milk or Fortified Human Milk Evaluation of the Impact of a Food Program on the Micronutrient Nutritional Status of Argentinean Lactating Mothers Nutrient intakes and impact of fortified breakfast cereals in schoolchildren. The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance. The effect of a nutrient dense drink on mental and physical function in institutionalized elderly people Gut microbiota in Malawian infants in a nutritional supplementation trial. Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Fortified juice drink improved iron and zinc status of schoolchildren. Immunity in frail elderly: a randomized controlled trial of exercise and enriched foods. Multi-micronutrient-fortified biscuits decreased prevalence of anemia and improved micronutrient status and effectiveness of deworming in rural Vietnamese school children. Fortification of maize meal improved the nutritional status of 1-3-year-old African children. Presenting the Results of Cochrane Systematic Reviews to a Consumer Audience: A Qualitative Study Еffects of fortified milk on cognitive abilities in school-aged children: results from a randomized-controlled trial Effect of Nutritional Interventions on Micronutrient Status in Pregnant Malawian Women with Moderate Malnutrition: A Randomized, Controlled Trial Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age. Double-blind cluster randomised controlled trial of wheat flour chapatti fortified with micronutrients on the status of vitamin A and iron in school-aged children in rural Bangladesh. Effect of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on infectious morbidity of preschool children. Triple-fortified rice containing vitamin A reduced marginal vitamin A deficiency and increased vitamin A liver stores in school-aged Thai children. Decreased parasite load and improved cognitive outcomes caused by deworming and consumption of multi-micronutrient fortified biscuits in rural Vietnamese schoolchildren. A six-month intervention with two different types of micronutrient-fortified complementary foods had distinct short- and long-term effects on linear and ponderal growth of Vietnamese infants. Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India.
In Cambodia , micronutrient deficiencies remain a critical public health problem . Our objective was to evaluate the impact of multi-micronutrient fortified rice ( MMFR ) formulations , distributed through a World Food Program school-meals program ( WFP-SMP ) , on the hemoglobin concentrations and iron and vitamin A ( VA ) status of Cambodian schoolchildren . The FORISCA-UltraRice+NutriRice study was a double-blind , cluster-r and omized , placebo-controlled trial . Sixteen schools participating in WFP-SMP were r and omly assigned to receive extrusion-fortified rice ( UltraRice Original , UltraRice New ( URN ) , or NutriRice ) or unfortified rice ( placebo ) six days a week for six months . Four additional schools not participating in WFP-SMP were r and omly selected as controls . A total of 2440 schoolchildren ( 6–16 years old ) participated in the biochemical study . Hemoglobin , iron status , estimated using inflammation-adjusted ferritin and transferrin receptors concentrations , and VA status , assessed using inflammation-adjusted retinol-binding protein concentration , were measured at the baseline , as well as at three and six months . Baseline prevalence of anemia , depleted iron stores , tissue iron deficiency , marginal VA status and VA deficiency were 15.6 % , 1.4 % , 51.0 % , 7.9 % , and 0.7 % , respectively . The strongest risk factors for anemia were hemoglobinopathy , VA deficiency , and depleted iron stores ( all p < 0.01 ) . After six months , children receiving NutriRice and URN had 4 and 5 times less risk of low VA status , respectively , in comparison to the placebo group . Hemoglobin significantly increased ( + 0.8 g/L ) after three months for the URN group in comparison to the placebo group ; however , this difference was no longer significant after six months , except for children without inflammation . MMFR containing VA effectively improved the VA status of schoolchildren . The impact on hemoglobin and iron status was limited , partly by sub- clinical inflammation . MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated Background Anemia continues to be a major public health problem among children in many regions of the world , and it is still not clear which strategy to treat it is most effective . Objective To evaluate the efficacy and children 's acceptance of several recognized strategies to treat anemia . Methods Non-breastfed children ( n = 577 ) , 6 to 43 mo of age , were screened for the trial ; 267 were anemic ( hemoglobin < 11.7 g/dL ) , and 266 of those were r and omized into 1 of 5 treatments to received daily either : an iron supplement ( IS ) , an iron+folic acid supplement ( IFS ) , a multiple micronutrient supplement ( MMS ) , a micronutrient-fortified complementary food as porridge powder ( FCF ) , or zinc+iron+ascorbic acid fortified water ( FW ) . The iron content of each daily dose was 20 , 12.5 , 10 , 10 and 6.7 mg respectively . Hemoglobin ( Hb ) , ferritin , total iron , weight and height were measured at baseline and after 4 months of treatment . Morbidity , treatment acceptability and adherence were recorded during the intervention . Results All treatments significantly increased Hb and total iron concentration ; ferritin did not change significantly . Groups MMS , IS and IFS  increased Hb ( g/dL ) [ 1.50 ( 95%CI : 1.17 , 1.83 ) , 1.48 [ ( 1.18 , 1.78 ) and 1.57 ( 1.26 , 1.88 ) , respectively ] and total iron ( ( μg/dL ) [ 0.15 ( 0.01 , 0.29 ) , 0.19 ( 0.06 , 0.31 ) and 0.12(-0.01 , 0.25 ) , respectively ] significantly more than FCF [ 0.92 ( 0.64 , 1.20 ) ] but not to FW group [ 0.14 ( 0.04 , 0.24 ) ] . The prevalence of anemia was reduced to a greater extent in the MMS and IFS groups ( 72 % and 69 % , respectively ) than in the FCF group ( 45 % ) ( p < 0.05 ) . There were no significant differences in anthropometry or in the number of episodes of diarrhea and respiratory infections among treatment groups . The supplements MMS and IS were less acceptable to children , than IFS , FCF and FW . Conclusion The three supplements IS , ISF and MMS  increased Hb more than the FCF ; the supplements that contained micronutrients ( IFS and MMS ) were more effective for reducing the prevalence of anemia . In general , fortified foods were better accepted by the study participants than supplements . Clinical Trial.gov BACKGROUND Provision of fortified juices may provide a convenient method to maintain and increase blood fat-soluble vitamins . OBJECTIVE To determine whether children consuming orange juice fortified with calcium and combinations of vitamins D , E , and A  could increase serum 25-hydroxyvitamin D [ 25(OH)D ] , α-tocopherol , and retinol levels . DESIGN A 12-week r and omized , double-blind , controlled trial . PARTICIPANTS / SETTING One hundred eighty participants ( aged 8.04±1.42 years ) were recruited at Tufts ( n=70 ) and Boston University ( n=110 ) during 2005 - 2006 . Of those recruited , 176 children were r and omized into three groups : CaD ( 700 mg calcium+200 IU vitamin D ) , CaDEA ( 700 mg calcium+200 IU vitamin D+12 IU vitamin E+2,000 IU vitamin A as beta carotene ) , or Ca ( 700 mg calcium ) . Children consumed two 240-mL glasses of CaD , CaDEA , or Ca fortified orange juice daily for 12 weeks . MAIN OUTCOME MEASURES Serum 25(OH)D , α-tocopherol , and retinol concentrations . STATISTICAL ANALYSES Changes in 25(OH)D , α-tocopherol , retinol , and parathyroid hormone concentrations were examined . Covariates included sex , age , race/ethnicity , body mass index , and baseline 25(OH)D , α-tocopherol , retinol , or parathyroid hormone levels . Multivariate models and repeated measures analysis of variance tested for group differences with pre-post measures ( n=141 ) . RESULTS Baseline 25(OH)D was 68.4±27.7 nmol/L ( 27.4±11.10 ng/mL ) ) , with 21.7 % of participants having inadequate 25(OH)D ( < 50 nmol/L [ 20.03 ng/mL ] ) . The CaD group 's 25(OH)D increase was greater than that of the Ca group ( 12.7 nmol/L [ 5.09 ng/mL ] , 95 % CI 1.3 to 24.1 ; P=0.029 ) . The CaDEA group 's increase in α-tocopherol concentration was greater than that in the Ca or CaD groups ( 3.79 μmol/L [ 0.16 μg/mL ] , 95 % CI 2.5 to 5.1 and 3.09 μmol/L [ 0.13 μg/mL ] , 95 % CI -1.8 to 4.3 ) , respectively ( P<0.0001 ) . Retinol levels did not change , and body weight remained as expected for growth . CONCLUSIONS Daily consumption of orange juice providing 200 IU vitamin D and 12 IU vitamin E increased 25(OH)D and α-tocopherol concentrations in young children within 12 weeks This study evaluated the effects of a multi-micronutrient fortified juice drink given in different frequencies of consumption on hemoglobin ( Hb ) concentration of schoolchildren . Hb was measured in 2423 schoolchildren aged 6- to 9-years-old at baseline . All anemic children ( n = 246 ) were r and omly allocated into groups : Daily dose ( HD : high dose ) , 5X/week ( MD : Moderate Dose ) , 3X/week ( LD : Low Dose ) and unfortified ( Control ) . Pre- and post- study measurements of micronutrients were collected from 228 children . At the endpoint , significant Hb increases were observed in all groups , but there was no significant difference between groups . There was a significant reduction in anemia prevalence in all groups from 100 % to 36 % ( Control ) , 30 % ( LD ) , 23 % ( MD ) and 26 % ( HD ) . No dose-response effect was observed in Hb in this population . Most likely , this result ed from better than expected micronutrient status and lower than expected severity of anemia and micronutrient deficiencies in this cohort . It is unlikely that the addition of a fortified beverage to school feeding programs in this population would have a positive impact . Whether such an intervention would be cost-effective as a preventative approach needs to be assessed . This study demonstrates the importance of targeting such interventions to appropriate population Abstract Objectives : There is no m and atory folic acid fortification of food in Finl and . We investigated the effects of mineral water fortified with folic acid , vitamins B6 , B12 , D and calcium on serum and erythrocyte folate concentrations , serum vitamin B12 and plasma homocysteine concentrations in pregnancy . Design : A r and omized , controlled , double-blind , parallel-group intervention study . Methods : Seventy-four pregnant women were recruited from two health care units . The study began at the eleventh week with a two-week run-in period , followed by an eight-week intervention period . The diet was monitored by food records . During the intervention , subjects consumed 1000 mL/day fortified or normal mineral water . The pregnancies were monitored carefully . Results : The folate intake was 255 μg/day in the study group and 274 μg/day in the controls . Serum folate concentrations increased in the study group by 10.3 nmol/L and decreased in the controls by 2.7 nmol/L ( P<0.05 ) during the study . The erythrocyte folate concentrations increased in the study group by 360.9 nmol/L and in the controls by 195.6 nmol/L ( P=0.004 ) and serum homocysteine concentrations fell by 1.1 μmol/L and by 0.3 μmol/L , respectively ( P<0.05 ) . Conclusions : Finnish pregnant women have low dietary folate intake . Fortified mineral water  improved folate status and reduced plasma homocysteine concentrations in the pregnant subjects BACKGROUND Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies . OBJECTIVE We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children ( aged 6 - 11 y ) attending primary schools . DESIGN In this r and omized , double-blind , placebo-controlled efficacy trial , children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo . RESULTS There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status , serum retinol , and anthropometry . At the 6-mo follow-up , among children with anemia ( hemoglobin < 110 g/L ) , there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group ( 9.2 and 0.2 g/L , respectively ) . Of those who were anemic at baseline , 69.4 % in the nonfortified group and 55.1 % in the fortified group remained anemic at follow-up ( RR : 0.79 ) , a cure rate of 21 % . The prevalence of children with low serum retinol concentrations ( < 200 microg/L ) dropped significantly from 21.4 % to 11.3 % in the fortified group compared with a nonsignificant change ( 20.6 % to 19.7 % ) in the nonfortified group . At follow-up , mean incremental changes in weight ( 1.79 compared with 1.24 kg ) , height ( 3.2 compared with 2.6 cm ) , and BMI ( 0.88 compared with 0.53 ) were significantly higher in the fortified group than in the nonfortified group . CONCLUSION The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency BACKGROUND Improved complementary feeding is cited as a critical factor for reducing stunting . Consumption of meats has been advocated , but its efficacy in low-re source setting s has not been tested . OBJECTIVE The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal . DESIGN This was a cluster r and omized efficacy trial conducted in the Democratic Republic of Congo , Zambia , Guatemala , and Pakistan . Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants . Blood tests were obtained at trial completion . RESULTS A total of 532 ( 86.1 % ) and 530 ( 85.8 % ) participants from the meat and cereal arms , respectively , completed the study .  Linear growth velocity did not differ between treatment groups : 1.00 ( 95 % CI : 0.99 , 1.02 ) and 1.02 ( 95 % CI : 1.00 , 1.04 ) cm/mo for the meat and cereal groups , respectively ( P = 0.39 ) . From baseline to 18 mo , stunting [ length-for-age z score ( LAZ ) < -2.0 ] rates increased from ~33 % to nearly 50 % . Years of maternal education and maternal height were positively associated with linear growth velocity ( P = 0.0006 and 0.003 , respectively ) ; LAZ at 6 mo was negatively associated ( P < 0.0001 ) . Anemia rates did not differ by group ; iron deficiency was significantly lower in the cereal group . CONCLUSION The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods BACKGROUND Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia BACKGROUND In many developing countries , children are at high risk of goiter , vitamin A deficiency , and iron deficiency anemia . OBJECTIVE We aim ed to develop a stable , efficacious salt fortified with iodine , iron , and vitamin A. DESIGN A novel spray-cooling technique was used with hydrogenated palm oil to package potassium io date , micronized ferric pyrophosphate , and retinyl palmitate into microcapsules ( mean particle size : 100 mum ) . We used the microcapsules to create triple-fortified salt ( TFS ) with 30 mug I , 2 mg Fe , and 60 mug vitamin A/g salt . After storage trials , we compared the efficacy of TFS with that of iodized salt in a 10-mo , r and omized , double-blind trial in goitrous schoolchildren ( n = 157 ) who had a high prevalence of vitamin A deficiency and iron deficiency anemia . RESULTS After storage for 6 mo , losses of iodine and vitamin A from the TFS were approximately 12 - 15 % , and color was stable . In the TFS group , mean hemoglobin increased by 15 g/L at 10 mo ( P < 0.01 ) , iron status indexes and body iron stores improved significantly ( P < 0.05 ) , and mean serum retinol , retinol-binding protein , and the ratio of retinol-binding protein to prealbumin increased significantly ( P < 0.01 ) . At 10 mo , prevalences of vitamin A deficiency and iron deficiency anemia were significantly lower in the TFS group than in the iodized salt group ( P < 0.001 ) . CONCLUSION Newly developed microcapsules containing iodine , iron , and vitamin A are highly stable when added to local African salt . TFS was efficacious in reducing the prevalence of iron , iodine , and vitamin A deficiencies in school-age children BACKGROUND Iron , zinc , and calcium can interact with each other in a way that inhibits their respective absorption . On the other h and , mineral fortification has been used to improve simultaneous iron and zinc absorption from food supplements . OBJECTIVE We evaluated the effect of a novel fortificant mixture consisting of NaFeEDTA , zinc methionine , ascorbic acid , and citric acid on iron and zinc absorption from a dry food supplement design ed for preschool children . DESIGN The st and ard food supplement contained cereal and legume flour , dried milk , and a mixture of micronutrients including ferrous sulfate and zinc sulfate as sources of supplemental iron and zinc , respectively . St and ard and novel food products were prepared as porridge with or without the addition of 200 mg Ca as calcium phosphate .  Iron absorption and zinc absorption from the food products were evaluated simultaneously in 13 nonpregnant , adult women by extrinsically labeling the products with radioisotopes of iron and zinc and carrying out whole-body counting 7 d after the food products were consumed in r and om order . RESULTS The absorption of iron from the NaFeEDTA-containing ( novel ) food product was 1.7 times that from the ferrous sulfate-containing ( st and ard ) product ( P = 0.015 ) . There was no significant effect of dietary calcium on iron absorption . Zinc absorption was not associated with the form of zinc consumed , but higher dietary calcium was marginally associated with lower zinc absorption ( P = 0.071 ) . CONCLUSIONS A mixture of fortificants containing NaFeEDTA , zinc sulfate or zinc methionine , ascorbic acid , and citric acid , but without calcium , can improve iron and zinc absorption from food products . A cost-benefit analysis of the novel fortificant mixture needs to be performed Due to their widespread acceptability , multinutrient-fortified foods and beverages may be useful in reducing micronutrient deficiencies , especially in developing countries . We studied the efficacy of a new fortified beverage in improving the nutritional status of children in Botswana . We screened 311 lower income urban school children , ages 6 - 11 y , in two primary schools near Gaborone . Children were given seven 240-mL servings weekly of either an experimental beverage ( EXP ) fortified with 12 micronutrients or an isoenergetic placebo drink ( CON ) for 8 wk . Weight , mid-upper arm circumference , hemoglobin , retinol , ferritin , vitamin B-12 , folate and riboflavin status were measured at baseline and at the end of the study . Plasma zinc and serum transferrin receptors also were measured at study end . A total of 145 children in the EXP group and 118 in the CON group completed the trial . Using multivariate analysis , the changes in mid-upper arm circumference , weight for age and total weight were significantly better in the EXP group than in the CON group ( P < 0.01 ) . Ferritin , riboflavin and folate status were significantly better in the EXP group than in the CON group at study end ( P < 0.01 ) , but serum vitamin B-12 was not . Zinc was significantly higher and transferrin receptors were significantly lower at the conclusion of the study in the EXP group than in the CON group ( P < 0.001 ) . Mean plasma retinol concentrations , which were low ( < 0.7 micro mol/L ) in both groups , did not change . We conclude that a micronutrient-fortified beverage may be beneficial as part of a comprehensive nutritional supplementation program in population s at risk for micronutrient deficiencies BACKGROUND Koko , a fermented maize porridge used as the primary complementary food in Ghana , has been implicated in the high prevalence of child malnutrition . Weanimix , a cereal-legume blend developed by the United Nations Children 's Fund and the Ghanaian government , has been promoted as an alternative . OBJECTIVE We evaluated the effect of feeding Weanimix and 3 other locally formulated , central ly processed complementary foods on the nutritional status of 208 breast-fed infants . DESIGN Infants were r and omly assigned to receive 1 of 4 foods from 6 to 12 mo of age : Weanimix ( W ) , Weanimix plus vitamins and minerals ( WM ) , Weanimix plus fish powder ( WF ) , and koko plus fish powder ( KF ) . Dietary and anthropometric data were collected regularly . Blood was collected at 6 and 12 mo of age to assess iron , zinc , vitamin A , and riboflavin status . Before and after the intervention , cross-sectional data on the anthropometric status of infants not included in the intervention ( NI ; n = 464 ) were collected . RESULTS There were no significant differences between intervention groups in weight or length gain or in hemoglobin , hematocrit , transferrin saturation , plasma zinc , or erythrocyte riboflavin values between 6 and 12 mo of age . From 9 to 12 mo of age , z scores were lower in NI infants than in the combined intervention groups [ at 12 mo : -1.71 + /- 0.90 compared with -1.19 + /- 0.93 for weight and -1.27 + /- 1.02 compared with -0.63 + /- 0.84 for length ( P < 0.001 for both ) , respectively ] . The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W , WF , and KF but not in group WM . Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined ( 0.14 + /- 0.3 compared with -0.04 + /- 0.3 micromol/L , P = 0 . 003 ) . CONCLUSIONS All 4 foods improved growth relative to the NI group . Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods BACKGROUND Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children . OBJECTIVE We assessed the effect of micronutrients , long-chain n-3 fatty acids , or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children . DESIGN Two 2-by-2 factorial r and omized controlled double-blind trials were performed home-based in Adelaide , South Australia , and at 6 primary schools in Jakarta , Indonesia . A total of 396 children ( aged 6 - 10 y ) in Australia and 384 children in Indonesia were r and omly allocated to receive a drink with a micronutrient mix ( iron , zinc , folate , and vitamins A , B-6 , B-12 , and C ) , with docosahexanoic acid ( DHA , 88 mg/d ) and eicosapentaenoic acid ( EPA , 22 mg/d ) , or with both or placebo 6 d/wk for 12 mo .  Biochemical indicators were determined at baseline and 12 mo . Cognitive performance was measured at baseline , 6 mo , and 12 mo . RESULTS The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children . DHA+EPA treatment increased plasma DHA and total plasma n-3 fatty acids in both countries . The micronutrient treatment result ed in significant increases in scores on tests representing verbal learning and memory in Australia ( estimated effect size : 0.23 ; 95 % CI : 0.01 , 0.46 ) . A similar effect was observed among Indonesian girls ( estimated effect size : 0.32 ; 95 % CI : -0.01 , 0.64 ) . No effects were found on tests measuring general intelligence or attention . No effects of DHA+EPA on the factors of cognitive tests were observed . CONCLUSION In well-nourished school-aged children , fortification with multiple micronutrients can result in improvements in verbal learning and memory Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries , despite longst and ing efforts to fortify foods or to distribute medicinal supplements to pregnant women . The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients ( iron , iodine , zinc , vitamin A , vitamin C , niacin , riboflavin , folate , vitamin B-12 , vitamin B-6 and vitamin E ) on the hemoglobin , iron and vitamin A status of pregnant women in Tanzania . A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a r and omized double-blind controlled trial in which study women received 8 wk of supplementation .  Hemoglobin , ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period . The supplement result ed in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56 % , respectively . The risk of iron deficiency was reduced by 70 % among those who had iron deficiency at baseline and by 92 % among those who had adequate stores . The micronutrient-fortified beverage may be a useful and convenient preventative measure , one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies We aim ed to assess the efficacy of whole cow 's milk fortified with ferrous gluconate and zinc oxide , along with ascorbic acid , in reducing the prevalence of anemia and improving iron  status of low income children 10 - 30 mo of age . Healthy children were r and omly assigned to drink 400 mL/d of cow 's whole milk , either fortified milk ( FM ) with 5.8 mg/400 mL of iron as ferrous gluconate , 5.28 mg/400 mL of zinc as zinc oxide , and 48 mg/400 mL of ascorbic acid , or nonfortified milk ( NFM ) with 0.2 mg iron/400 mL , 1.9 mg zinc/400 mL , and 6.8 mg ascorbic acid/400 mL. Hemoglobin , serum ferritin , soluble transferrin receptors ( TfR ) , and C-reactive protein concentrations were measured at baseline and 6 mo after intervention . The prevalence of anemia declined from 41.4 to 12.1 % ( P < 0.001 ) , or 29 percentage points , in the FM group ; there was no change in the NFM group . Hemoglobin ( coefficient = 0.22 , P < 0.01 ) was positively and TfR ( coefficient = -0.29 , P < 0.001 ) negatively associated with treatment , controlling for their respective baseline values , age , and gender . Treatment with FM was negatively associated with the likelihood of being anemic ( pseudo R(2 ) = 0.085 , P < 0.03 ) after 6 mo of intervention . Ferrous gluconate added to whole cow 's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status  of Mexican toddlers . The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1 - 11 y of age in Mexico BACKGROUND High homocysteine and low B vitamin concentrations have been linked to the risk of vascular disease , stroke , and dementia and are relatively common in older adults . OBJECTIVE We assessed the effect of breakfast cereal fortified with folic acid , vitamin B-6 , and vitamin B-12 on vitamin and homocysteine status . DESIGN A r and omized , double-blind trial was conducted in 189 volunteers aged 50 - 85 y. The subjects had no history of hypertension , anemia , asthma , cancer , or cardiovascular or digestive disease and did not regularly consume multiple or B vitamin supplements or highly fortified breakfast cereal . Subjects were r and omly assigned to consume 1 cup ( 0.24 L ) breakfast cereal fortified with 440 microg folic acid , 1.8 mg vitamin B-6 , and 4.8 microg vitamin B-12 or placebo cereal for 12 wk . Blood was drawn at 0 , 2 , 12 , and 14 wk . Methionine-loading tests were conducted at baseline and week 14 . RESULTS Final baseline-adjusted plasma homocysteine concentrations were significantly lower and B vitamin concentrations were significantly higher in the treatment group than in the placebo group ( P < 0.001 ) . The percentage of subjects with plasma folate concentrations < 11 nmol/L decreased from 2 % to 0 % , with vitamin B-12 concentrations < 185 pmol/L from 9 % to 3 % , with vitamin B-6 concentrations < 20 nmol/L from 6 % to 2 % , and with homocysteine concentrations > 10.4 micromol/L ( women ) or > 11.4 micromol/L ( men ) from 6.4 % to 1.6 % . The percentage of control subjects with values beyond these cutoff points remained nearly constant or increased . CONCLUSIONS In this relatively healthy group of volunteers , consumption of 1 cup fortified breakfast cereal daily significantly increased B vitamin and decreased homocysteine concentrations , including post-methionine-load homocysteine concentrations The impact of iron-only supplements ( FE ) versus multiple micronutrient supplements containing iron ( MM ) during pregnancy on iron status was assessed in a sub sample ( n = 453 ) of women who participated in a r and omized double-blind trial in Mexico . Compliance , monitored by observation , was high ( > 85 % ) . The two groups were similar at recruitment ( < 13 wk gestation ) for various sociodemographic characteristics and for mean hemoglobin ( Hb ) concentrations and prevalence of anemia ( Hb < 110 g/L ; 11 % ) . However , mean serum ferritin was higher ( P < 0.05 ) in the MM group ( n = 142 ) compared to the FE group ( n = 148 ) and the prevalence of iron deficiency ( serum ferritin < 12 micro g/L ) was lower in the MM group ( 44.4 % ) compared to the FE group ( 57.4 % ) . By the third trimester , almost half the women were anemic in both groups , and mean Hb ( g/L ) was lower for the MM group ( 104.2 ; 95 % CI : 102.5 , 106.0 ) compared to the FE group ( 108.1 ; 95 % CI : 106.4 , 109.8 ) after adjusting for baseline serum ferritin . In contrast , there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum ( 90.9 and 45.1 % for the MM group ; 92.6 and 47.3 % for the FE group , respectively ) . In conclusion , rather than improve Hb or iron status relative to FE-only supplements as hypothesized , MM supplements may have slightly reduced Hb concentrations during pregnancy . Neither supplement was able to meet iron needs as evidence d by dramatic increases in anemia and iron deficiency by the end of pregnancy Adolescent girls have high nutrient needs and are susceptible to micronutrient deficiencies . The objective of this study was to test the effect of a multiple-micronutrient-fortified beverage on  hemoglobin ( Hb ) concentrations , micronutrient status , and growth among adolescent girls in rural Bangladesh . A total of 1125 girls ( Hb > or = 70 g/L ) enrolled in a r and omized , double-blind , placebo-controlled trial and were allocated to either a fortified or nonfortified beverage of similar taste and appearance . The beverage was provided at schools 6 d/wk for 12 mo . Concentrations of Hb and serum ferritin ( sFt ) , retinol , zinc , and C-reactive protein were measured in venous blood sample s at baseline , 6 mo , and 12 mo . In addition , weight , height , and mid-upper arm circumference ( MUAC ) measurements were taken . The fortified beverage increased the Hb and sFt and retinol concentrations at 6 mo ( P < 0.01 ) . Adolescent girls in the nonfortified beverage group were more likely to suffer from anemia ( Hb < 120 g/L ) , iron deficiency ( sFt < 12 microg/L ) , and low serum retinol concentrations ( serum retinol < 0.70 micromol/L ) ( OR = 2.04 , 5.38 , and 5.47 , respectively ; P < 0.01 ) . The fortified beverage group had greater increases in weight , MUAC , and BMI over 6 mo ( P < 0.01 ) . Consuming the beverage for an additional 6 mo did not further improve the Hb concentration , but the sFt level continued to increase ( P = 0.01 ) . The use of multiple-micronutrient-fortified beverage can contribute to the reduction of anemia and improvement of micronutrient status and growth in adolescent girls in rural Bangladesh A micronutrient-fortified rusk for weanling children was tested in a rural area near Beijing . Two hundred twenty-six children aged 6 - 13 mo were r and omly assigned by village to either a micronutrient-fortified or an unfortified rusk , daily for 3 mo . The fortified rusk contained extra zinc ; iron ; calcium ; vitamins A , D , and B-12 ; thiamin , riboflavin , niacin , and folic acid . Infants receiving the fortified rusk exhibited no decline in hemoglobin concentrations during the study whereas those receiving the unfortified rusk exhibited a significant decline . Improvements were also seen in erythrocyte porphyrin , plasma vitamin A , and riboflavin status , but these improvements were seen in both of the groups . Micronutrient fortification was probably beneficial for iron status and the fortified rusk promises to be an effective vehicle for supplementation BACKGROUND Deficiencies of iron , iodine , and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren . OBJECTIVE The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children . DESIGN Micronutrient status was assessed in 115 children aged 6 - 11 y before and after consumption of biscuits ( fortified with iron , iodine , and beta-carotene ) for 43 wk over a 12-mo period and was compared with that in a control group ( n = 113 ) who consumed nonfortified biscuits .  Cognitive function , growth , and morbidity were assessed as secondary outcomes . RESULTS There was a significant between-group treatment effect on serum retinol , serum ferritin , serum iron , transferrin saturation , and urinary iodine ( P < 0.0001 ) and in hemoglobin and hematocrit ( P < 0.05 ) . The prevalence of low serum retinol concentrations ( < 0.70 micromol/L ) decreased from 39.1 % to 12.2 % , of low serum ferritin concentrations ( < 20 microg/L ) from 27.8 % to 13.9 % , of anemia ( hemoglobin < 120 g/L ) from 29.6 % to 15.6 % , and of low urinary iodine concentrations ( < 100 microg/L ) from 97.5 % to 5.4 % . There was a significant between-group treatment effect ( P < 0.05 ) in cognitive function with the digit span forward task ( short-term memory ) . Fewer school days were missed in the intervention than in the control group because of respiratory- ( P = 0.097 ) and diarrhea-related ( P = 0.013 ) illnesses . The intervention had no effect on anthropometric status [ corrected ] . CONCLUSIONS Fortified biscuits result ed in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [ corrected ] Despite potential benefits , human milk may fail to meet preterm infants ' nutrient requirements . We tested the hypothesis that fortified breast milk , fed alone or with preterm formula , would improve neurodevelopment and growth at 18-mo follow-up without adverse short-term clinical or biochemical consequences . Two hundred seventy-five preterm infants from two medical centers ( birth weight < 1850 g ; mean gestation 29.8 + /- 2.7 wk ) whose mothers chose to provide breast milk were r and omly assigned to receive for a mean of 39 d a multinutrient fortifier or control supplement containing phosphate and vitamins . Breast milk comprised 47.6 % and 46.4 % of enteral intake in fortified and control groups , respectively ; preterm formula supplements were used when insufficient breast milk was available . Overall , there were no significant growth advantages with fortification ; although , when breast milk exceeded 50 % of intake , fortification promoted faster weight gain ( an advantage of 1.6 g.kg-1.d-1 ; 95 % CI : 0.1 , 3.1 ; P < 0.05 ) . Compared with control infants , the fortified group showed 1 ) higher plasma urea from week 2 ( P = 0.04 ) , 2 ) higher plasma calcium ( mean 2.34 + /- 0.01 compared with 2.27 + /- 0.02 mmol/L ; P = 0.003 ) , 3 ) a greater rise in alkaline phosphatase by week 6 ( P = 0.04 ) , 4 ) more clinical infections ( suspected plus proven ; 43 % compared with 31 % , P = 0.04 ) , 5 ) a nonsignificantly increased incidence of necrotizing enterocolitis ( 5.8 % compared with 2.2 % , P = 0.12 ) , and 6 ) higher white cell and platelet counts . Developmental scores at 18 mo were slightly but not significantly higher in the fortified group . This study confirmed that breast milk fortifiers can improve short-term growth ( when breast milk intakes are high ) ; but beneficial effects on long-term development remained unproven . Future research is required to evaluate potential adverse consequences and explore more optimal fortification strategies Linear growth retardation and anemia are the most prevalent nutritional problems in the world ; effective interventions are urgently needed . We evaluated Ecuador 's National Food Nutrition Program ( PANN 2000 ) that included a micronutrient-fortified complementary food ( FCF ) , Mi Papilla , in poor periurban and rural communities of Ecuador . The program is preventive and targeted to all infants and young children living in poor communities and receiving government health services . We compared dietary intake , micronutrient status , and growth over 11 mo in a cohort of children from the catchment areas of the PANN 2000 with same-age control children in nearby communities eligible to enter the program 1 y later . PANN 2000 children enrolled in the program when they were age 9 - 14 mo and were age 20 - 25 mo at the final survey . They consumed significantly more energy , protein , fat , iron , zinc , vitamin A , and calcium than control children because of their FCF consumption . Anemia , 76 % in both groups at baseline , fell to 27 % in PANN 2000 children but only to 44 % in control children ( P < 0.001 ) . The odds of being anemic were 58 % lower for PANN 2000 children ( P = 0.003 ) . The effects on linear growth and weight were limited to children who were older when the program began ( 12 - 14 mo ) and were significant for weight ( interaction with age , 0.38 kg ; P = 0.029 ) and positive but not significant for length ( 0.66 cm ; P = 0.08 ) . An FCF , including ferrous sulfate , delivered through public health services , is highly effective in improving weight and hemoglobin and reducing anemia BACKGROUND Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded linear growth and reducing anemia in stunted children . DESIGN Saharawi refugee children ( n = 374 ) aged 3 - 6 y with initial height-for-age z scores < -2 were assigned to 1 of 5 groups : fortified spread ( FS ) , fortified spread plus metronidazole ( FS+M ) , unfortified spread ( US ) , unfortified spread plus metronidazole ( US+M ) , or control . Supervised supplementation was given daily for 6 mo . Weight , height , knee-heel length , hematologic indexes , parasitic infections , and morbidity were assessed at 0 , 3 , and 6 mo . RESULTS Linear growth of children fed FS was 30 % faster at 3 mo than in US and control groups , after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups . No additional benefits from metronidazole were observed . Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups ( 37 + /- 40 , 19 + /- 15 , and 16 + /- 17 g/L , respectively ; P < 0.0001 ) , and anemia was reduced by nearly 90 % . CONCLUSIONS FS , and not US , induces catch-up growth in stunted children whose diets are poor in micronutrients . Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 BACKGROUND Maize-meal porridge is used for infant feeding in many African countries , including South Africa . A low-cost , finely milled , maize-meal porridge was fortified with beta-carotene , iron , and zinc ( 100 % of recommended dietary allowance ) , as well as ascorbic acid , copper , selenium , riboflavin , vitamin B-6 , vitamin B-12 , and vitamin E. OBJECTIVE We assessed whether the fortified porridge could reduce anemia and improve the micronutrient status and motor development of infants .  DESIGN Infants aged 6 - 12 mo ( n = 361 ) were r and omly assigned to receive either the fortified or unfortified porridge for 6 mo . Primary outcomes were hemoglobin and serum retinol , zinc , and ferritin concentrations and motor development . Growth was assessed as a secondary outcome . Primary and secondary outcomes were assessed at baseline and 6 mo . RESULTS Two hundred ninety-two infants completed the study . The fortified-porridge group had an intervention effect of 9.4 microg/L ( 95 % CI : 3.6 , 15.1 microg/L ) for serum ferritin and 9 g/L ( 95 % CI : 6 , 12 g/L ) for hemoglobin concentrations . The proportion of infants with anemia decreased from 45 % to 17 % in the fortified-porridge group , whereas it remained > 40 % in the control group . The fortified-porridge group achieved on average 15.5 of the 25 motor development score items , whereas the control group achieved 14.4 items ( P = 0.007 ) . Serum retinol concentration showed an inconsistent effect , and no intervention effect was observed for serum zinc concentrations . CONCLUSIONS This low-cost fortified porridge can potentially have a significant effect in reducing anemia and improving iron status and motor development of infants in poor setting s. The formulation needs some adjustment in terms of zinc fortification Abstract Chronic stress has a negative influence on health . The aim was to determine stress reducing effects of yoghurt enriched with bioactive components as compared to normal yoghurt .  High-trait anxiety individuals ( n = 67 ) aged 18–63 years participated in a r and omized , placebo-controlled , double-blinded intervention with parallel groups . They received either yoghurt enriched with alpha-lactalbumin , casein tripeptides and B vitamins ( active ) or isoenergetic st and ard yoghurt ( control ) . To detect changes in psychological and physiological stress , State-Trait Anxiety Inventory , Profile of Mood States , salivary cortisol , inflammatory markers , blood pressure , heart rate variability ( HRV ) and actigraphy were monitored . We observed higher ratings of vigor ( p = 0.047 ) and reduced feeling of inefficiency ( p = 0.048 ) in the active group . HRV ( baseline adjusted mean 49.1 ± 2.3 ms ) and recovery index ( 106.6 ± 33.4 ) were higher in the active group than in controls ( 42.5 ± 2.2 ms and 80.0 ± 29.3 ) ( p = 0.046 and p = 0.02 , respectively ) . In conclusion , daily intake of yoghurt enriched with bioactive components may aid in stress coping Fortifying rice with multiple micronutrients could be a promising strategy for combat micronutrient deficiencies in developing countries . We determined the efficacy of extruded rice grains fortified with multiple micronutrients on the prevalence of anemia , micronutrient status , and  physical and cognitive performance  in 6- to 12-y-old , low-income school children in Bangalore , India . In a r and omized , double-blind , controlled trial , 258 children were assigned to 1 of 3 intervention groups to receive rice-based lunch meals fortified with multiple micronutrients with either low-iron ( 6.25 mg ) or high-iron ( 12.5 mg ) concentrations or identical meals with unfortified rice . The meals were provided 6 d/wk for 6 mo . Anthropometric , biochemical , physical performance , and cognitive assessment s were taken at baseline and endpoint . At baseline , study groups were comparable , with 61 % of the children being anemic . However , only < 10 % were deficient in iron , vitamin A , and zinc . After 6 mo , plasma vitamin B-12 and homocysteine concentrations ( both P < 0.001 ) as well as physical performance ( P < 0.05 ) significantly improved in the intervention arms . No between-group differences were observed in hemoglobin concentration , anemia , and deficiencies of other micronutrients or cognitive function after 6 mo , but paired analyses revealed a small reduction in anemia prevalence in children in the low-iron group . The fortified rice was efficacious in improving vitamin B-12 status and physical performance in Indian school children Background Fortification of staple foods is considered an effective and safe strategy to combat micronutrient deficiencies , thereby improving health . While improving micronutrient status might be expected to have positive effects on immunity , some studies have reported increases in infections or inflammation after iron supplementation . Objective To study effects of micronutrient-fortified rice on  hookworm infection  in Cambodian schoolchildren . Methods A double-blinded , cluster-r and omized trial was conducted in 16 Cambodian primary schools partaking in the World Food Program school meal program . Three types of multi-micronutrient fortified rice were tested against placebo rice within the school meal program : UltraRice_original , UltraRice_improved and NutriRice . Four schools were r and omly assigned to each study group ( placebo n = 492 , UltraRice_original n = 479 , UltraRice_improved n = 500 , NutriRice n = 506 ) . Intestinal parasite infection was measured in fecal sample s by Kato-Katz method at baseline