Effectiveness of daily and weekly iron supplementation in the prevention of anemia in infants. Oral zinc supplementation in pregnant women and its effect on birth weight: a randomised controlled trial Small-Quantity Lipid-Based Nutrient Supplements, Regardless of Their Zinc Content, Increase Growth and Reduce the Prevalence of Stunting and Wasting in Young Burkinabe Children: A Cluster-Randomized Trial The impact of prenatal vitamin A and zinc supplementation on growth of children up to 2 years of age in rural Java, Indonesia. Effectiveness of Zinc Supplementation to Full Term Normal Infants: A Community Based Double Blind, Randomized, Controlled, Clinical Trial Zinc supplementation during pregnancy in low-income teenagers of Mexican descent: effects on selected blood constituents and on progress and outcome of pregnancy. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. Redistribution of vitamin A after iron supplementation in Indonesian infants. Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. Effect of a zinc-fortified formula on immunocompetence and growth of malnourished infants. Zinc supplementation reduces the incidence of persistent diarrhea and dysentery among low socioeconomic children in India. Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population. Zinc supplementation and psychosocial stimulation: effects on the development of undernourished Jamaican children. Multiple micronutrient supplements improve micronutrient status and anemia but not growth and morbidity of Indonesian infants: a randomized, double-blind, placebo-controlled trial. Zinc supplementation increases growth and circulating insulin-like growth factor I (IGF-I) in growth-retarded Vietnamese children. Dose-response trial of prophylactic zinc supplements, with or without copper, in young Ecuadorian children at risk of zinc deficiency. Comparison of the effects of zinc delivered in a fortified food or a liquid supplement on the growth, morbidity, and plasma zinc concentrations of young Peruvian children. Zinc supplementation improves the growth of stunted rural Guatemalan infants. Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: a randomized controlled trial in a semirural community in Mexico. Adding zinc to supplemental iron and folic acid does not affect mortality and severe morbidity in young children. Maternal zinc supplementation and growth in Peruvian infants. Iron intake and iron nutritional status of infants fed iron-fortified beikost with meat. Zinc supplementation during pregnancy: effects on selected blood constituents and on progress and outcome of pregnancy in low-income women of Mexican descent. Effects of separate delivery of zinc or zinc and vitamin A on hemoglobin response, growth, and diarrhea in young Peruvian children receiving iron therapy for anemia. Zinc supplementation does not affect growth, morbidity, or motor development of US term breastfed infants at 4-10 mo of age. Multiple micronutrient supplementation improves anemia, micronutrient nutrient status, and growth of Vietnamese infants: double-blind, randomized, placebo-controlled trial. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: interactions between iron and zinc. Efficacy of zinc supplementation in reducing the incidence and prevalence of acute diarrhea--a community-based, double-blind, controlled trial. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, growth, and morbidity of Peruvian infants. Combined iron and folic acid supplementation with or without zinc reduces time to walking unassisted among Zanzibari infants 5- to 11-mo old. Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand. Randomized controlled trial of the effect of daily supplementation with zinc or multiple micronutrients on the morbidity, growth, and micronutrient status of young Peruvian children. Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial. Serum zinc changes due to iron supplementation in teen-age pregnancy. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development. Daily and Weekly Iron Supplementations are Effective in Increasing Hemoglobin and Reducing Anemia in Infants. Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young north Indian children. Mother's iron status, breastmilk iron and lactoferrin – are they related? The impact of prenatal vitamin A and zinc supplementation on birth size and neonatal survival - a double-blind, randomized controlled trial in a rural area of Indonesia. Serum ferritin as a measure of iron stores in normal subjects. Neither a zinc supplement nor phytate-reduced maize nor their combination enhance growth of 6- to 12-month-old Guatemalan infants. Short-term zinc supplementation with dispersible tablets or zinc sulfate solution yields similar positive effects on plasma zinc concentration of young children in Burkina Faso: a randomized controlled trial. Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial Effect of iron fortification of nursery complementary food on iron status of infants in the DPRKorea. Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa The effect of iron in formula milk after 6 months of age. Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal. Low Zinc Intake During Exclusive Breast‐Feeding Does Not Impair Growth Effect of zinc supplementation on development and growth of Chilean infants. In-home fortification with 2.5 mg iron as NaFeEDTA does not reduce anaemia but increases weight gain: a randomised controlled trial in Kenyan infants. Prevention of iron-deficiency anemia: comparison of high- and low-iron formulas in term healthy infants after six months of life. Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants Effect of routine prophylactic supplementation with iron and folic acid on preschool child mortality in southern Nepal: community-based, cluster-randomised, placebo-controlled trial Effect of intermittent treatment with amodiaquine on anaemia and malarial fevers in infants in Tanzania: a randomised placebo-controlled trial A randomized placebo-controlled trial of iron supplementation in breastfed young infants initiated on complementary feeding: effect on haematological status. Effect of probiotic L. plantarum IS-10506 and zinc supplementation on humoral immune response and zinc status of Indonesian pre-school children. Micronutrient supplementation and pregnancy outcomes: double-blind randomized controlled trial in China. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial The effects of prophylactic iron given in prenatal supplements on iron status and birth outcomes: a randomized controlled trial. Impact of zinc supplementation on diarrheal morbidity and growth pattern of low birth weight infants in kolkata, India: a randomized, double-blind, placebo-controlled, community-based study. Iron fortified follow on formula from 9 to 18 months improves iron status but not development or growth: a randomised trial The added benefit of zinc supplementation after zinc treatment of acute childhood diarrhoea: a randomized, double-blind field trial. Impact of zinc supplementation on diarrhoeal morbidity in rural children of West Bengal, India Effects of Maternal Multimicronutrient Supplementation on the Mental Development of Infants in Rural Western China: Follow-up Evaluation of a Double-Blind, Randomized, Controlled Trial Supplementing iron and zinc: double blind, randomized evaluation of separate or combined delivery Short-term developmental outcome of iron prophylaxis in infants. Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Effects of three different iron supplementations in term healthy infants after 5 months of life. Zinc supplements in breastfed infants Impact of zinc supplementation on mental and psychomotor scores of children aged 12 to 18 months: a randomized, double-blind trial. Follow‐on formula in the prevention of iron deficiency: a multicentre study Iron‐fortified and unfortified cow's milk: Effects on iron intakes and iron status in young children Effect of daily zinc supplementation on child mortality in southern Nepal: a community-based, cluster randomised, placebo-controlled trial Zinc supplementation in infants with a nutritional pattern of failure to thrive: a double-blind, controlled study. Prevention of iron deficiency and psychomotor decline in high-risk infants through use of iron-fortified infant formula: a randomized clinical trial. Nutritional status of lactating mothers and their breast milk concentration of iron, zinc and copper in rural Vietnam. Differing effects of low and high bulk maternal dietary supplements during pregnancy. Daily multivitamins with iron to prevent anemia in high-risk infants: a randomized clinical trial. Impact of zinc supplementation on morbidity from diarrhea and respiratory infections among rural Guatemalan children. Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age. Ferrous Gluconate and Ferrous Sulfate Added to a Complementary Food Distributed by the Mexican Nutrition Program Oportunidades Have a Comparable Efficacy to Reduce Iron Deficiency in Toddlers Evaluation of two iron-fortified, milk-based formulas during infancy. Zinc supplementation during pregnancy: a double blind randomised controlled trial Plasma zinc concentration responds to short-term zinc supplementation, but not zinc fortification, in young children in Senegal1,2.