and after three and seven months . In a subgroup ( N = 330 ) , fecal calprotectin was measured by ELISA as a marker for intestinal inflammation . Results Baseline prevalence of hookworm infection was 18.6 % , but differed considerably among schools ( range 0%- 48.1%).Micronutrient-fortified rice significantly increased risk of new hookworm infection . This effect was modified by baseline hookworm prevalence at the school ; hookworm infection risk was increased by all three types of fortified rice in schools where baseline prevalence was high ( > 15 % ) , and only by UltraRice_original in schools with low baseline prevalence . Neither hookworm infection nor fortified rice was related to fecal calprotectin . Conclusions Consumption of rice fortified with micronutrients can increase hookworm prevalence , especially in environments with high infection pressure . When considering fortification of staple foods , a careful risk-benefit analysis is warranted , taking into account severity of micronutrient deficiencies and local prevalence of parasitic infections . Trial Registration Clinical Trials.gov BACKGROUND Multiple micronutrient deficiencies are prevalent in India . OBJECTIVE The study aims to establish the efficacy of multi-micronutrient fortified salt in addressing multiple micronutrient deficiencies among children compared to nutrition education and no intervention in Tamilnadu . METHODS The study employed a community based r and omized controlled trial design ed to study the impact of multiple micronutrient salt ( micronutrient group ) in comparison with nutrition education ( education group ) and no intervention ( control group ) on haemoglobin , serum ferritin , soluble transferrin receptor , body iron stores , serum retinol and urinary iodine outcomes over a period of 8 months . The fortified salt contained iron , iodine , vitamin A , vitamin B12 and folic acid . All the children were dewormed at baseline and at the end of the study just before the biochemical measurements . RESULTS There was a significant improvement in most biochemical parameters studied in the micronutrient group when compared with the control group whereas this was not seen between the education and control . Over 8 months , in the micronutrient group , hemoglobin increased by 0.52 g/dL , retinol by 8.56 μg/dL , ferritin by 10.8 μg/L , body iron stores by 1.27 mg and the decrease in the prevalence of retinol deficiency was from 51.6 % to 28.1 % , anaemia from 46.0 % to 32.6 % , iron deficiency from 66.9 % to 51.3 % and iron deficiency anaemia from 35.2 % to 31.0 % , while the prevalence of all these deficiencies increased or the changes were not significant in the other two groups . CONCLUSIONS Multiple micronutrient fortified salt was able to improve iron and vitamin A status , whereas this was not seen in the nutrition education group OBJECTIVE This study was conducted to test the efficacy of a multiple micronutrient-fortified cooking salt . METHODS A r and omized controlled trial with a pre- and post-test design was used to study children 5 to 18 years of age , with an experimental ( n=213 ) and control group ( n=189 ) . The children were sample d from 3 residential schools and were studied for 9 months . The experimental group received a multiple micronutrient-fortified salt containing vitamins A , B(1 ) , B(2 ) , B(6 ) , B(12 ) , as well as folic acid , niacin , iron , iodine , and zinc . The control group received iodized salt . Biochemical measurements [ hemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( sTfR ) , C-reactive protein ( CRP ) , alpha-1 acid glycoprotein ( AGP ) , serum retinol , serum vitamin B(12 ) , serum folic acid , serum zinc , and urinary iodine ( UI ) ] were measured at baseline and post-intervention . Hemoglobin was measured in all the children three times during the study period , while the remaining biochemical measurements were performed in a sub sample of children . Children between 11 and 18 years of age were given cognitive tests to assess memory and attention . RESULTS There was a significant improvement ( p<0.05 ) in all the biochemical measurements and memory tests in the experimental group when compared with the control group . Post-intervention in the experimental group , the increase in hemoglobin was 0.67 g/dL ( p<0.05 ) . Iron status and body iron stores increased significantly ( p<0.05 ) in the experimental group compared to the control group , while serum zinc increased by 50 mug/dL ( p<0.05 ) , and the prevalence of retinol deficiency decreased from 57.1 % at baseline to 16 % post-intervention ( p<0.05 ) . CONCLUSION The multiple micronutrients from the multiple micronutrient-fortified cooking salt were absorbed in the children and helped in combating micronutrient deficiencies OBJECTIVE To assess the efficacy of micronutrient fortified sugar c and ies in improving the iron and vitamin A status in children aged 3 to 6 years . DESIGN Triple blind r and omized controlled trial . SETTING S Anganwadis and preparatory schools in rural Haryana . METHODS 410 children were r and omized in four groups . One group received full dose c and y ( vitamin A 1000 IU and 14 mg elemental iron ) daily , the second group received full dose c and y for 3 days a week , the third group received half dose c and y ( vitamin A 500 IU and 7 mg elemental iron ) daily and the fourth received placebo . The c and ies were provided to children under supervision of field workers . Hemoglobin , S. ferritin , S. retinol and S. retinol binding protein levels were estimated at baseline and after 13 weeks of intervention . RESULTS The increase in hemoglobin was least in the placebo group ( 0.3 g/dL ) as compared to the two full dose groups ( 1.15 - 1.18 g/dL , P < 0.001 ) . Among anemic children , the increase in hemoglobin was about 2 g/dL in the full dose group and 0.7 g/dL in the placebo group ( P < 0.001 ) . S. ferritin levels increased significantly only in the full dose daily group ( p < 0.05 ) . The prevalence of anemia decreased from around 50 % at baseline to 9.6 % in the full dose daily group ( p < 0.01 ) . Based on the S. retinol levels , the study area was not vitamin A deficient and the intervention did not result in a significant improvement in the vitamin A status of the children . CONCLUSION Micronutrient fortified c and ies were effective in improving the hemoglobin level and decreasing anemia prevalence . It could serve as a suitable vehicle for micronutrient supplementation in children and other target groups OBJECTIVE To evaluate the efficacy of a multiple micronutrient fortified beverage containing eleven nutrients at physiological levels in prevention of anaemia and improving iron and vitamin A status  during pregnancy . DESIGN A r and omised double blind placebo controlled study . SETTING Mpwapwa and Kongwa Districts in Dodoma Region of Tanzania . SUBJECTS Five hundred and seventy nine pregnant women were screened for entry into the study and 439 women who met the study criteria were enrolled . INTERVENTIONS Study participants received either a fortified ( F ) or non-fortified ( NF ) orange flavoured drinks identical in appearance , provided in two self administered servings per day for an eight week period . MAIN OUTCOME MEASURES Comparison of haemoglobin ( Hb ) , serum ferritin ( SF ) and serum retinol ( SR ) at baseline and follow up . RESULTS After eight weeks of supplementation , the F group ( n=129 ) had a significantly higher Hb increase of 0.86 g/dL compared to 0.45 g/dL in the NF group ( n=130 ) p<0.0001 . Gestational age at entry into the study , moderated the effect on Hb of the fortified drink . Women at earlier gestational age upon entry , had a higher rise in Hb than women of late gestational age ( 0.8 g/dL versus 0.04 g/dL rise respectively , p=0.038 , n=188 ) . The risk of being anaemic at the end of the study for those in the F group was reduced by 51 % ( RR=0.49 , CI=0.28 to 0.85 ) . Iron stores ( by serum ferritin levels ) increased by 3 microg/L in the F group ( p=0.012 ) and a decrease of 2 microg/L in the NF group ( p=0.115 ) . The follow up ferritin concentration depended on initial ferritin level . Regardless of treatment group , serum retinol concentrations were significantly higher in mothers who had delivered . Mothers who had adequate levels at entry benefited more from the supplement than those with low levels ( 0.26 micromol/L versus no significant difference ) . CONCLUSIONS The multiple micronutrient-fortified beverage given for eight weeks to pregnant women improved their haemoglobin , serum ferritin and retinol status . The risk for anaemia was also significantly reduced . The important predictors of Hb increase at follow up were the fortified beverage , baseline Hb , serum retinol , baseline ferritin and gestational age at entry into study . Anthropological research showed that the beverage was highly acceptable and well liked OBJECTIVE To evaluate the long-term effect on micronutrient status of a beta-carotene- , iron- and iodine-fortified biscuit given to primary school children as school feeding . DESIGN Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years ( n = 108 ) ; in addition , cross-sectional data from three subsequent surveys conducted in the same school are reported . SETTING A rural community in KwaZulu-Natal , South Africa . SUBJECTS Children aged 6 - 11 years attending the primary school where the biscuit was distributed . RESULTS There was a significant improvement in serum retinol , serum ferritin , haemoglobin , transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention . However , when the school reopened after the summer holidays , all variables , except urinary iodine , returned to pre-intervention levels . Serum retinol increased again during the next 9 months , but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays ; this pattern was repeated in two further cross-sectional surveys . Haemoglobin gradually deteriorated at each subsequent assessment , as did serum ferritin ( apart from a slight increase at the 42-month assessment at the end of the school year ) . CONCLUSIONS This study has shown that fortification of a biscuit with beta-carotene at a level of 50 % of the Recommended Dietary Allowance ( RDA ) was enough to maintain serum retinol concentrations from day to day , but not enough to sustain levels during the long school holiday break . Other long-term solutions , such as local food production programmes combined with nutrition education , should also be examined . The choice of the iron compound used as fortificant in the biscuit needs further investigation Background / Objectives : A multiple micronutrient-fortified drink could be an effective strategy to combating micronutrient deficiencies in school going children . To assess the efficacy of a multiple micronutrient-fortified drink in reducing iron deficiency ( ID ) , ID anemia ( IDA ) , anemia and improving micronutrient status among schoolchildren with low iron stores . The study employed a school-based , r and omized , double-blind , placebo-controlled design .Subjects/ Methods : Schoolchildren with low serum ferritin ( SF < 20 μg/l ) ( n=246 ) , aged 6–12 years were r and omly 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 assessment s were taken at baseline and endline . Results : 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 . Conclusions : 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 schoolchildren Iron ( Fe ) , zinc ( Zn ) , and vitamin A ( VA ) deficiencies are common among children in developing countries and often occur in the same individual . Rice is widely consumed in the developing countries of Asia and the low phytate in polished rice makes it ideal for Zn and Fe fortification . Triple-fortified rice grains with Zn , Fe , and VA were produced using hot extrusion technology . The main objective of the present study was to determine the impact of triple-fortified extruded rice on Zn status in school children in Southern Thail and . Although serum zinc was the main outcome indicator , Fe and VA status were also assessed . School children with low serum zinc ( n = 203 ) were r and omized to receive either triple-fortified rice ( n = 101 ) or natural control rice ( n = 102 ) as a component of school lunch meals for 5 mo . Serum Zn , hemoglobin , serum ferritin , serum retinol , and C-reactive protein were measured at baseline and at the end of the study . After the intervention , serum Zn increased ( P < 0.05 ) in both the fortification ( 11.3 ± 1.3 μmol/L ) and control ( 10.6 ± 1.4 μmol/L ) groups , most likely due to the proper implementation of the school lunch and school milk programs , with the increase greater in the group receiving the triple-fortified rice ( P < 0.05 ) . Because the children were not Fe or VA deficient at baseline , there was no change in Fe or VA status . We conclude that Zn fortification of extruded rice grains is efficacious and can be used to improve Zn status in school children Background : Iron-deficiency anemia is a major public health problem among school-aged children in sub-Saharan Africa . Objective : To evaluate the effectiveness of micronutrient-fortified rice to increase hemoglobin ( Hb ) concentration and reduce the prevalence of anemia among schoolchildren . Methods : Nine hundred four schoolchildren participated in this cluster-r and omized trial during a 7-month intervention period . The study was conducted in 12 primary schools in rural Burundi . Hemoglobin , socioeconomic status , febrile illness , and dietary diversity were measured at baseline and follow-up . The changes in Hb concentration and anemia status were analyzed using linear and logistic mixed models , respectively . The micronutrient formulation contained an iron-to-zinc molar ratio of approximately 2.2 . Results : There was no significant difference in Hb concentration between the intervention and control groups ( β = .09 g/dL ; 95 % confidence interval : −0.21 to 0.38 ) following the 7-month intervention . Nearly half the children reported having a fever within 2 weeks prior to baseline or follow-up . Children with febrile illness preceding follow-up were less than half as likely to show improvement in anemia status ( odds ratio = 0.47 , P < .001 ) , with an average 0.56 g/dL smaller improvement in Hb at follow-up ( P < .001 ) . Conclusion : The high prevalence of fever and low iron-to-zinc molar ratio of the Ultra Rice formulation may have contributed to the lack of improvement in Hb . Alternatively , the detected anemia may not have been due to nutrient deficiencies . Anemia interventions in Burundi should implement multiple strategies to eliminate both iron deficiency and infectious causes of anemia Dietary nutrients may have pharmacological value in modulating the immune system . We studied the effects of two enteral diets , which differed in their content of arginine , fat source , and select trace elements , on immune function in critically injured patients . Leukocytes were isolated from healthy volunteers and severely injured ( ISS > 13 ) patients on the first , sixth , and tenth day of receiving either a st and ard diet or experimental diet .  Monocytes were assayed for tumor necrosis factor , procoagulant activity , and prostagl and in E2 following endotoxin exposure . Neutrophil oxidant production and lymphocyte blastogenesis was assessed . Leukocyte function was uniformly depressed compared to normal patients on day 1 . The response of leukocytes from patients receiving experimental diet improved or " normalized " by day 6 , while remaining depressed in patients receiving st and ard diet . Dietary nutrient modification can effect cellular immune responses to inflammatory stimuli in severely injured patients OBJECTIVE Even though current policy is strongly focused on the crucial first ' 1000 days ' , it might be still possible to enhance cognitive function during the pre-adolescent and adolescent years by improving micronutrient status . In Cambodia , nutritional status is poor . Provision of rice fortified with micronutrients through a school meal programme ( SMP ) could be a cost-effective strategy to help improve health and school performance . The present study aim ed to evaluate the effect of three different micronutrient-fortified rice formulations on cognitive function in Cambodian children . SETTING Sixteen Cambodian schools receiving SMP . DESIGN The FORISCA-UltraRice ® +NutriRice ® study was a r and omized , double-blind , placebo-controlled trial . Four groups of four schools were r and omly allocated to receive normal rice , UltraRice ® Original , UltraRice ® New or NutriRice ® . Within each school , 132 children were r and omly selected .  Data on cognitive performance ( picture completion , block design and Raven 's coloured progressive matrices ( RCPM ) ) , anthropometry , parasite infestation and micronutrient status were collected before the intervention and after 6 months . SUBJECTS Cognitive data were available for 1796 children aged 6 - 16 years .  RESULTS All cognitive scores improved after 6 months ( P<0·001 ) . Block design score improvement was significantly higher in children consuming UltraRice ® Original ( P=0·03 ) compared with the other fortified rice groups and placebo . No difference among groups was found on RCPM or picture completion scores . Stunting , parasite infestation and inflammation negatively affected the impact of the intervention . CONCLUSIONS Combined with other interventions , using SMP to distribute fortified rice to schoolchildren may be a cost-effective way to increase cognitive performance and thereby improve school performance and educational achievements OBJECTIVE To study the effects of human milk fortification on short term growth and biochemical parameters in preterm very low birth weight ( VLBW ) appropriate for gestation ( AGA ) and small for gestation ( SGA ) babies . DESIGN Prospect i ve , r and omized controlled trial . SETTING Level III neonatal unit . SUBJECTS Preterm infants weighing < or = 1500 grams and < or = 34 weeks of gestation born between March 2001 to June 2002 . METHODS Babies ( n = 166 ) were r and omized in two groups either to get fortified human milk or exclusive human milk along with mineral and vitamin supplementation when feed volume reached 150 mL/Kg/day . Fortification was done with a powdered fortifier added in expressed breast milk and continued till the baby reached 2 Kg or full breast feeds . Primary outcome measures were Short-term growth ( daily weight , length and head circumference ( HC ) weekly ) till discharge or 2 Kg . RESULTS Fortification ( n = 85 , birth weight 1202 g , gestation 30.8 wk ) result ed in better growth in preterm VLBW babies as compared to control group ( n=81 , birth weight 1259 g , gestation 31.3 wk ) . Weight gain ( 15.1 and 12.9 g/kg/d , P < 0.001 ) , length ( 1.04 and 0.86 cm/week , P = 0.017 ) and HC ( 0.83 and 0.75 cm/week , P<0.001 ) increased significantly in fortified group . SGA babies showed significant improvements in weight ( 16 g/Kg/d and 12.9 g/kg/d , P = 0.002 ) and length ( 1.09 cm/week and 0.92 cm/week , P = 0.042 ) in fortified group ( n = 38 ) as compared to control group ( n = 29 ) . In AGA subgroup , there was significant increase ( P = 0.006 ) in length ( 1 cm vs 0.82 cm ) in fortified group but no difference in weight ( P = 0.12 ) or HC ( P=0.054 ) in fortified ( n=47 ) vs control ( n=52 ) group . Biochemical parameters were comparable , however feed intolerance was more in control group . CONCLUSION Preterm VLBW babies showed better growth with human milk fortification . The effect is significant in SGA ( weight and length)rather than AGA ( only length ) babies BACKGROUND Prenatal multiple micronutrient ( MMN ) or balanced energy and protein supplementation has a limited effect on birth size of the offspring . OBJECTIVE The objective was to determine whether a prenatal MMN-fortified food supplement ( FFS ) improves anthropometric measures at birth compared with supplementation with an MMN pill alone . DESIGN We conducted a nonblinded , individually r and omized controlled trial in 1296 pregnant women in 2 villages in rural Burkina Faso . Supplements were provided on a daily basis , and compliance was closely verified by using a community-based network of home visitors . RESULTS Anthropometric measures at birth were available for analysis for 87 % of the 1175 live singleton deliveries enrolled . After adjustment for gestational age at birth , the FFS group had a significantly higher birth length ( + 4.6 mm ; P = 0.001 ) . FFS supplementation result ed in a modestly higher birth weight ( + 31 g ; P = 0.197 ) . Subgroup analyses showed clinical ly important treatment effects on birth length ( + 12.0 mm ; P = 0.005 ) and on birth weight ( + 111 g ; P = 0.133 ) for underweight [ body mass index ( in kg/m(2 ) ) < 18.5 ] pregnant women . Women with early pregnancy anemia who received FFS gave birth to longer newborns ( + 7.3 mm ; P = 0.002 ) than did those who received MMN supplementation . CONCLUSIONS The provision of FFS to pregnant women result ed in higher birth length than did MMN supplementation . For women with a suboptimal prepregnancy nutritional status , MMN supplementation should be complemented with a balanced energy and protein supplement to produce a clinical effect on birth size . The trial was registered at clinical trials.gov as NCT00909974 Background Multiple micronutrients ( MMN ) are commonly prescribed in pediatric primary healthcare in sub-Saharan Africa to improve nutritional status and appetite without evidence for their effectiveness or international clinical guidelines . Community-wide MMN supplementation has shown limited and heterogeneous impact on growth and morbidity . Short-term ready-to-use therapeutic foods in acutely sick children in a hospital setting also had limited efficacy regarding subsequent growth . The effectiveness of MMN in improving morbidity or growth in  sick children presenting for primary care has not been assessed . Methods and findings We undertook a double-blind r and omised controlled trial of small-quantity lipid-based nutrient supplements ( SQ-LNS ) fortified with 23 micronutrients in children aged 6 months ( mo ) to 5 years ( y ) presenting with an illness at a rural primary healthcare centre in The Gambia . Primary outcomes were repeat clinic presentations and growth over 24 wk . Participants were r and omly assigned to receive 1 of 3 interventions : ( 1 ) supplementation with micronutrient-fortified SQ-LNS for 12 wk ( MMN-12 ) , ( 2 ) supplementation with micronutrient-fortified SQ-LNS for 6 wk followed by unfortified SQ-LNS for 6 wk ( MMN-6 ) , or ( 3 ) supplementation with unfortified SQ-LNS for 12 wk ( MMN-0 ) to be consumed in daily portions . Treatment masking used 16 letters per 6-wk block in the r and omisation process . Blinded intention-to-treat analysis based on a prespecified statistical analysis plan included all participants eligible and correctly enrolled . Between December 2009 and June 2011 , 1,101 children ( age 6–60 mo , mean 25.5 mo ) were enrolled , and 1,085 were assessed  ( MMN-0 = 361 , MMN-6 = 362 , MMN-12 = 362 ) . MMN supplementation was associated with a small increase in height-for-age z-scores 24 wk after recruitment ( effect size for MMN groups combined : 0.084 SD/24 wk , 95 % CI : 0.005 , 0.168 ; p = 0.037 ; equivalent to 2–5 mm depending on age ) . No significant difference in frequency of morbidity measured by the number of visits to the clinic within 24 wk follow-up was detected with 0.09 presentations per wk for all groups ( MMN-0 versus MMN-6 : adjusted incidence rate ratio [ IRR ] 1.03 , 95 % CI : 0.92 , 1.16 ; MMN-0 versus MMN-12 : 1.05 , 95 % CI : 0.93 , 1.18 ) . In post hoc analysis , clinic visits significantly increased by 43 % over the first 3 wk of fortified versus unfortified SQ-LNS ( adjusted IRR 1.43 ; 95 % CI : 1.07 , 1.92 ; p = 0.016 ) , with respiratory presentations increasing by 52 % with fortified SQ-LNS ( adjusted IRR 1.52 ; 95 % CI : 1.01 , 2.30 ; p = 0.046 ) . The number of severe adverse events during supplementation were similar between groups ( MMN-0 = 20 [ 1 death ] ; MMN-6 = 21 [ 1 death ] ; MMN-12 = 20 [ 0 death ] ) . No participant withdrew due to adverse effects . Study limitations included the lack of supervision of daily supplementation . Conclusion Prescribing micronutrient-fortified SQ-LNS to ill children presenting for primary care in rural Gambia had a very small effect on linear growth and did not reduce morbidity compared to unfortified SQ-LNS . An early increase in repeat visits indicates a need for the establishment of evidence -based guidelines and caution with systematic prescribing of MMN . Future research should be directed at underst and ing the mechanisms behind the lack of effect of MMN supplementation on morbidity measures and limited effect on growth . Trial registration IS RCT N 73571031 Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition . In the present study , we investigated the effects of micronutrients and sugar , alone and in combination , in a beverage on growth and cognition in schoolchildren . In a 2 × 2 factorial design , children ( n 414 , 6 - 11 years ) were r and omly allocated to consume beverages containing ( 1 ) micronutrients with sugar , ( 2 ) micronutrients with a non-nutritive sweetener , ( 3 ) no micronutrients with sugar or ( 4 ) no micronutrients with a non-nutritive sweetener for 8.5 months . Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II ( KABC-II ) subtests and the Hopkins Verbal Learning Test ( HVLT ) . Micronutrients decreased the OR for Fe deficiency at the endpoint ( OR 0.19 ; 95 % CI 0.07 , 0.53 ) . Micronutrients  increased KABC Atlantis ( intervention effect : 0.76 ; 95 % CI 0.10 , 1.42 ) and HVLT Discrimination Index ( 1.00 ; 95 % CI 0.01 , 2.00 ) scores . Sugar  increased KABC Atlantis ( 0.71 ; 95 % CI 0.05 , 1.37 ) and Rover ( 0.72 ; 95 % CI 0.08 , 1.35 ) scores and HVLT Recall 3 ( 0.94 ; 95 % CI 0.15 , 1.72 ) . Significant micronutrient × sugar interaction effects on the Atlantis , Number recall , Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone . Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls ( micronutrients - 0.08 ; 95 % CI - 0.15 , - 0.01 ; sugar - 0.07 ; 95 % CI - 0.14 , - 0.002 ) , but in combination , this effect was attenuated . The beverages with micronutrients or added sugar alone had a beneficial effect on cognition , which was attenuated when provided in combination OBJECTIVE We investigated the effect of a micronutrient-enriched beverage on body composition , bone mineral content ( BMC ) , bone area , and bone mineral density ( BMD ) at various sites in schoolchildren . METHODS A double-blind , placebo-controlled , matched-pair , cluster , r and omization study was carried out in residential schoolchildren 6 to 16 y of age who lived near Hyderabad , India . Children ( n = 268 ) were selected r and omly from two classes of each grade ( 1 to 9 ) and were provided a micronutrient-enriched beverage ( n = 146 ) or a placebo drink ( n = 122 ) . Bone parameters such as BMC , BMD , and bone area at various sites and the entire body were measured with dual-energy X-ray absorptiometry at the beginning and end of the study . Increments of outcome variables were subjected to paired t test with appropriate corrections to assess the effect of the supplement on bone health . RESULTS After 14 mo , increments for height , weight , fat-free mass , percentage of fat , whole-body BMC , whole-body bone area , and BMD at the neck of the femur were significantly greater ( P < 0.05 ) in the supplemented group than in the placebo group . CONCLUSIONS The micronutrient-rich supplement increased tissue growth and skeletal shell in apparently normal children in the 14-mo period . It did not increase whole-body or site-specific BMD except at the neck of the femur . Amounts of calcium and other nutrients contained in the supplement were inadequate for tissue growth with density increases . This study raises important questions about the nutrient requirements of Indian children who consume a diet of cereals and pulses The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status , linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape , South Africa . The study was design ed as an intervention study . In both the experimental and control groups , serum retinol concentration showed a decline over the intervention period of 6 months . The decline was less pronounced in the experimental group . This result ed in a significantly ( P<005 ) higher serum retinol concentration at 12 months in the experimental group ( 26.8±5.8 μg/dl ) compared with the control group ( 21.4±5 μg/dl ) . Serum iron concentration also declined over the intervention period . The decline was less pronounced in the experimental group . No difference was observed in haemoglobin levels between the groups at 12 months . Serum zinc concentration did not differ significantly between the two groups at follow up . Weight gain over the 6 months period did not differ significantly between the experimental ( 2.1±0.9 kg ) and control groups ( 2.1±1.2 kg ) . There was no difference in linear growth between the experimental ( 10.0±1.5 cm ) and control group ( 10.1±2.1 cm ) at the end of the follow-up period . Weight and length at 6 months significantly predicted weight and length at 12 months . No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention . Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group . No benefit was observed in serum zinc concentration , linear growth and psychomotor development Background Nutrition in the school-aged child matters for brain development and public policy investments globally . Our group previously conducted a trial in urban schools of Haiti to examine the effects of a fortified peanut butter snack , Vita Mamba , with limited findings for anemia . Objective We aim ed to test the hypothesis that Vita Mamba , with systematic deworming in both study arms , would significantly reduce anemia  among rural , school-aged children . Methods A cluster , r and omized longitudinal study was conducted in two rural communities of the North-East Department of Haiti , 2014–2015 . Healthy children ages 3–16 years were enrolled ( n = 321 ) and assigned by school to intervention ( Vita Mamba and deworming ) and control ( deworming ) . Vita Mamba contains 260 kcal and meets > 75 % of the Recommended Dietary Allowance for critical micronutrients . Multivariate regression analyses including propensity score matching techniques to correct for potential group imbalance ( Kernel-based Matching and Propensity Score Weighting ) were applied to examine difference-in-difference intervention effects . Results At baseline , 51 % of the children were anemic  with no significant differences between study groups . Vita Mamba supplementation showed a consistent , positive effect across regression models on increasing Hb concentration and reducing the odds of anemia compared to the control group after adjusting for child age , vitamin A supplementation , milk consumption , and height-for-age z score . The average treatment effect for the treated in the Propensity Score Weighting models was 0.62±0.27 grams per 100 milliliters ( g/dL ) for Hb concentration ( F = 4.64 , P = 0.001 ) , and the odds of anemia were reduced by 88 % ( Wald χ² = 9.77 , P = 0.02 ) . No differences in change in anthropometric markers were evident . Conclusions School feeding programs that integrate fortified foods with deworming could reduce anemia burden with important implication s for learning , health , and well-being . The rural-urban differences in anemia require further study OBJECTIVE To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification . DESIGN Pre- and post-intervention study using a longitudinal cohort . SETTING Nangweshi refugee camp , Zambia . SUBJECTS Two hundred and twelve adolescents ( 10 - 19 years ) , 157 children ( 6 - 59 months ) and 118 women ( 20 - 49 years ) were selected at r and om by household survey in July 2003 and followed up after 12 months . RESULTS Maize grain was milled and fortified in two custom- design ed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration . During the intervention period mean Hb increased in children ( 0.87 g/dl ; P < 0.001 ) and adolescents ( 0.24 g/dl ; P = 0.043 ) but did not increase in women . Anaemia decreased in children by 23.4 % ( P < 0.001 ) but there was no significant change in adolescents or women . Serum transferrin receptor ( log10-transformed ) decreased by -0.082 microg/ml ( P = 0.036 ) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency ( -8.5 % ; P = 0.079 ) . In adolescents , serum retinol increased by 0.16 micromol/l ( P < 0.001 ) and vitamin A deficiency decreased by 26.1 % ( P < 0.001 ) . CONCLUSIONS The introduction of fortified maize meal led to a decrease in  anaemia in children and a decrease in vitamin A deficiency in adolescents . Central ised , camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations Background : Very low birth weight infants ( < 1500 g ) have high nutritional needs . Deficiencies of minerals , trace elements ( especially zinc ) may develop as a result of rapid growth , low body stores and low content of these substances in human milk We hypothesized that fortification of human milk might prevent deficiencies . Methods : Prospect i ve , r and omized trial to evaluate mineral , trace element , thyroid status and growth of infants fed human milk fortified with different amounts of calcium , phosphorus and protein , with ( BMF ) or without ( FM 85 ) trace elements . Sixty-two infants , 1000 to 1499 g birth weight , were r and omized .  Minerals and trace elements in serum , red blood cells and human milk and alkaline phosphatase activity , TSH , T4 and FT4 in serum were measured once until the fifth day and at 3 and 6 weeks of life . Clinical course and anthropometric measurements were recorded . Results : Intake of zinc , copper , manganese , calcium , phosphorus and magnesium was higher in the BMF group ( P < 0.001 ) . Serum zinc concentrations < 0.49 mg/L occurred in 12 % of the FM 85 group and 7 % of the BMF group at 6 weeks ( not significant ) . Median alkaline phosphatase activity was 436/379 IU/L in the FM 85/BMF group at 6 weeks ( P < 0.01 ) . The FM 85 group showed a higher weight gain ( P < 0.05 ) , possibly because of higher caloric ( P < 0.01 ) and protein intake ( P < 0.05 ) at 3 weeks . Conclusions : Zinc deficiency was rare . Elevated intake of calcium , phosphorus and zinc was associated with lower serum alkaline phosphatase activity but did not influence serum zinc concentration Micronutrient powders ( MNP ) are often added to complementary foods high in inhibitors of iron and zinc absorption . Most MNP therefore include high amounts of iron and zinc , but it is no longer recommended in malarial areas to use untargeted MNP that contain the Reference Nutrient Intake for iron in a single serving . The aim was to test the efficacy of a low-iron and -zinc ( each 2.5 mg ) MNP containing iron as NaFeEDTA , ascorbic acid ( AA ) , and an exogenous phytase active at gut pH. In a double-blind controlled trial , South African school children with low iron status ( n = 200 ) were r and omized to receive either the MNP or the unfortified carrier added just before consumption to a high-phytate maize porridge 5 d/wk for 23 wk ; primary outcomes were iron and zinc status and a secondary outcome was somatic growth . Compared with the control , the MNP increased serum ferritin ( P < 0.05 ) , body iron stores ( P < 0.01 ) and weight-for-age Z-scores ( P < 0.05 ) and decreased transferrin receptor ( P < 0.05 ) . The prevalence of iron deficiency fell by 30.6 % ( P < 0.01 ) and the prevalence of zinc deficiency decreased by 11.8 % ( P < 0.05 ) . Absorption of iron from the MNP was estimated to be 7 - 8 % . Inclusion of an exogenous phytase combined with NaFeEDTA and AA may allow a substantial reduction in the iron dose from existing MNP while still delivering adequate iron and zinc . In addition , the MNP is likely to enhance absorption of the high native iron content of complementary foods based on cereals and /or legumes Background The period of complementary feeding , starting around 6 months of age , is a time of high risk for growth faltering and morbidity . Low micronutrient density of locally available foods is a common problem in low income countries . Children of HIV-infected women are especially vulnerable . Although antiretroviral prophylaxis can reduce breast milk HIV transmission in early infancy , there are no clear feeding guidelines for after 6 months . There is a need for acceptable , feasible , affordable , sustainable and safe ( AFASS by WHO terminology ) foods for both HIV-exposed and unexposed children after 6 months of age . Methods and Findings We conducted in Lusaka , Zambia , a r and omised double-blind trial of two locally made infant foods : porridges made of flour composed of maize , beans , bambaranuts and groundnuts . One flour contained a basal and the other a rich level of micronutrient fortification .  Infants ( n = 743 ) aged 6 months were r and omised to receive either regime for 12 months . The primary outcome was stunting ( length-for-age Z<−2 ) at age 18 months . No significant differences were seen between trial arms overall in proportion stunted at 18 months ( adjusted odds ratio 0.87 ; 95 % CI 0.50 , 1.53 ; P = 0.63 ) , mean length-for-age Z score , or rate of hospital referral or death . Among children of HIV-infected mothers who breastfed < 6 months ( 53 % of HIV-infected mothers ) , the richly-fortified porridge  increased length-for-age and reduced stunting ( adjusted odds ratio 0.17 ; 95 % CI 0.04 , 0.84 ; P = 0.03 ) . Rich fortification improved iron status at 18 months as measured by hemoglobin , ferritin and serum transferrin receptors . Conclusions In the whole study population , the rich micronutrient fortification did not reduce stunting or hospital referral but did improve iron status and reduce anemia . Importantly , in the infants of HIV-infected mothers who stopped breastfeeding before 6 months , the rich fortification improved linear growth . Provision of such fortified foods may benefit health of these high risk infants . Trial registration Controlled-Trials.com IS RCT Background : Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50 % . Although nutrition counselling has shown modest benefits , few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting . Methods : A cluster-r and omized controlled trial was conducted in rural Bangladesh to test the effect of two local , ready-to-use foods ( chickpea and rice-lentil based ) and a fortified blended food ( wheat-soy-blend++ , WSB++ ) compared with Plumpy’doz , all with nutrition counselling vs nutrition counselling alone ( control ) on outcomes of linear growth ( length and length-for-age z-score , LAZ ) , stunting ( LAZ < −2 ) , weight-for-length z-score ( WLZ ) and wasting ( WLZ < −2 ) in children 6–18 months of age . Children ( n = 5536 ) were enrolled at 6 months of age and , in the food groups , provided with one of the allocated supplements daily for a year . Results : Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower ( by 0.02–0.04/month ) in the Plumpy’doz ( P = 0.02 ) , rice-lentil ( < 0.01 ) , and chickpea ( < 0.01 ) groups relative to control , whereas WLZ decline was lower only in Plumpy’doz and chickpea groups . WSB++ did not impact on these outcomes . The prevalence of stunting was 44 % at 18 months in the control group , but lower by 5–6 % ( P ≤ 0.01 ) in those receiving Plumpy’doz and chickpea . Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 ( all P < 0.05 ) , respectively , in all four food groups relative to the control . Conclusions : In rural Bangladesh , small amounts of daily fortified complementary foods , provided for a year in addition to nutrition counselling , modestly increased linear growth and reduced stunting at 18 months of age OBJECTIVE To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration , as primary outcomes . DESIGN Non-blinded , r and omised controlled study . SETTING Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago , Chile . SUBJECT Pregnant women were assigned to receive regular powdered milk ( n = 477 ) or a milk product fortified with multiple micronutrients and omega-3 fatty acids  ( n = 495 ) . RESULTS Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls ( 65.4 g difference , 95 % confidence interval ( CI ) 5 - 126 g ; P = 0.03 ) and the incidence of very preterm birth ( 0.80 just for mean birth weight and birth length in the on-treatment analysis ; birth length in that analysis had a difference of 0.57 cm ( 95 % CI 0.19 - 0.96 cm ; P = 0.003 ) . CONCLUSIONS The new intervention result ed in increased mean birth weight . Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation Objective To evaluate the efficacy of milk fortified with specific multiple micronutrients on morbidity in children compared with the same milk without fortification . Design Community based , double masked , individually r and omised trial . Setting Peri-urban settlement in north India . Participants Children ( n=633 ) aged 1 - 3 r and omly allocated to receive fortified milk ( n=316 ) or control milk ( n=317 ) . Intervention One year of fortified milk providing additional 7.8 mg zinc , 9.6 mg iron , 4.2 � g selenium , 0.27 mg copper , 156 � g vitamin A , 40.2 mg vitamin C , 7.5 mg vitamin E per day ( three feeds ) . Main outcome measures Days with severe illnesses , incidence and prevalence of diarrhoea , and acute lower respiratory illness . Results Study groups were comparable at baseline ; compliance in the groups was similar . Mean number of episodes of diarrhoea per child was 4.46 ( SD 3.8 ) in the intervention ( fortified milk ) group and 5.36 ( SD 4.1 ) in the control group . Mean number of episodes of acute lower respiratory illness was 0.62 ( SD 1.1 ) and 0.83 ( SD 1.4 ) , respectively . The fortified milk reduced the odds for days with severe illnesses by 15 % ( 95 % confidence interval 5 % to 24 % ) , the incidence of diarrhoea by 18 % ( 7 % to 27 % ) , and the incidence of acute lower respiratory illness by 26 % ( 3 % to 43 % ) . Consistently greater beneficial effects were observed in children aged ≤24 months than in older children . Conclusion Milk is well accepted as a means of delivery of micronutrients . Consumption of milk fortified with specific micronutrients can significantly reduce the burden of common morbidities among preschool children , especially in the first two years of life . Trial registration NCT00255385 Many children suffer from nutritional deficiencies that may negatively affect their academic performance  . This cluster-r and omized controlled trial aim ed to test the effects of micronutrient-fortified milk in Chinese students . Participants received either micronutrient-fortified ( n = 177 ) or unfortified ( n = 183 ) milk for six months . Academic performance , motivation , and learning strategies were estimated by end-of-term tests and the Motivated Strategies for Learning Question naire . Blood sample s were analyzed for micronutrients . In total , 296 students ( 82.2 % ) completed this study . Compared with the control group , students in the intervention group reported higher scores in several academic subjects ( p < 0.05 ) , including language s , mathematics , ethics , and physical performance at the end of follow-up . Students in the intervention group showed greater self-efficacy and use of cognitive strategies in learning , and reported less test anxiety ( p < 0.001 ) . Moreover , vitamin B2 deficiency ( odds ratio ( OR ) = 0.18 , 95 % confidence interval ( CI ) : 0.11~0.30 ) and iron deficiency ( OR = 0.34 , 95 % CI : 0.14~0.81 ) were less likely in the students of the intervention group , whereas vitamin D , vitamin B12 , and selenium deficiencies were not significantly different . “ Cognitive strategy ” had a partial mediating effect on the test scores of English ( 95 % CI : 1.26~3.79 ) and Chinese ( 95 % CI : 0.53~2.21 ) . Our findings suggest that micronutrient-fortified milk may improve students ’ academic performance , motivation , and learning strategies Background Interventions providing foods fortified with multiple micronutrients can be a cost-effective and sustainable strategy to improve micronutrient status and physical growth of school children . We evaluated the effect of micronutrient-fortified yoghurt on the biochemical status of important micronutrients ( iron , zinc , iodine , vitamin A ) as well as growth indicators among school children in Bogra district of Bangladesh . Methods In a double-masked r and omized controlled trial ( RCT ) conducted in 4 primary schools , 1010 children from classes 1–4 ( age 6–9 years ) were r and omly allocated to receive either micronutrient fortified yoghurt ( FY , n = 501 ) or non-fortified yoghurt ( NFY , n = 509 ) . For one year , children were fed with 60 g yoghurt everyday providing 30 % RDA for iron , zinc , iodine and vitamin A.  