OBJECTIVE To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants . METHODS R and omized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro , Brazil , between 2004 and 2005 . Three concurrent cohorts were compared : daily group ( n=150 ; 12.5 mg Fe/day ) ; weekly group ( n=147 ; 25 mg Fe/week ) and control group . The intervention consisted of universal supplementation with iron sulfate for 24 weeks , combined with educational adherence-promoting measures . OUTCOME mean serum hemoglobin concentration , distribution and prevalence of anemia ( Hb<110.0 g/l ) at age 12 months . Effectiveness was evaluated considering both intent to treat and adherence to protocol , using multiple regression analysis ( linear and Poisson ) . RESULTS Groups were homogeneous in terms of descriptive variables . The intervention was implemented successfully , with high adhesion to protocol in both groups , and no statistical difference between them . After adjustment , only the daily regimen showed a protective effect . Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen . No protective effect was detected for the weekly regimen . CONCLUSIONS Universal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis Pakistan lies in a zinc deficient area where oral zinc supplementation has been advocated for various reasons . A double blind , r and omised case-control study was carried out on pregnant women to evaluate the effects of  oral zinc supplementation  on the weights of newborns .  No significant difference was found in the birth weights between the cases supplemented with 20 mg elemental zinc and controls receiving oral placebos ( p = 0.57 ) Small-quantity lipid-based nutrient supplements ( SQ-LNS ) are promising home fortification products , but the optimal zinc level needed to improve growth and reduce morbidity is uncertain . We aim ed to assess the impact of providing SQ-LNS with varied amounts of zinc , along with illness treatment , on zinc-related outcomes compared with st and ard care . In a placebo-controlled , cluster-r and omized trial , 34 communities were stratified to intervention ( IC ) or non-intervention cohorts ( NIC ) . 2435 eligible IC children were r and omly assigned to one of four groups:1 ) SQ-LNS without zinc , placebo tablet ; 2 ) SQ-LNS containing 5 mg zinc , placebo tablet ; 3 ) SQ-LNS containing 10 mg zinc , placebo tablet ; or 4 ) SQ-LNS without zinc and 5 mg zinc tablet  from 9–18 months of age . During weekly morbidity surveillance , oral rehydration salts were provided for reported diarrhea and antimalarial therapy for confirmed malaria . Children in NIC ( n = 785 ) did not receive SQ-LNS , tablets , illness surveillance or treatment . At 9 and 18 months , length , weight and hemoglobin were measured in all children . Reported adherence was 97±6 % for SQ-LNS and tablets . Mean baseline hemoglobin was 89±15g/L. At 18 months , change in hemoglobin was greater in IC than NIC ( + 8 vs -1g/L , p<0.0001 ) , but 79.1 % of IC were still anemic ( vs. 91.1 % in NIC ) . Final plasma zinc concentration did not differ by group . During the 9-month observation period , the incidence of diarrhea was 1.10±1.03 and of malaria 0.54±0.50 episodes per 100 child-days , and did not differ by group . Length at 18 months was significantly greater in IC compared to NIC ( 77.7±3.0 vs. 76.9±3.4 cm ; p<0.001 ) and stunting prevalence was significantly lower in IC ( 29.3 % ) than NIC ( 39.3 % ; p<0.0001 ) , but did not differ by intervention group within IC . Wasting prevalence was also significantly lower in IC ( 8.7 % ) than in NIC ( 13.5 % ; p = 0.0003 ) . Providing SQ-LNS daily with or without zinc , along with malaria and diarrhea treatment , significantly increased growth and reduced stunting , wasting and anemia prevalence in young children . Trial Registration Clinical Trials.gov OBJECTIVE To determine whether prenatal vitamin A and /or Zn supplementation affects postnatal growth . DESIGN Follow-up of a r and omized controlled trial monitoring growth in children from birth up to 24 months of age . SETTING Central Java , Indonesia . SUBJECTS Children ( n 343 ) of mothers participating in a double-blinded , r and omized controlled study of vitamin A and /or Zn supplementation during pregnancy . We report the effects of prenatal supplementation on infant growth , measured as weight-for-age Z-scores ( WAZ ) , height-for-age Z-scores ( HAZ ) and weight-for-height Z-scores ( WHZ ) , from 0 to 24 months , as well as differences in growth faltering among the supplementation groups . RESULTS For HAZ , the absolute differences between the vitamin