Anthropometric measurements and blood/urine sample s were collected at base- , mid- and end-line . All children ( FY , n = 278 , NFY , n = 293 ) consenting for the end-line blood sample were included in the present analyses . Results Both groups were comparable at baseline for socio-economic status variables , micronutrient status markers and anthropometry measures . Compliance was similar in both the groups . At baseline 53.4 % of the population was anemic ; 2.1 % was iron deficient ( ferritin < 15.0 μg/L and TfR > 8.3 mg/L ) . Children in the FY group showed improvement in Hb ( mean difference : 1.5 ; 95 % CI : 0.4 - 2.5 ; p = 0.006 ) as compared to NFY group . Retinol binding protein ( mean diff : 0.05 ; 95 % CI : 0.002 - 0.09 ; p = 0.04 ) and iodine levels ( mean difference : 39.87 ; 95 % CI : 20.39 - 59.35 ; p < 0.001 ) decreased between base and end-line but the decrease was significantly less in the FY group . Compared to NFY , the FY group had better height gain velocity ( mean diff : 0.32 ; 95 % CI : 0.05 - 0.60 ; p = 0.02 ) and height-for-age z-scores ( mean diff : 0.18 ; 95 % CI : 0.02 - 0.33 ; p = 0.03 ) . There was no difference in weight gain velocity , weight-for-age z-scores or Body Mass Index z-scores . Conclusion In the absence of iron deficiency at baseline the impact on iron status would not be expected to be observed and hence can not be evaluated . Improved Hb concentrations in the absence of a change in iron status suggest improved utilization of iron possibly due to vitamin A and zinc availability . Fortification improved height gain without affecting weight gain . Trial registration Clinical Trial.gov : Background Multiple micronutrient deficiencies are highly prevalent among preschool children and often lead to anemia and growth faltering . Given the limited success of supplementation and health education programs , fortification of foods could be a viable and sustainable option . We report results from a community based double-masked , r and omized trial among children 1–4 years evaluating the effects of micronutrients ( especially of zinc and iron ) delivered through fortified milk on growth , anemia and iron status markers as part of a four group study design , running two studies simultaneously . Methods and Findings Enrolled children ( n = 633 ) were r and omly allocated to receive either micronutrients fortified milk ( MN = 316 ) or control milk ( Co = 317 ) . Intervention of MN milk provided additional 7.8 mg zinc , 9.6 mg iron , 4.2 µg selenium , 0.27 mg copper , 156 µg vitamin A , 40.2 mg vitamin C , and 7.5 mg vitamin E per day ( three serves ) for one year . Anthropometry was recorded at baseline , mid- and end- study . Hematological parameters were estimated at baseline and end- study . Both groups were comparable at baseline . Compliance was over 85 % and did not vary between groups . Compared to children consuming Co milk , children consuming MN milk showed significant improvement in weight gain ( difference of mean : 0.21 kg/year ; 95 % confidence interval [ CI ] 0.12 to 0.31 , p<0.001 ) and height gain ( difference of mean : 0.51 cm/year ; 95 % CI 0.27 to 0.75 , p<0.001 ) . Mean hemoglobin ( Hb ) ( difference of 13.6 g/L ; 95 % CI 11.1 to 16.0 , p<0.001 ) and serum ferritin levels ( difference of 7.9 µg/L ; 95 % CI 5.4 to 10.5 , p<0.001 ) also improved . Children in MN group had 88 % ( odds ratio = 0.12 , 95 % CI 0.08 to 0.20 , p<0.001 ) lower risk of iron deficiency anemia . Conclusions / Significance Milk provides an acceptable and effective vehicle for delivery of specific micronutrients , especially zinc and iron . Micronutrient bundle improved growth and iron status and reduced anemia in children 1–4 years old . Trial Registration Clinical Trials.gov We studied the impact of a food supplementation program ( Plan Más Vida ( PMV ) ) on the micronutrient nutritional condition of pregnant women from low-income families 1 year after its implementation . The food program provided supplementary diet ( wheat and maize — fortified flour , rice or sugar , and fortified soup ) . We performed a prospect i ve , nonexperimental , cross-sectional study in the province of Buenos Aires , Argentina , evaluating pregnant women at baseline ( n = 164 ) and 1 year after PMV implementation ( n = 108 ) .  Biochemical tests ( hemogram , ferritin , vitamin A , zinc , and folic acid ) , anthropometric assessment s ( weight and height ) , and dietary surveys ( 24 h recall ) were performed at the two study points . One year after PMV implementation , no significant changes in anthropometric values were observed . Folic acid deficiency and the risk of vitamin A deficiency ( retinol , 20–30 μg/dl ) decreased significantly ( 35.8 to 6.1 % and 64 to 41 % , respectively ; p < 0.000 ) . Anemia and prevalence of iron and zinc deficiency values did not change . Diet survey results showed that although nutrient intake increased significantly , it was still below recommendations . Implementation of the PMV and of the government nutritional strategies had a high impact on the prevalence of folic acid deficiency . We also observed a decrease in the risk of vitamin A deficiency , and no impact on iron and zinc nutritional status . Adherence to the specific fortified food ( soup ) was not good and intra-family dilution and distribution of food was high Background Poor micronutrient status is reported among adolescents across Europe and USA . This may be related to the well-documented decline in the regular consumption of breakfast by this group . The regular consumption of a breakfast cereal offers a possible means to improve micronutrient status ; fortified cereal is likely to have enhanced benefit . A study was conducted to determine the efficacy of the regular consumption of a fortified cereal with milk , compared with unfortified cereal , consumed either as a breakfast or a supper , in improving micronutrient intake and micronutrient status of adolescent girls . Methods A r and omised , double-blind , placebo-controlled intervention trial was conducted in girls recruited at ages 16–19 years , from schools and colleges in Sheffield , UK . Girls were r and omised to receive 50 g fortified or unfortified cereal , with 150 ml semi-skimmed milk , daily , for 12 weeks , as a breakfast or as a supper .  Dietary intake was estimated using a 4-d food diary and blood collected for the assessment of nutritional status . Within-group changes were tested using a paired sample t test ; two-way ANOVA was used to analyse effects of the intervention , with cereal type and time of consumption as factors , correcting for baseline values . The analysis was conducted on 71 girls who completed the study . Results Consumption of unfortified cereal elicited an increase in the intake of vitamins B1 , B2 and B6 ; consumption of fortified cereal elicited increases in vitamins B1 , B2 , B6 , B12 , folate and iron ( P < 0.001 ) and of vitamin D ( P = 0.007 ) , all increases were significantly greater than for unfortified cereal . Consumption of the fortified cereal also led to a significant improvement in biomarkers of status for vitamins B2 , B12 , folate and of iron , compared with girls receiving the unfortified cereal , and maintained vitamin D status , in contrast with the girls receiving the unfortified cereal ( P < 0.001 ) . Conclusions The daily consumption of cereal with milk for 12 weeks by adolescent girls , increased intakes of micronutrients . The consumption of fortified cereal elicited greater increases than for unfortified cereal and improved biomarkers of micronutrient status . The findings justify strategies to encourage the consumption of fortified cereal with milk by adolescents , either as a breakfast or a supper . Trial registration Registered with Current Controlled Trials ( Registration : IS RCT N55141306 OBJECTIVE To compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread ( FS ) or micronutrient-fortified maize-soy flour ( likuni phala [ LP ] ) . DESIGN R and omized , controlled , single-blind trial . SETTING Rural Malawi . PARTICIPANTS A total of 182 six-month-old infants . INTERVENTION Participants were r and omized to receive 1 year of daily supplementation with 71 g of LP ( 282 kcal ) , 50 g of FS ( FS50 ) ( 256 kcal ) , or 25 g of FS ( FS25 ) ( 130 [ corrected ] kcal ) . OUTCOME MEASURES Weight and length gains and the incidences of severe stunting , underweight , and wasting . RESULTS Mean weight and length gains in the LP , FS50 , and FS25 groups were 2.37 , 2.47 , and 2.37 kg ( P = .66 ) and 12.7 , 13.5 , and 13.2 cm ( P = .23 ) , respectively . In the same groups , the cumulative 12-month incidence of severe stunting was 13.3 % , 0.0 % , and 3.5 % ( P = .01 ) , of severe underweight was 15.0 % , 22.5 % , and 16.9 % ( P = .71 ) , and of severe wasting was 1.8 % , 1.9 % , and 1.8 % ( P > .99 ) . Compared with LP-supplemented infants , those given FS50 gained a mean of 100 g more weight and 0.8 cm more length . There was a significant interaction between baseline length and intervention ( P = .04 ) ; in children with below-median length at enrollment , those given FS50 gained a mean of 1.9 cm more than individuals receiving LP . CONCLUSION One-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants , but it is likely to boost linear growth in the most disadvantaged individuals and , hence , decrease the incidence of severe stunting Objective : We investigated the effects of mineral water fortified with folic acid , vitamins B6 , B12 , D and calcium on folate concentrations in serum and erythrocytes , serum vitamin B12 and plasma homocysteine concentrations in free-living subjects . In addition , we investigated the bioavailability of calcium added to mineral water by measuring urinary calcium excretion and serum alkaline phosphatase activity . Design : R and omized , controlled , double-blinded , parallel design . Setting : Outpatient dietary intervention with free-living subjects in Eastern Finl and .Subjects : Altogether , 66 subjects were recruited for the study . In all , 60 subjects completed the study . Interventions : The study began with a 2-week run-in period followed by an 8-week intervention period . During the intervention study , subjects consumed mineral water fortified with folic acid ( 563 μg/day ) , vitamins B6 ( 1 mg/day ) , B12 ( 7.5 μg/day ) , cholecalciferol ( 0.6 μg/day ) and calcium ( 563 mg/day ) or placebo mineral water . Results : The fortified mineral water increased serum and erythrocyte folate concentrations by 16.1±5.6 nmol/l ( P<0.001 ) and 199±76 nmol/l ( P<0.001 ) , respectively , and decreased plasma homocysteine concentration by 1.6 μmol/l ( P<0.001 ) . Urinary calcium excretion and serum alkaline phosphatase activity for 24 h increased significantly ( P<0.001 and P=0.01 respectively ) in the intervention group . Conclusions : Mineral water fortified with folic acid , vitamins B6 , B12 and D and calcium enhanced folate status and reduced plasma homocysteine concentration in normohomocysteinemic subjects without folate deficiency . Indirect measures of calcium and bone metabolism indicated that the calcium used in the fortification of the mineral water was bioavailable . Sponsorship : Olvi PLC , Iisalmi , Finl and Background / Objectives : We aim ed to assess the effects on mild morbidity of a richly micronutrient-fortified complementary/replacement food given to Zambian infants aged 6 - 18 months . Previous results ( The Chilenje Infant Growth , Nutrition and Infection Study Team , 2010 ) showed an increase in the rate of hospital referral for pneumonia in the same cohort . Subject/ Methods : A total of 743 six-month-old healthy Zambian infants were r and omised to receive either a richly or a basal micronutrient-fortified porridge for 12 months . Mild morbidity was defined as an illness that did not cause death or require hospitalisation and was diagnosed on clinical examination at scheduled visits . Results : There was no evidence of an effect of trial arm on overall mild morbidity during the study ( odds ratio (OR)=1.04 , 95 % confidence interval (CI)=0.90 , 1.20 , P=0.62 ) . Infants in the richly fortified arm had significantly more visits in which they were diagnosed with lower respiratory tract infections/pneumonia ( OR=1.65 , 95 % CI=1.06 , 2.59 , P=0.03 ) and fewer visits in which a diagnosis of urinary tract infection was made ( OR=0.43 , 95 % CI=0.21 , 0.87 , P=0.02 ) . Maternally reported symptoms were similar between trial arms . Conclusion : Compared with the basal diet , the richly micronutrient-fortified food was associated with more episodes of lower respiratory infections/pneumonia diagnosed at scheduled visits , which reinforces our previously reported findings of a higher incidence in hospital referral for pneumonia Summary Background Green leafy vegetables ( GLV ) are rich sources of β – carotene , iron and other micronutrients . Our in vitro studies have demonstrated good antioxidant potential in GLV . Moreover linkages of GLV intakes with plasma retinol and ascorbic acid were seen in apparently healthy Indians . Aim of the study To investigate the effect of GLV as a natural fortificant of multiple micronutrients through a prospect i ve human trial . Methods Short – term ( 0–4 h ) response ( AUC ) of single dose of 7.9 mg β – carotene and 130 mg ascorbic acid through a spinach – carrot meal against the st and ard meal without GLV plus10 mg β – carotene and 150 mg ascorbic acid tablets was studied in two groups of 4 young volunteers each . In the second trial of 3 weeks ' supplementation , 5 groups of young adults ( n = 40 ) were given either 100 g GLV/day alone or with tablets of vitamin E ( 100 mg/day ) , or C ( 100 mg/day ) or more oil ( 5 g/day ) or non – GLV meal with tablet of β – carotene ( 10 mg/day ) . Hemoglobin ( Hb ) , plasma β – carotene , zinc , vitamin C , glucose , and triglycerides were measured . Results In a postpr and ial response , AUC were comparable in both GLV and st and ard meals for β – carotene and ascorbic acid . In case of triglycerides and glucose AUC the GLV meal showed a better recovery to the baseline value after 4 hours than the st and ard meal . Three weeks ' supplementation of GLV with more oil result ed in significant increase of plasma β – carotene ( 51 % ) and Hb ( 9 % ) . GLV with vitamin E showed a significant increase in plasma β – carotene ( 40 % ) , Hb ( 8 % ) and plasma vitamin C ( 6 % ) . Supplementing β – carotene without GLV  significantly increased Hb ( 11 % ) , plasma zinc ( 14 % ) in addition to β – carotene . Multiple regression analyses weighted for energy intake indicated a significant association of percent increase in Hb with intakes of iron , riboflavin , folic acid , β – carotene , copper , phytate and fiber ( p < 0.01 ) , percent change in plasma zinc with intakes of zinc , β – carotene , vitamin C , riboflavin , copper , iron , and thiamin ( p < 0.01 ) , percent change in vitamin C with intakes of vitamin C , vitamin E , niacin , riboflavin , thiamin , β – carotene , zinc , phytate and fiber ( p < 0.05 ) and percent change in plasma β – carotene with intakes of β – carotene , thiamin , folic acid , zinc , phytate and tannins ( p < 0.05 ) . Conclusion Using 100 g GLV/day with 10 g oil could be a single moderate strategy for supplementation of iron , β – carotene , ascorbic acid and zinc Summary Single interventions for helminthic infections and micronutrient deficiencies are effective , but it is not clear whether combined interventions will provide equal , additive or synergistic effects to improve children 's health . The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children . A double-blind , r and omized , placebo-controlled trial in 11 rural South African primary schools r and omly allocated 579 children aged between 8 and 10 years into six study groups , half of whom received antihelminthic treatment at baseline . The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits , either unfortified or fortified with vitamin A and iron or with vitamin A only , given daily for 16 weeks . The outcome measures were anthropometric , micronutrient and parasite status , and scholastic and cognitive test scores . There was a significant treatment effect of vitamin A on serum retinol ( p < 0.01 ) , and the suggestion of an additive effect between vitamin A fortification and de-worming . Fortified biscuits improved micronutrient status in rural primary school children ; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection . The burden of micronutrient deficiency ( anaemia , iron and vitamin A ) and stunting in this study population was low and , coupled with the restricted duration of the intervention ( 16 weeks ) , might have limited the impact of the interventions OBJECTIVE To test the hypothesis that micronutrient beverages can provide the daily iron and zinc needs of small children . STUDY DESIGN Forty children aged 6 to 9 years were recruited ( Lima , Peru ) . For 4 weeks , they received a daily serving of a beverage containing multiple micronutrients . Over 2 consecutive days , subjects received stable isotope-labeled servings of the beverage with and without a meal as well as an intravenous dose of zinc .  Iron and zinc bioavailability were assessed using mass spectrometry . RESULTS Iron absorption was significantly lower with a meal than without ( 9.8 + /- 6.7 % versus 11.6 + /- 6.9 % , P=.04 ) , but zinc absorption was not ( 24.5 + /- 10.7 % versus 22.8 + /- 7.6 % , P=.2 ) . In either case , however , a single daily serving provided most of the iron and zinc requirements for the children . CONCLUSIONS Single daily servings of multinutrient-fortified beverages can meet much of the mineral needs for small children . Food has a small inhibitory effect on iron , but not zinc , absorption ; therefore , these beverages can be efficacious even when given with a meal Objective To assess the nutritional advantage of fortified human milk in the small for gestational age neonate . Methods Term asymmetric small for gestational age babies were r and omly assigned to either the study group or the control group . The babies in the study group received fortified EBM , ( more proteins , calories , vitamins and minerals ) whereas babies in the control group received EBM only . Babies were followed up weekly for a period of 28 ± 2 days for physical growth ( weight , length and OFC ) . Biochemical markers of nutritional status ( Blood urea , serum calcium , phosphorus , alkaline phosphatase , serum electrolytes and serum protein ) were done initially and then on Day 28 ± 2 . Results The weight gain in the study group ( 38.77 ± 7.43 g/day ) was significantly better than in the control group ( 28.71 ± 3.18 g/day ) . The length and OFC gain in the study group ( 1.14 ± 0.33 cm/week and 0.62 ± 0.07 cms/week , respectively ) were significantly better than in the control group ( 0.87 ± 0.17 cm/week and 0.49 ± 0.07 cm/week respectively ) . The biochemical markers of nutrition , however , were not significantly different in the two groups . Conclusion Fortified breast milk results in improved physical growth in the term asymmetric small for gestational age neonate Background Micronutrient deficiencies during pregnancy are associated with adverse pregnancy outcomes , including reduced birthweight . Low birthweight is associated with increased risk of infant mortality and growth failure . Objectives To assess the effects of prenatal supplementation with UNIMMAP ( United Nations International Multiple Micronutrient Preparation ) compared with iron/folic acid on average birthweight and incidence of low birthweight . Methods Pregnant women from 78 villages in Niger were included in a cluster-r and omized , double-blinded , controlled supplementation trial . Baseline , monthly follow-up , and birth data were collected . Cluster analysis was conducted to assess differences in mean birthweight and incidence of low birthweight between groups using multiple linear regression models . Analyses were stratified by nutrition status and duration of supplementation . Results Of the 3,670 women recruited , 2,550 completed the study and provided complete birthweight data ( 1,328 received  multiple micronutrients and 1,222 received iron/folic acid ) . Mean birthweight was significantly higher ( 67 g , p < .001 ) with multiple micronutrients ( 3,092 ± 190 g ) than with iron/folic acid ( 3,025 ± 205 g ) ; this corresponded to a 14 % fall in the incidence of low birthweight ( from 8.4 % with multiple micronutrients to 7.2 % with folic acid fortification ) . The impact of multiple micronutrients was greater when the supplements were taken for more than 150 days . The incidence of low birthweight was further reduced in women who entered pregnancy with a poorer nutrition status . Conclusions Prenatal supplementation with multiple micronutrients had a greater positive impact on birthweight  than supplementation with iron/folic acid . Our data suggest that prenatal supplementation with multiple micronutrients as part of a prenatal care package in addition to interventions to promote improved maternal prepregnancy nutrition status is an important strategy to increase birthweight and reduce the incidence of low birthweight Micronutrient-fortified , cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries , but their nutritional quality is not always optimal . In a double-blind r and omized trial , we compared the efficacy of a locally produced porridge based on maize , beans , bambaranuts , and groundnuts fortified with 19 ( rich ) or 9 ( basal ) micronutrients .  Infants aged 6 mo from Lusaka , Zambia were r and omized to receive the richly fortified ( n = 373 ) or basal ( n = 370 ) porridge daily for 12 mo along with routine vitamin A supplements .  Baseline and final micronutrient status and inflammation ( based on α-1-glycoprotein ) were assessed using nonfasting blood sample s. Baseline prevalence of anemia ( 39 % ) and zinc deficiency ( 51 % ) were a public health concern . There were overall treatment effects on hemoglobin ( Hb ) ( P = 0.001 ) , serum transferrin receptor ( P < 0.001 ) , serum ferritin ( P < 0.001 ) , and serum selenium ( P = 0.009 ) ; biomarker responses for iron and zinc were modified by baseline concentrations , and for Hb and iron by socioeconomic status . At 18 mo , the adjusted odds of anemia , iron deficiency anemia ( Hb < 105 g/L and transferrin receptor > 11.0 mg/L ) , and iron deficiency were 0.37 ( 95 % CI = 0.25 , 0.55 ) , 0.18 ( 0.09 , 0.35 ) , and 0.30 ( 0.18 , 0.50 ) times those in the basal group , respectively . The rich level of fortification had no overall treatment effect on serum zinc ( 1.09 ; 0.66 , 1.80 ) but improved serum zinc in children with lower Hb concentrations at baseline ( P = 0.024 ) . A locally produced cereal- and legume-based infant food richly fortified with micronutrients  reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian infants Micronutrients are important in physical work capacity and therefore performance . The impact of a multi-micronutrient-fortified nutritional beverage on physical performance measures among clinical ly healthy school-age children was assessed in a double-blind ( for test and placebo groups ) , placebo-controlled , r and omized trial in children aged between 7 and 10.5 y ( n = 300 ) . The participants with height- and weight-for-age Z-scores between 0 and ≥ -3 were r and omized to 1 of 3 study arms : fortified choco-malt beverage powder ( F ) , matched energy equivalent unfortified placebo ( U ) , and untreated control ( C ) . Participants in the F and C groups were given 40 g fortified ( 19 key vitamins and minerals ) and unfortified choco-malt beverage , respectively , daily for 120 d. Primary efficacy outcomes included endurance and aerobic capacity using a 20-m shuttle test and step test . Other physical performance measures included speed ( 40-m sprint ) , visual reaction time , maximal h and grip , and forearm static endurance . Micronutrient status included thiamin , riboflavin , folate , niacin , iron , pyridoxal phosphate , and vitamins B-12 and C. All measurements were made at baseline and the end of the intervention . There was a within-subject increase in aerobic capacity and whole body endurance ( P < 0.05 ) accompanied by a significant improvement in the status of iron thiamin , riboflavin , pyridoxal phosphate , folate , and vitamins C and B-12 in the F group compared to the within-subject changes in the other 2 groups ( P < 0.05 ) . The study suggests that multiple micronutrient supplementation in similar population s may be beneficial in improving micronutrient status and enhancing aerobic capacity and endurance in children Infants were fed  cow 's milk‐based formulas  containing 4 mg of iron/I  from 1.5 to 6 months of age and their hematological status was compared to infants receiving the same formula but with 7 mg of iron/l and with breast‐fed infants . One formula with 4 mg of iron/l contained iron as ferrous sulfate , in another , part of the iron was provided as bovine lactoferrin . We also studied the effect of selenium ( 10 μg/l ) and copper ( 0.4 mg/l ) supplementation on selenium and copper status . There were no significant differences in hematological indices among the groups at 6 months of age ; all infants had satisfactory iron status . Serum transferrin receptor levels , a potential novel indicator of iron status , were highest in breast‐fed infants , suggesting a cellular need for iron , and lowest in infants receiving formula with 7 mg of iron/l . Selenium status , as assessed by serum glutathione peroxidase activity , was similar at 6 months of age in breast‐fed infants and infants fed  formula fortified with selenium but lower in infants fed unfortified formula . The lowest levels of glutathione peroxidase activity were found in infants fed the highest concentration of iron ( 7 mg/l ) . Serum copper concentrations were similar in all groups , but the lowest levels were found in infants fed the highest concentration of iron . These results suggest that 4 mg of iron/l is adequate for infants up to 6 months of age and that higher levels may have some negative effects Objective : To assess the effect of supplementation with an antioxidant fortified margarine on the body 's antioxidant status and on parameters of oxidative damage to lipids . Design : Single blind , placebo controlled trial , two treatment groups balanced for sex , age and Quetelet Index . Setting : Unilever Research Laboratorium , The Netherl and s . Subjects : Thirty-one healthy adult volunteers accomplished the study . Volunteers were recruited among inhabitants of the surrounding area of the research laboratory . Interventions : Volunteers consumed during the four weeks either 15 g/d of an antioxidant fortified margarine ( providing 121 mg vitamin C , 31 mg vitamin E , 2.7 mg α-carotene and 5.3 mg β-carotene ) or an ordinary margarine . Fasting blood sample s were taken before and at the end of the study . Results : Consumption of the antioxidant fortified margarine significantly increased the levels of the supplied antioxidants in plasma and LDL as compared to the changes found after consumption of the control margarine , with the largest increases found in LDL levels of α-carotene ( 15.5-fold increase , 95 % CI : 8.4–27.8-fold ) and β-carotene ( 4.3-fold increase , 95 % CI : 2.2–7.9-fold ) . This increased antioxidant status in the antioxidant fortified margarine group result ed in a significantly increased total antioxidant activity of LDL and resistance of LDL to oxidation ( lag time and rate of oxidation ) as compared to baseline but not in comparison to the changes found in the control group . Conclusion : Consumption of moderate doses of vitamin E , vitamin C , α-carotene and β-carotene , supplied in a full-fat margarine and consumed as part of a normal diet , effectively increases the blood levels of these antioxidants OBJECTIVES A 6 wk , double-blind , placebo-controlled study investigated the effects of a nutritional supplement beverage containing milk-based micronutrients and fortified with vitamins and minerals on pain symptoms and activity in adults with osteoarthritis . METHODS Thirty-one subjects with osteoarthritis of both knees were r and omized into two groups and given 12 oz daily of the micronutrient-containing beverage or a placebo for 6 wk . Subjects were instructed not to change their normal activities and diets . Body weights , vital signs , blood chemistries , and adverse events were monitored to assess safety . The principal outcome measurement for efficacy was the Western Ontario MacMaster Universities Osteoarthritis Index ( WOMAC ) derived from the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) question naire administered weekly . RESULTS Safety indicators remained unchanged in the test and placebo groups . All KOOS scores improved significantly ( P < 0.03 ) over time in the micronutrient group , whereas scores only for sport function and knee-related quality of life improved in the placebo group . The overall treatment effect ( based on changes in the WOMAC composite score ) was significant ( P = 0.016 ) . The effect size was moderate at 0.555 . CONCLUSIONS Thus , daily consumption of the nutritional beverage containing milk-based micronutrients , vitamins , and minerals was beneficial in alleviating symptoms and dysfunction in subjects with osteoarthritis In Vietnam , nutrition interventions do not target school children despite a high prevalence of micronutrient deficiencies . The present r and omised , placebo-controlled study evaluated the impact of providing school children ( n 403 ) with daily multiple micronutrient-fortified biscuits ( FB ) or a weekly Fe supplement ( SUP ) on anaemia and Fe deficiency . Micronutrient status was assessed by concentrations of Hb , and plasma ferritin ( PF ) , transferrin receptor ( TfR ) , Zn and retinol . After 6 months of intervention , children receiving FB or SUP had a significantly better Fe status when compared with the control children ( C ) , indicated by higher PF ( FB : geometric mean 36·9 ( 95 % CI 28·0 , 55·4 ) μg/l ; SUP : geometric mean 46·0 ( 95 % CI 33·0 , 71·7 ) μg/l ; C : geometric mean 34·4 ( 95 % CI 15·2 , 51·2 ) μg/l ; P < 0·001 ) and lower TfR concentrations ( FB : geometric mean 5·7 ( 95 % CI 4·8 , 6·52 ) mg/l ; SUP : geometric mean 5·5 ( 95 % CI 4·9 , 6·2 ) mg/l ; C : geometric mean 5·9 ( 95 % CI 5·1 , 7·1 ) mg/l ; P = 0·007 ) . Consequently , body Fe was higher in children receiving FB ( mean 5·6 ( sd 2·2 ) mg/kg body weight ) and SUP ( mean 6·1 ( sd 2·5 ) mg/kg body weight ) compared with the C group ( mean 4·2 ( sd 3·3 ) mg/kg body weight , P < 0·001 ) . However , anaemia prevalence was significantly lower only in the FB group ( 1·0 % ) compared with the C group ( 10·4 % , P = 0·006 ) , with the SUP group being intermediate ( 7·4 % ) . Children receiving FB had better weight-for-height Z-scores after the intervention than children receiving the SUP ( P = 0·009 ) . Vitamin A deficiency at baseline modified the intervention effect , with higher Hb concentrations in vitamin A-deficient children receiving FB but not in those receiving the SUP . This indicates that vitamin A deficiency is implicated in the high prevalence of anaemia in Vietnamese school children , and that interventions should take other deficiencies besides Fe into account to improve Hb concentrations . Provision of biscuits fortified with multiple micronutrients is effective in reducing anaemia prevalence in school children Moderate childhood wasting is defined as having a weight-for-height Z-score ( WHZ ) < -2 , but > or = -3 . These children are typically given fortified corn/soy blended flour ( CSB ) , but this intervention has shown limited effectiveness . Fortified spreads ( FS ) can be used as supplementary foods instead ; they are energy-dense , lipid-based pastes with added powdered micronutrients . In this r and omized clinical effectiveness trial , the recovery rates were compared among children with moderate wasting who received either milk/peanut FS , soy/peanut FS , or CSB .  Children received isoenergetic quantities of food , 314 kJ x kg(-1 ) x d(-1 ) , for up to 8 wk with biweekly follow-up . The primary outcome was recovery , defined as having a WHZ > -2 . Time-event analysis was used to compare the recovery rate . A total of 1362 children were enrolled in the study . Children receiving soy/peanut FS had a similar recovery rate to those receiving milk/peanut FS and children in either FS group were more likely to recover than those receiving CSB ( 80 % in both FS groups vs. 72 % in the CSB group ; P < 0.01 ) . The rate of weight gain in the first 2 wk was greater among children receiving milk/peanut FS ( 2.6 g x kg(-1 ) x d(-1 ) , n = 465 ) or children receiving soy/peanut FS ( 2.4 g x kg(-1 ) x d(-1 ) , n = 450 ) than among children receiving CSB ( 2.0 g x kg(-1 ) x d(-1 ) , n = 447 ; P < 0.05 ) . Rates of length gain did not differ among the 3 groups . A total of 8 % of children in each feeding group developed edema , indicative of severe malnutrition , while receiving supplemental feeding . We conclude that FS are superior supplementary foods to CSB for moderately wasted Malawian children To investigate whether an intervention including micronutrient-fortified complementary foods can improve iron status , we conducted a r and omized controlled trial in 5-mo-old Vietnamese infants ( n = 246 ) . Villages ( n = 29 ) were r and omly divided into those receiving instant flour ( FF ) or a food complement ( FC ) both fortified with micronutrients or nothing [ control ( C ) ] . FF and FC infants received daily for 6 mo at least 2 meals of fortified complementary foods . Micronutrient status was assessed by measurement of hemoglobin ( Hb ) and plasma ferritin ( PF ) , transferrin receptor , zinc , and retinol . Final Hb ( mean ± SD ) was higher in the FF ( 112.5 ± 8.0 g/L ) and FC ( 114.0 ± 7.0 g/L ) groups compared with C ( 109.0 ± 8.0 g/L ; P = 0.006 ) . PF ( geometric mean [ 95 % CI ] ) was also higher in FF ( 19.8 μg/L [ 17.5 - 22.3 ] ) and FC ( 20.8 μg/L [ 18.3 - 23.6 ] ) compared with C ( 11.1 μg/L [ 9.8 - 12.5 ] ; P < 0.0001 ) . Anemia prevalence decreased more in the FC group ( -43.6 % ) compared with C ( -10.3 % ; P = 0.006 ) . The change in prevalence of PF < 12 μg/L was different in the FF ( -16.4 % ) and FC ( -6.7 % ) groups compared with C ( + 30.4 % ; P < 0.01 ) . Endpoint prevalence of iron deficiency ( ID ) and ID anemia ( IDA ) were lower in the FF ( 13.4 and 6.7 % , respectively ) and FC ( 15.2 and 3.8 % ) groups compared with C ( 57.5 and 37.5 % ) ( P < 0.0001 ) . Retinol and zinc concentrations did not differ among groups , but endpoint prevalence of zinc deficiency was lower in FF infants ( 36.1 % ) than in C infants ( 52.9 % ; P = 0.04  ) . Micronutrient-fortified complementary foods  significantly improved iron status and decreased the prevalence of anemia , ID , and IDA  in Vietnamese infants and can be an important tool to reduce ID in infancy in developing countries We aim ed to analyse growth and recovery from undernutrition among moderately underweight ambulatory children receiving micronutrient-fortified maize-soy flour ( Likuni Phala , LP ) or ready-to-use fortified spread ( FS ) supplementary diet . One hundred and seventy-six 6 - 18-month-old individuals were r and omized to receive 500 g LP or 350 g FS weekly for 12 weeks . Baseline and end of intervention measurements were used to calculate anthropometric gains and recovery from underweight , wasting and stunting . Mean weight-for-age increased by 0.22 ( 95 % CI 0.07 - 0.37 ) and 0.28 ( 0.18 - 0.40 ) Z-score units in the LP and FS groups respectively . Comparable increase for mean weight-for-length was 0.39 ( 0.20 - 0.57 ) and 0.52 ( 0.38 - 0.65 ) Z-score units . Recovery from underweight and wasting was 20 % and 93 % in LP group and 16 % and 75 % in FS group . Few individuals recovered from stunting and mean length-for-age was not markedly changed . There were no statistically significant differences between the outcomes in the two intervention groups . In a poor food-security setting , underweight infants and children receiving supplementary feeding for 12 weeks with ready-to-use FS or maize-soy flour porridge show similar recovery from moderate wasting and underweight . Neither intervention , if limited to a 12-week duration , appears to have significant impact on the process of linear growth or stunting Malnutrition is an inclusive term that entails the lack , excess or imbalance of one or more nutrients required to maintain normal nutritional status and optimal health . Malnutrition affects a large segment of the world 's children . 1 It is estimated that the prevalence of childhood malnutrition in South Africa ranges from 5 % to 50 % of the current poputation.2 It is well documented that an inadequate intake of micronutrients causes deficiency disorders and that such deficiencies often accompany malnutrTtion . 3 The dietary intake of calcium , iron , zinc , folic acid , riboflavin , vitamin 86 and vitamin C  has been reported to be low , in comparison with the recommended dietary allowances (RDA),4 in a significant proportion of children in the country ; it is often lower than 67 % of the RDA , indicating a population at risk of deficiency.s » In adults 15 - 64 years of age , the dietary intake of such micronutrients as vitamin 8 6 , iron , calcium , magnesium , zinc , copper and folic acid  has also been reported to be significantly lower than the RDA.S , S Fortification of food staples has been successfully implemented in a number of countries to increase the dietary intake of micronutrients . Schoolchildren in Nigeria are rarely targeted by micronutrient interventions . We completed a 6-mo , double-blind , placebo-controlled trial to determine the effects of a multi-micronutrient beverage on biochemical and anthropometric indicators of nutritional status among schoolchildren participating in a pilot school feeding program in Nasarawa State , Nigeria . Children received 1 of 2 interventions 5 d/wk during school hours : 1 ) 250 mL/d of a multi-micronutrient beverage that included vitamin A , iron , and zinc ( micronutrient ) ; or 2 ) an isoenergetic control beverage ( control ) .  At baseline , 566 children 5 - 13 y old were r and omized to groups  ( micronutrient : n = 288 ; control : n = 278 ) . Height , weight , hemoglobin , and serum concentrations of C-reactive protein , ferritin , retinol , and zinc were measured at baseline and at the end of the study . A total of 270 children in the micronutrient group and 264 children in the control group completed the study .  Self-reports of vomiting increased in both groups at 6 mo ; however , the prevalence tended to be greater in the micronutrient group ( 21 % ) compared to the control group ( 14 % ) ( P = 0.06 ) . Biochemical changes were greater in the micronutrient group compared to control for serum retinol ( 0.10 ± 0.02 μmol/L vs. 0.02 ± 0.02 μmol/L ; P = 0.016 ) and zinc ( 1.0 ± 0.2 μmol/L vs. 0.6 ± 0.2 μmol/L ; P = 0.031 ) . The intervention did not significantly affect hemoglobin or serum ferritin concentrations . The cost effectiveness of the intervention needs to be further evaluated , as does the efficacy of the beverage on anemia and indicators of iron status OBJECTIVE To evaluate whether an oral nutritional supplement enriched with omega-3 fatty acids , micronutrients , and probiotics affected body weight ( BW ) changes , serum albumin and prealbumin levels in patients with head and neck cancer ( HNC ) cachexia . STUDY DESIGN Sixty-eight HNC patients were r and omly assigned to receive either an Ethanwell/Ethanzyme ( EE ) regimen enriched with omega-3 fatty acids , micronutrients , and probiotics , or control ( Isocal ) for a 3-month period . Analysis of covariance was used to examine the association between BW change and variables . RESULTS Patients with body mass index ( BMI ) < 19 and those receiving the EE regimen consumed fewer daily calories but showed significantly increased BW and maintained higher serum albumin and prealbumin levels than other patients ( P<.05 ) . Their BW changes were significantly associated with changes in serum albumin and prealbumin levels . CONCLUSIONS EE regimen improved BW as well as serum albumin and prealbumin levels in HNC patients with BMI < 19 BACKGROUND Fortification with multiple micronutrients has been shown to improve growth and cognitive performance among children in developing countries , but it is unknown whether higher concentrations are more effective than lower concentrations . OBJECTIVE We compared the effect of 2 different concentrations of a combination of micronutrients and n-3 ( omega-3 ) fatty acids on indicators of growth and cognitive performance in low-income , marginally nourished schoolchildren in Bangalore , India . DESIGN In a 2-by-2 factorial , double-blind , r and omized controlled trial , 598 children aged 6 - 10 y were individually allocated to 1 of 4 intervention groups to receive foods fortified with either 100 % or 15 % of the Recommended Dietary Allowance of micronutrients in combination with either 900 mg alpha-linolenic acid plus 100 mg docosahexaenoic acid or 140 mg alpha-linolenic acid for 12 mo . Anthropometric and biochemical assessment s were performed at baseline and 12 mo . Cognitive performance was measured at baseline and at 6 and 12 mo . RESULTS The high micronutrient treatment significantly improved linear growth at 12 mo ( 0.19 cm ; 0.01 , 0.36 ) and short-term memory at 6 mo ( 0.11 SD ; 0.01 , 0.20 ) and was less beneficial on fluid reasoning at 6 ( -0.10 SD ; -0.17 , -0.03 ) and 12 ( -0.12 SD ; -0.20 , -0.04 ) mo than was the low micronutrient treatment , whereas no differences were observed on weight , retrieval ability , cognitive speediness , and overall cognitive performance . No significant differences were found between the n-3 treatments . CONCLUSIONS The high micronutrient treatment was more beneficial for linear growth than was the low micronutrient treatment . However , with some small differential effects , higher micronutrient concentrations were as effective as lower concentrations on cognitive performance . This trial was registered at clinical trials.gov as NCT00467909 Mexico 's Oportunidades program provides conditional cash transfers , nutrition education , health services , and fortified food supplements for the young children of poor families . We have documented the effects of the program on growth and reduction of anemia . To better underst and the impact pathways and disentangle the relative effects on dietary intake of the food supplements compared with other program components , we analyzed data from a r and omized effectiveness evaluation of the Oportunidades program in rural children aged 12 - 59 mo . All Oportunidades beneficiaries received the cash transfers and the health and education components , but some children did not consume the supplements . The children 's diet was evaluated using a single 24-h recall . The impact was estimated using multiple linear regression models with community-level r and om effects . Comparisons were made among children who received all the benefits of Oportunidades , including the fortified food supplement ( SG ) , beneficiaries of the program who did not consume the food supplement ( NSG ) , and the control group ( CG ) . Relative to the NSG and CG , respectively , the SG consumed greater amounts of [ mean ( 95 % CI ) ] : energy , 94 ( 28 , 160 ) and 111 ( 43 , 180 ) kcal/d ; iron , 7.6 ( 6.3 , 8.9 ) and 7.7 ( 6.5 , 9.0 ) mg/d ; zinc , 7.5 ( 6.4 , 8.6 ) and 7.6 ( 6.5 , 8.7 ) mg/d ; and vitamin A , 0.109 ( 0.071 , 0.147 ) and 0.120 ( 0.080 , 0.159 ) mg retinol equivalents/d . No differences were found between the NSG and CG ( P > 0.05 ) . To conclude , the Oportunidades program had a positive impact on the diet of children .  The effects of the program on dietary intake result ed from the food supplement and not from improvements in the home diet . Our findings are useful for identifying which program components contributed to the effects on the nutritional status of children Abnormalities in bone mineral metabolism are frequently found in very low-birth-weight infants , especially if fed breast milk . To assess the efficacy of a breast-milk fortifier in the feeding of these very small infants , very low-birth-weight babies ( between 1,000 g-1,500 g at birth ) were r and omly assigned to one of two groups on day 4 of life . The fortified group received the fortifier mixed in equal proportions with their own mother 's milk , while the breast-milk group received only their own mother 's milk . All infants received an oral vitamin D supplement of 750 IU/day . The study was continued until the infants weighed 1,800 g , at which stage breast feeding was encouraged . Thirty infants in the breast-milk group and 29 in the fortified group completed the study . Infants in the fortified group had significantly lower alkaline phosphatase values , a greater bone mineral content ( BMC ) and BMC /bone width ratio , and lower urinary calcium excretion than the breast-milk group at a weight of 1,800 g. At follow-up study 3 months after delivery , when most of the infants in both groups had been breast fed for at least 6 weeks , the breast-milk group 's biochemical and BMC abnormalities were almost totally corrected and were now similar to those of the fortified group . Thus , the addition of the fortifier to breast milk during the first 4–6 weeks of life decreased the biochemical evidence of abnormal bone mineral homeostasis and increased BMC in very low-birth-weight infants . By 3 months of age , however , the breast-milk group had almost totally corrected its abnormalities This study was conducted to evaluate the impact of a food aid program ( Plan Más Vida , PMV ) on the micronutrient nutritional condition of lactating mothers 1 year after its implementation . The food program provided supplementary diets ( wheat- and maize-fortified flour , rice or sugar , and fortified soup ) to low-income families from the province of Buenos Aires , Argentina . A prospect i ve , non-experimental study was carried out to evaluate the micronutrient nutritional status of lactating mothers ( n = 178 at baseline and n = 151 after 1 year ) .  Biochemical tests ( hemoglobin , ferritin , zinc , vitamin A , and folic acid ) , anthropometric assessment s ( weight and height ) and dietary surveys ( 24-h recall ) were performed . We found no significant changes in anthropometric values 1 year after the intervention . The risk for vitamin A ( retinol 20–30 μg/dl ) and folate deficiency significantly decreased 1 year after PMV implementation ( 56.3 vs. 29.9 and 50.3 vs. 3.4 % , respectively ; p < 0.001 ) . Anemia was seen in 25.8 % of lactating mothers at baseline , without statistically significant differences 1 year after ( p = 0.439 ) . The nutritional data obtained after assessing the early impact of PMV actions may be useful to provincial health authorities to perform periodic evaluations in the future OBJECTIVE : To report micronutrient intakes in Northern Irel and schoolchildren , and to establish the contribution of fortified breakfast cereal to overall nutrient intakes and achievement of current dietary recommendations . DESIGN : Analysis of dietary intakes and physical characteristics of participants in a r and omly selected 2 % population sample of 1015 schoolchildren aged 12 and 15 years in Northern Irel and during the 1990/1 school year . MAIN OUTCOME MEASURES : Dietary intakes , physical characteristics , and their association with consumption of fortified breakfast cereal . RESULTS : Mean micronutrient intakes were generally adequate with the exception of low intakes of folate ( boys and girls ) and iron ( girls ) . Fortified breakfast cereals , consumed by a high proportion ( 94 % boys ; 83 % girls ) of the sample , were associated with higher daily intakes of most micronutrients and fibre and with a macronutrient profile consistent with current nutritional recommendations . Appreciable proportions of subjects who did not consume fortified breakfast cereals had daily intakes that fell below the lower reference nutrient intake for riboflavin , niacin , folate , vitamin B-12 , and iron ( girls ) . CONCLUSIONS : The results demonstrate the potential of fortification in contributing to micronutrient intakes of schoolchildren , particularly where requirements are high , or for those on marginal diets of low nutritional quality Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies . This study aim ed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status , cognition , physical performance and nutritional deficiencies of 7 - 10 years old south Indian children . A r and omized , double blind placebo controlled study design was used with normal healthy children from low to middle income families , aged 7 - 10 years r and omly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink . The drinks were provided 6 days/week for 5 months . Assessment s included anthropometry , blood biochemistry , physical performance and cognition at baseline and endline . The baseline characteristics of the study groups were similar . The changes in body weight and height were similar between the groups at the end of the study . Levels of vitamin B12 , red cell folate and vitamin B2 significantly improved in the intervention group , while vitamin D , selenium and body iron showed no difference . The Hemoglobin ( Hb ) and serum ferritin levels of the control group decreased at endline , while those in the intervention group maintained their levels . The serum transferrin receptor levels increased in both the groups . The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline . Overall improvement in cognitive and physical performance was seen in both the groups at endline , with no significant differences between the groups . The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2 , Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink . It also reduced anemia and the risk of deficiencies of iron , and B12 , in apparently healthy children . Clinical Trials.gov IdentifierNCT01415557 . Clinical Trial RegistryIndia - REF/2012/12/004332 Objectives To determine whether in the current study the supply of a nutrient dense drink has a positive effect on mental and physical function of institutionalized elderly people . Design A 24-week , r and omized , double-blind , placebo-controlled , parallel-group , intervention trial . Setting Homes for the elderly and nursing homes in the Netherl and s. Participants Institutionalized elderly people older than 60 years , with a BMI ≤ 30 kg/m2 , and a Mini-Mental State Examination score of at least 10 points . InterventionIn addition to their usual diet the participants ( n=176 ) received either a nutrient dense drink or a placebo drink twice a day during 24 weeks . Measurements The functionality measures included cognitive function , mood , physical performance and the ability to perform activities of daily living . Results In the supplement group a favorable effect of the intervention drink on body weight ( 1.6 kg difference in change ; P = .035 ) , calf circumference ( 0.9 cm difference in change ; P = .048 ) , and blood values ( e.g. Hcy decreased from 16.8 to 11.2 µmol/L in the supplement group ) was found . In the total group no significant effect was found on functionality outcomes . However , a subgroup of participants with BMI at baseline below 24.4 kg/m2 performed better on the cognitive subscale of Alzheimer ’s Disease Assessment Scale ( P = .09 ) , and its language sub score ( P = .01 ) after 24 weeks of intervention . Conclusion The results in the total group of this trial suggest that the nutritional supplement used in this study improves nutritional status . Furthermore , the results of this trial suggest that it is effective as treatment for decreasing function in a subgroup of institutionalized elderly people with low BMI OBJECTIVES To examine whether two forms of lipid-based nutrient supplements ( LNS ) or a micronutrient-fortified corn-soya blend were associated with development of the gut microbiota in Malawian infants , to assess the microbiota profiles at the age of 6 and 18 months and to follow the changes during the 12-month period . METHODS This was a sub study of a 4-arm r and omised controlled trial conducted in rural Malawi . Infants at the age of 6 months were r and omised to receive no supplement during the primary follow-up period ( control ) , 54 g/day of micronutrient-fortified LNS with milk protein base ( milk LNS ) , 54 g/day of micronutrient-fortified LNS with soya protein base ( soya LNS ) , or 71 g/day of micronutrient-fortified corn-soya blend for 12 months . Stool sample s were collected at baseline ( 6 months ) and end of trial ( 18 months ) . The 16S rRNA gene was amplified and subjected to multiplex sequencing . RESULTS A total of 213 infants had paired microbiota data at 6 and 18 months of age . The Dirichlet-multinomial test showed no significant difference in microbiota profile between the four intervention groups at either age ( each P > 0.10 ) . Bifidobacterium longum was most abundant at both ages . Lactobacillus ruminis , Shigella and Salmonella were present . The abundance of Prevotella and Faecalibacterium increased with age ( each P < 0.001 ) , while Bifidobacteriaceae and Enterobacteriaceae exhibited significant decrease ( each P < 0.001 ) . CONCLUSIONS Nutritional supplementation by LNS or corn-soya blend for twelve months did not affect the gut microbiota profile in the rural Malawian context Objective : Fortified spreads ( FSs ) have proven effective in the rehabilitation of severely malnourished children . We examined acceptability , growth and change in blood haemoglobin ( Hb ) concentration among moderately underweight ambulatory infants given FS . Methods : This was a r and omised , controlled , parallel-group , investigator-blind clinical trial in rural Malawi . Six- to 17-month-old underweight infants ( weight for age < −2 ) , whose weight was greater than 5.5 kg and weight-for-height z score greater than −3 received for 12 weeks at home 1 of 8 food supplementation schemes : nothing , 5 , 25 , 50 , or 75 g/day milk-based FS or 25 , 50 , or 75 g/day soy-based FS . Outcome measures included change in weight , length and blood Hb concentration . Results : A total of 126 infants started and 125 completed the intervention . All infants accepted the spread well , and no intolerance was recorded . Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS . Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS . All average gains were largest among infants receiving 50 g of FS daily : mean difference ( 95 % confidence interval ) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g ( range , −130 to 700 g ) , 0.9 cm ( range , −0.3 to 2.2 cm ) , and 17 g/L ( range , 0 to 34 g/L ) for weight , length and blood Hb concentration , respectively . In soy- vs milk-based FS groups , average outcomes were comparable . Conclusions : Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants . Further trials should test this hypothesis Energy and micronutrient deficiency remain prevalent among Filipino children .  Juice drinks are commonly consumed and could be a viable vehicle for fortification to supplement the nutrient gap . This study determined the effects of a newly developed non-carbonated fortified juice drink on the iron , zinc and nutritional status of schoolchildren . One hundred r and omly selected anemic children were r and omly allocated into two groups in a doubly-masked placebo controlled manner : Group 1 received the fortified juice , Group 2 received the non-fortified juice for 100 days , five days a week under strict supervision . The juice drink was fortified with vitamin A , zinc , iron , vitamin C and lysine . The non-fortified juice was fortified only with vitamin C.  All children were dewormed prior to the intervention . Hemoglobin , plasma ferritin and plasma zinc , weight and height were assessed using st and ard methods before and after intervention . A two-day 24-hour food recall was also collected . The basal prevalence of anemia was significantly reduced in both the fortified group ( 100 % to 13 % ) and the non-fortified group ( 100 % to 40 % ) at endline . The mean plasma ferritin levels were similar in both groups at baseline and endline . At endline , mean plasma zinc in the fortified group has significantly increased by 20 μg/dL from a baseline value of 83.9 μg/dL to 103.9 μg/dL , while the non-fortified group remained at similar levels with baseline . Basal weight and height significantly increased among all children at endline . The fortified juice drink was effective in reducing the prevalence of anemia and improved the zinc status of children OBJECTIVE To examine the effects of 17-wk physical exercise and enriched foods on cellular immune response ( CIR ) in frail elderly . METHODS A total of 112 independently living , frail elderly men and women ( mean age 79.2 + /- 5.9 ) received : twice weekly comprehensive , moderate intensity , progressive group exercise ( group A , N = 26 ) ; daily enriched foods ( group B , N = 31 ) ; both ( group C , N = 29 ) ; or neither ( group D , N = 26 ) . Exercises focused on skills training . Foods were enriched with micronutrients with a high prevalence of deficiency in older people ( at 25 - 100 % the RDA ) . A social program and identical regular foods were offered as a control .  CIR was measured by delayed-type hypersensitivity skin test response ( DTH ) against seven recall antigens expressed as the total number of positive responses and sum of diameters of all positive responses . RESULTS No independent or interactive effect of enriched foods was observed . Therefore , exercise ( groups A + C ) was compared with no exercise ( groups B + D ) . Nonexercising subjects showed an average decline of 0.5 responses compared with an unchanged responsiveness among exercising subjects ( difference = 0.5 , 95 % CI : 0.04 - 0.89 , P = 0.03 adjusted for baseline DTH , activity level , and micronutrient status ) . Nonexercising subjects had a larger decline in the sum of diameters of all positive responses than exercising subjects but the difference did not reach significance ( adjusted difference = 2.1 mm , 95 % CI:-1.0 - 4.8 ) . CONCLUSION Exercise may prevent or slow the age-related decline in immune response .  Micronutrient enriched foods showed no effect . As infectious diseases can have debilitating or even fatal consequences for the elderly , prevention of the age-related decline in CIR could significantly improve their quality of life Concurrent micronutrient deficiencies are prevalent among Vietnamese school children . A school-based program providing food fortified with multiple micronutrients could be a cost-effective and sustainable strategy to improve health and cognitive function of  school children . However , the efficacy of such an intervention may be compromised by the high prevalence of parasitic infestation . To evaluate the efficacy of school-based intervention using multi-micronutrient-fortified biscuits with or without deworming on anemia and micronutrient status in Vietnamese schoolchildren , a r and omized , double-blind , placebo-controlled trial was conducted among 510 primary schoolchildren , aged 6 - 8 y , in rural Vietnam .  Albendazole ( Alb ) ( 400 mg ) or placebo was given at baseline . Nonfortified or multi-micronutrient-fortified biscuits including iron ( 6 mg ) , zinc ( 5.6 mg ) , iodine ( 35 microg ) , and vitamin A ( 300 microg retinol equivalents ) were given 5 d/wk for 4 mo . Multi-micronutrient fortification significantly improved the concentrations of hemoglobin ( + 1.87 g/L ; 95 % CI : 0.78 , 2.96 ) , plasma ferritin ( + 7.5 microg/L ; 95 % CI : 2.8 , 12.6 ) , body iron ( + 0.56 mg/kg body weight ; 95 % CI : 0.29 , 0.84 ) , plasma zinc ( + 0.61 micromol/L ; 95 % CI : 0.26 , 0.95 ) , plasma retinol ( + 0.041 micromol/L ; 95 % CI : 0.001 , 0.08 ) , and urinary iodine ( + 22.49 micromol/L ; 95 % CI : 7.68 , 37.31 ) . Fortification reduced the risk of anemia and deficiencies of zinc and iodine by > 40 % . Parasitic infestation did not affect fortification efficacy , whereas fortification significantly enhanced deworming efficacy , with the lowest reinfection rates in children receiving both micronutrients and Alb . Multi-micronutrient fortification of biscuits is an effective strategy to improve the micronutrient status of Vietnamese schoolchildren and enhances effectiveness of deworming OBJECTIVE To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1 - 3-year-old malnourished African children . DESIGN A r and omised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A , thiamine , riboflavin and pyridoxine , while 23 control children and their families received unfortified maize meal . The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households . METHODS Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics ' criteria and aged 1 - 3 years were r and omly assigned to an experimental or control group . Baseline measurements included demographic , socio-economic and dietary data , as well as height , weight , haemoglobin , haematocrit , serum retinol and retinol-binding protein ( RBP ) . Anthropometric , blood and serum variables were measured again after 12 months of intervention . Complete baseline measurements were available for 44 children and end data for only 36 . Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests , t-tests and analysis of variances using the SPSS program , controlling for expected weight gain in this age group over 12 months . Relationships between changes in variables were examined by calculating correlation coefficients . RESULTS The children in the experimental group had a significantly ( P < or = 0.05 ) higher increase in body weight than control children ( 4.6 kg vs. 2.0 kg ) and both groups had significant ( P < or = 0.05 ) but similar increases in height . The children in the experimental group showed non-significant increases in haemoglobin and serum retinol , while the control children had a significant ( P = 0.007 ) decrease in RBP . The change in serum retinol showed a significant correlation with baseline retinol ( P = 0.014 ) , RBP ( P = 0.007 ) and weight ( P = 0.029 ) , as well as with changes in haemoglobin ( P = 0.029 ) . CONCLUSION Despite a small sample size , this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1 - 3-year-old African children . The study confirmed the relationship between vitamin A and iron status . The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa Objective . To develop and obtain feedback about a summary format for Cochrane review s that is accessible to a consumer audience , without oversimplification or incorrect presentation . Methods . We developed 3 versions of a Plain Language Summary ( PLS ) format of a Cochrane Systematic Review .  Using a semi-structured interview guide we tested these versions among 34 members of the public in Norway , Argentina , Canada , and Australia . The authors analyzed feedback , identified problems , and generated new solutions before retesting to produce a final version of a Plain Language Summary format . Results . Participants preferred results presented as words , supplemented by numbers in a table . There was a lack of underst and ing regarding the difference between a review and an individual study , that the effect is rarely an exact number , that evidence can be of low or high quality , and that level of quality is a separate issue from intervention effect . Participants also found it difficult to move between presentations of dichotomous and continuous outcomes . Rephrasing the introduction helped participants grasp the concept of a review . Confidence intervals were largely ignored or misunderstood . Our attempts to explain them were only partially successful . Text modifiers ( ‘ ‘ probably , ’ ’ ‘ ‘ may ’ ’ ) to convey different levels of quality were only partially understood , whereas symbols with explanations were more helpful . Participants often understood individual information elements about effect size and quality of these results , but did not always actively merge these elements . Conclusion . Through testing and iteration the authors identified and addressed several problems , using explanations , rephrasing , and symbols to present scientific concepts . Other problems remain , including how best to present confidence intervals and continuous outcomes . Future research should also test information elements in combination rather than in isolation . The new Plain Language Summary format is being evaluated in a r and omized controlled trial Background Micronutrients such as vitamins and minerals and long-chain polyunsaturated omega-3 fatty acids ( PUFAs ) are essential for children ’s brain development and cognitive functions . The current study investigated whether milk fortified with micronutrients and PUFA can result in improved cognitive function in mainstream school children . Methods One-hundred- and -nineteen children ( age 8–14 , 58 boys ) were r and omly allocated to a fortified milk group or a regular full milk control group . Participants consumed 0.6L/day of the milk for 5 months . We recorded relevant biochemical , anthropometric , and cognitive measures ( working memory and processing speed ) at the start of the study and at follow-up after 5 months . Results The fortified milk significantly increased docosahexaenoic acid ( DHA ) ( change from baseline of 28 % [ 95 % CI 17–39 % ] vs. −6 % [ 95 % CI − 13 to 0 % ] in the control group ) and serum 25OH-vitamin D concentrations ( 41 % [ 95 % CI 30–52 % ] vs. 21 % [ 95 % CI 11–30 % ] in the control group ) . The fortified milk improved working memory on one of two tests ( 32 % [ 95 % CI 17–47 % ] vs. 13 % [ 95 % CI 6–19 % ] in the control group ) . The fortified milk also indirectly increased processing speed on one of two tests ; this effect was small and completely mediated by increases in 25OH-vitamin D concentrations . Conclusions These results suggest that fortifying milk with micronutrients and PUFA could be an effective and practical way to aid children ’s cognitive development Micronutrient deficiencies during pregnancy are common in Africa and can cause adverse outcomes . The objective was to measure micronutrient status and change in moderately malnourished pregnant Malawian women r and omized to one of three nutritional interventions . Serum vitamin B12 , 25-hydroxyvitamin D , folate , retinol , ferritin , zinc , albumin and C-reactive protein were measured in pregnant women with MUAC ≥20.6 cm and ≤23.0 cm at enrollment ( n = 343 ) and after 10 weeks ( n = 229 ) of receiving : ( 1 ) ready-to-use supplementary food ( RUSF ) ; ( 2 ) fortified corn-soy blend ( CSB+ ) with multiple-micronutrient supplement ( CSB+UNIMMAP ) ; or ( 3 ) CSB+ with iron and folic acid ( CSB+IFA ) . Each provided 100–300 % Recommended Dietary Allowance of most micronutrients and 900 kcal/day . Birth length was measured in 272 infants . Enrollment measurements indicated deficiencies in vitamin B12 ( 20.9 % ) and zinc ( 22.3 % ) , low values of ferritin ( 25.1 % ) and albumin ( 33.7 % ) , and elevated CRP ( 46.0 % ) . Vitamin B12 is known to decrease in the third trimester ; the RUSF group had the smallest decrease from enrollment to week 10 ( 3 % ) , compared to 20 % decrease in the CSB+IFA group and 8 % decrease in the CSB+UNIMMAP group ( p = 0.001 ) . Mean serum 25-hydroxyvitamin D increased most in the RUSF group ( + 6.4 ng/mL ) , compared to CSB+IFA ( + 1.7 ng/mL ) and CSB+UNIMMAP ( + 2.7 ng/mL ) ( p < 0.001 ) . Micronutrient deficiencies and inflammation are common among moderately malnourished pregnant women and had little improvement despite supplementation above the RDA , with the exception of vitamins B12 and BACKGROUND Management of severe acute malnutrition ( SAM ) in children comprises two potential phases : stabilisation and rehabilitation . During the initial stabilisation phase , children receive treatment for dehydration , electrolyte imbalances , intercurrent infections and other complications . In the rehabilitation phase ( applicable to children presenting with uncomplicated SAM or those with complicated SAM after complications have been resolved ) , catch-up growth is the main focus and the recommended energy and protein requirements are much higher . In-hospital rehabilitation of children with SAM is not always desirable or practical - especially in rural setting s - and home-based care can offer a better solution . Ready-to-use therapeutic food ( RUTF ) is a widely used option for home-based rehabilitation , but the findings of our previous review were inconclusive . OBJECTIVES To assess the effects of home-based RUTF used during the rehabilitation phase of SAM in children aged between six months and five years on recovery , relapse , mortality and rate of weight gain . SEARCH METHODS We search ed the following data bases in October 2018 : CENTRAL , MEDLINE , Embase , six other data bases and three trials registers . We ran separate search es for cost-effectiveness studies , contacted research ers and healthcare professionals in the field , and checked bibliographies of included studies and relevant review s. SELECTION CRITERIA R and omised controlled trials ( RCTs ) and quasi- RCTs , where children aged between six months and five years with SAM were , during the rehabilitation phase , treated at home with RUTF compared to an alternative dietary approach , or with different regimens and formulations of RUTF compared to each other . We assessed recovery , deterioration or relapse and mortality as primary outcomes ; and rate of weight gain , time to recovery , anthropometrical changes , cognitive development and function , adverse outcomes and acceptability as secondary outcomes . DATA COLLECTION AND ANALYSIS We screened for eligible studies , extracted data and assessed risk of bias of those included , independently and in duplicate . Where data allowed , we performed a r and om-effects meta- analysis using Review Manager 5 , and investigated substantial heterogeneity through subgroup and sensitivity analyses . For the main outcomes , we evaluated the quality of the evidence using GRADE , and presented results in a ' Summary of findings ' table per comparison . MAIN RESULTS We included 15 eligible studies ( n = 7976 ; effective sample size = 6630 ) , four of which were cluster trials . Eight studies were conducted in Malawi , four in India , and one apiece in Kenya , Zambia , and Cambodia . Six studies received funding or donations from industry whereas eight did not , and one study did not report the funding source .The overall risk of bias was high for six studies , unclear for three studies , and low for six studies . Among the 14 studies that contributed to meta-analyses , none ( n = 5 ) , some ( n = 5 ) or all ( n = 4 ) children were stabilised in hospital prior to commencement of the study . One small study included only children known to be HIV-infected , another study stratified the analysis for ' recovery ' according to HIV status , while the remaining studies included HIV-uninfected or untested children . Across all studies , the intervention lasted between 8 and 16 weeks . Only five studies followed up children postintervention ( maximum of six months ) , and generally reported on a limited number of outcomes .We found seven studies with 2261 children comparing home-based RUTF meeting the World Health Organization ( WHO ) recommendations for nutritional composition ( referred to in this review as  st and ard RUTF )  with an alternative dietary approach ( effective sample size = 1964 ) . RUTF probably improves recovery ( risk ratio ( RR ) 1.33 ; 95 % confidence interval ( CI ) 1.16 to 1.54 ; 6 studies , 1852 children ; moderate- quality evidence ) , and may increase the rate of weight gain slightly ( mean difference ( MD ) 1.12 g/kg/day , 95 % CI 0.27 to 1.96 ; 4 studies , 1450 children ; low- quality evidence ) , but we do not know the effects on relapse ( RR 0.55 , 95 % CI 0.30 to 1.01 ; 4 studies , 1505 children ; very low- quality evidence ) and mortality ( RR 1.05 , 95 % CI 0.51 to 2.16 ; 4 studies , 1505 children ; very low- quality evidence ) .Two quasi-r and omised cluster trials compared st and ard , home-based RUTF meeting total daily nutritional requirements with a similar RUTF but given as a supplement to the usual diet ( 213 children ; effective sample size = 210 ) . Meta- analysis showed that st and ard RUTF meeting total daily nutritional requirements may improve recovery ( RR 1.41 , 95 % CI 1.19 to 1.68 ; low- quality evidence ) and reduce relapse ( RR 0.11 , 95 % CI 0.01 to 0.85 ; low- quality evidence ) , but the effects are unknown for mortality ( RR 1.36 , 95 % CI 0.46 to 4.04 ; very low- quality evidence ) and rate of weight gain ( MD 1.21 g/kg/day , 95 % CI - 0.74 to 3.16 ; very low- quality evidence ) .Eight studies r and omised 5502 children ( effective sample size = 4456 ) and compared st and ard home-based RUTF with RUTFs of alternative formulations ( e.g. using locally available ingredients , containing less or no milk powder , containing specific fatty acids , or with added pre- and probiotics ) . For recovery , it made little or no difference whether st and ard or alternative formulation RUTF was used ( RR 1.03 , 95 % CI 0.99 to 1.08 ; 6 studies , 4188 children ; high- quality evidence ) . St and ard RUTF decreases relapse ( RR 0.84 , 95 % CI 0.72 to 0.98 ; 6 studies , 4188 children ; high- quality evidence ) . However , it probably makes little or no difference to mortality ( RR 1.00 , 95 % CI 0.80 to 1.24 ; 7 studies , 4309 children ; moderate- quality evidence ) and may make little or no difference to the rate of weight gain ( MD 0.11 g/kg/day , 95 % CI -0.32 to 0.54 ; 6 studies , 3807 children ; low- quality evidence ) whether st and ard or alternative formulation RUTF is used . AUTHORS ' CONCLUSIONS Compared to alternative dietary approaches , st and ard RUTF probably improves recovery and may increase rate of weight gain slightly , but the effects on relapse and mortality are unknown . St and ard RUTF meeting total daily nutritional requirements may improve recovery and relapse compared to a similar RUTF given as a supplement to the usual diet , but the effects on mortality and rate of weight gain are not clear . When comparing RUTFs with different formulations , the current evidence does not favour a particular formulation , except for relapse , which is reduced with st and ard RUTF . Well- design ed , adequately powered , pragmatic RCTs with st and ardised outcome measures , stratified by HIV status , and that include diarrhoea as an outcome , are needed Food fortification is a cost-effective and sustainable strategy to prevent or correct micronutrient deficiencies . A double-blind cluster ( bari ) r and omised controlled trial was conducted in a rural community in Bangladesh to evaluate the impact of consumption of chapatti made of micronutrient-fortified wheat flour for 6 months by school-aged children on their vitamin A , haemoglobin and iron status . A total of 43 baris ( group of households ) were r and omly selected . The baris were r and omly assigned to either intervention or control group . The intervention group received wheat flour fortified with added micronutrients ( including 66 mg hydrogen-reduced elemental iron and 3030 μg retinol equivalent as retinyl palmitate per kilogram of flour ) , while the control group received wheat flour without added micronutrients .  A total of 352 children were enrolled in the trial , 203 in the intervention group and 149 in the control group . Analyses were carried out on children who completed the study ( 191 in the intervention group and 143 in the control group ) . Micronutrient-fortified wheat flour chapatti significantly increased serum retinol concentration at 6 months by 0.12 μmol L(-1 ) [ 95 % confidence interval ( CI ) : 0.06 , 0.19 ; P < 0.01 ] . The odds of vitamin A deficiency was significantly lower for children in the intervention group at 3 months [ odds ratio ( OR ) = 0.26 ; 95 % confidence interval ( CI ) : 0.07 , 0.89 ; P < 0.05 ] and 6 months ( OR = 0.21 ; 95 % CI : 0.06 , 0.68 ; P < 0.01 ) . No demonstrable effect of fortified chapatti consumption on iron status , haemoglobin levels or anaemia was observed . Consumption of fortified chapattis demonstrated a significant improvement in the vitamin A status , but not in iron , haemoglobin or anaemia status OBJECTIVE Improvement of hemoglobin and serum retinol and facilitation of the mobilization of iron storage were achieved with a multiple-micronutrient-fortified diet in preschoolers for 6 mo in a suburb of Chongqing , China . We investigated whether fortification with multiple micronutrients in a diet for preschool children results in changes in children 's infectious morbidity compared with diets fortified solely with vitamin A and with vitamin A plus iron . METHODS From December 2005 to June 2006 , 226 2- to 6-y-old preschool children were recruited from three nurseries r and omly assigned to three different fortified-diet groups for 6 mo . Group I was fortified with vitamin A ; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron , thiamine , riboflavin , folic acid , niacinamide , zinc , and calcium , respectively . The secondary functional outcomes , morbidity of diarrhea and respiratory infection , were collected during supplementation . RESULTS The groups were comparable concerning compliance and loss to follow-up . There was evidence of a lower incidence rate of respiratory-related illnesses , diarrhea-related illness , fewer symptoms of runny nose , cough , and fever , and shorter duration of respiratory-related illnesses and cough for children in group III compared with children in groups I and II . However , there was no significantly or clinical ly important difference between children in groups I and II . CONCLUSION The beneficial effects on infectious morbidity over 6 mo , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a diet for preschool children Vitamin A (VA)-fortified rice is a potential intervention strategy to prevent VA deficiency in at-risk population s.  Hot-extruded , triple-fortified rice grains with added VA , zinc , and iron were produced by hot extrusion technology and their ability to improve VA status was tested in Thai schoolchildren . The fortification levels were 10 mg of iron , 9 mg of zinc , and 1.05 mg of VA/g extruded rice . A paired stable isotope dilution technique with labeled ¹³C₂-retinyl acetate ( ¹³C-RID ) was used to quantify VA pool size at the beginning and end of the feeding period . Fifty healthy schoolchildren with a serum retinol ( SR ) concentration of > 0.7 μmol/L were r and omly assigned to 2 groups to receive either triple-fortified rice ( n = 25 ) or natural rice ( n = 25 ) for 2 mo as part of the daily school meal . The fortified grains , mixed 1:50 with regular rice , were estimated to provide an extra 890 μg of VA/d , 5 d/wk . ¹³C₂-retinyl acetate ( 1.0 μmol ) was administered orally to each child before and at the end of the feeding period to estimate total body reserves ( TBRs ) of VA , which increased significantly ( P < 0.05 ) in the intervention group from 153 ± 66 μmol retinol at baseline to 269 ± 148 μmol retinol after 2 mo of feeding . There was no change in the TBRs of VA in the control group ( 108 ± 67 vs. 124 ± 89 μmol retinol ) ( P = 0.22 ) . Serum retinol remained unchanged in both groups . We conclude that VA-fortified , hot-extruded rice is an efficacious vehicle to provide additional VA to at-risk population s , and that the efficacy of VA-fortified foods can be usefully monitored by the ¹³C-RID measurement of TBRs of VA but not by changes in SR concentration Micronutrient deficiencies are associated with impaired growth and cognitive  function  . A school-based fortification program might benefit schoolchildren but a high prevalence of parasite infestation might affect effectiveness . A r and omized , double-blind , placebo-controlled 2 × 2 factorial trial was conducted to assess the efficacy of multi-micronutrient fortified biscuits with or without de-worming on growth , cognitive function , and parasite load in Vietnamese schoolchildren . Schoolchildren ( n = 510 ) , 6 - 8 years of age were r and omly allocated to receive albendazole or placebo at baseline and four months of multi-micronutrient fortified biscuits ( FB ) or non-fortified biscuits .  Children receiving FB for four months scored higher on two cognitive tests : Raven 's Colored Progressive Matrices and the Digit Span Forward test . Children receiving albendazole plus FB had the lowest parasite load after four months . In children receiving FB , mid-upper arm circumference was slightly improved ( + 0.082 cm ) but there were no differences in other indexes of anthropometry . Combining multi-micronutrient fortified biscuits with de-worming is an effective strategy Traditional complementary foods ( CF ) with a low nutrient density have been implicated in growth faltering , stunting , and other adverse outcomes in children . The efficacy of 2 types of locally produced , micronutrient-fortified CF to prevent stunting of infants living in rural Vietnam was evaluated . In a village-r and omized controlled study , 426 infants , 5 mo of age , received for 6 mo a fortified CF , either as an instant flour ( FF ) or a food complement ( FC ) in village canteens , or traditional CF at home ( C ) . After 6 mo of intervention , weight , length , length-for-age Z-score ( LAZ ) and weight-for-age Z-score were greater in the 2 intervention groups compared with the C group , with an estimated effect of + 0.22 LAZ for the FF group and + 0.21 LAZ for the FC group . At the last follow-up , 18 mo after the intervention , there was no significant difference in height-for-age Z-score ( HAZ ) between the groups , even though the HAZ in the FF group was 0.17 greater than that in the C group ( P = 0.18 ) . In contrast , the weight-for-height Z-score and BMI Z-score , indices of ponderal growth , were greater in the FF group ( -0.49 and -0.26 , respectively ) than in the FC group ( -0.73 and -0.49 , respectively ) , with Z-scores in the C group intermediate and not significantly different from the others . This study shows that regular provision of locally produced CF fortified with micronutrients partly stopped growth faltering in Vietnamese infants , with differential effects on long-term length and ponderal growth . Providing only micronutrients instead of a complete array of nutrients might result in only short-term length growth benefits Anemia and micronutrient deficiencies are common among Indian schoolchildren . We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India . In this placebo-controlled , cluster-r and omized study , 499 schoolchildren ( 6 - 10 y ) received either multiple micronutrients ( treatment group ) or placebo ( control group ) as part of school meals ( 6 d/wk ) for 8 mo . Both groups were dewormed at the beginning of the study . The micronutrient premix provided 10 mg iron , 375 microg vitamin A , 4.2 mg zinc , 225 microg folic acid , and 1.35 microg vitamin B-12 for each child per day ( approximately 75 % recommended dietary allowance ) . Blood sample s drawn before and after the intervention were analyzed for hemoglobin , ferritin , retinol , zinc , folate , and vitamin B-12 . Baseline prevalence of anemia ( 37 % ) , iron deficiency anemia ( 10 % ) , low serum ferritin ( 24 % ) , retinol ( 56 % ) , zinc ( 74 % ) , folate ( 68 % ) , and vitamin B-12 ( 17 % ) did not differ between groups . Postintervention , fewer in the treatment group had lower serum retinol [ odds ratio ( OR ) ( 95 % CI ) : 0.57 ( 0.33 - 0.97 ) ] and folate [ OR ( 95 % CI ) : 0.47 ( 0.26 - 0.84 ) ] than the control group . The serum vitamin B-12 concentration decreased in both groups , but the magnitude of change was less in the treatment than in the control group ( P < 0.05 ) . Total body iron ( TBI ) increased in both groups ; however , the change was greater in the treatment than in the control group ( P < 0.05 ) . Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A , folate , and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status
BACKGROUND Vitamins and minerals are essential for growth and maintenance of a healthy body , and have a role in the functioning of almost every organ .
Multiple interventions have been design ed to improve micronutrient deficiency , and food fortification is one of them .
OBJECTIVES To assess the impact of food fortification with multiple micronutrients on health outcomes in the general population , including men , women and children .