A-only and vitamin A + Zn groups at 3 and 9 months were 0·34 SD and 0·37 SD , respectively , and the absolute difference between the vitamin A-only and Zn-only groups at 18 months was 0·31 SD . Compared with placebo , none of the supplements affected growth . Defining growth faltering as a downward crossing of two or more major percentile lines , 50 - 75 % of the children were found to be growth faltering within 9 months of age , whereas 17 % and 8 % scored < -2 SD for WAZ and HAZ , respectively . Prenatal supplementation did not reduce the prevalence of growth faltering . CONCLUSIONS Prenatal vitamin A supplementation had a small but significant effect on postnatal growth of children 's length until 18 months of age compared with supplementation with either vitamin A + Zn or Zn alone , but not compared with placebo . It had no effects on other anthropometric measures and did not reduce the prevalence of growth faltering . Future studies should duplicate these findings before recommendations can be made The study was aim ed to test whether zinc supplementation , if initiated early , can prevent stunting and promote optimum body composition in full term infants . For this , full term pregnant women from low income urban community were enrolled and were followed-up for 24 months postpartum . Body mass index ( BMI ) was calculated from maternal weight and height that were collected one month after delivery . Infants ' weight , and length , head , chest and mid upper arm circumferences and skin fold thicknesses at triceps , biceps and subscapular area were collected at baseline ( before r and omization ) and once in three months up till 24 months . Three hundred and twenty four infants were r and omized and allocated to zinc ( 163 ) or placebo ( 161 ) groups respectively . Supplementation of zinc was initiated from 4 months of age and continued till children attained 18 months . The control ( placebo ) group of children received riboflavin 0.5 mg/day , whereas the intervention ( zinc ) group received 5 mg zinc plus riboflavin 0.5 mg/day . When infants were 18 months old , dietary intakes ( in 78 children ) were calculated by 24 hour diet recall method and hemoglobin , zinc , copper and vitamin A were quantified in blood sample s collected from 70 children . The results showed prevalence of undernutrition ( body mass index < 18.5 ) in 37 % of the mothers . Mean±SD calorie consumption and zinc intakes from diets in infants were 590±282.8 Kcal/day and 0.97±0.608 mg/day respectively . Multiple linear regression models demonstrated maternal weight as a strong predictor of infants ' weight and length at 18 months of age . As expected , diarrhea duration impacted infants ' linear growth and weight gain adversely . Zinc supplementation for a mean period of 190 days , starting from 4 months up to 18 months of age , in full term normal infants , consuming an average energy of 590 Kcal/day , had significant effect on the skin fold thicknesses , but not on their linear growth . Trial Registration Clinical Trail Registration India ( CTRI ) As a follow-up of our study of pregnant women , we report effects of zinc supplementation during pregnancy in another population of 138 Hispanic teenagers in Los Angeles . Teenagers were r and omized ( double-blind ) to a control or zinc-supplemented group and received similar daily vitamin and mineral supplements except for 20 mg zinc added to the zinc-supplemented group 's capsules . Initially , mean dietary zinc intakes of both groups were about 50 % of the Recommended Dietary Allowance and their mean serum zinc levels did not differ significantly ( 69.8 + /- 11.2 micrograms/dl in control and 69.0 + /- 11.4 micrograms/dl in zinc-supplemented group ) . Zinc supplementation did not maintain mean serum zinc levels during pregnancy but , as in our earlier study , it reduced ( p = 0.018 ) the number of low serum zinc values ( less than or equal to 53 micrograms/dl ) in late pregnancy . Zinc supplementation did not affect outcome of pregnancy but serum zinc levels were lower ( p = 0.038 ) in teenagers with pregnancy-induced hypertension than in normotensives Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with anemia ( hemoglobin < 110 g/L ) , 16 % vitamin A deficiency ( plasma retinol < 0.7 micromol/L ) , 47 % zinc deficiency ( plasma zinc < 10.7 micromol/L ) , 2 % underweight , and 11 % stunting . There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study . The DMM was the most effective intervention tested , not only for improving anemia but also for improving iron , zinc , riboflavin , and tocopherol status BACKGROUND Deficiencies of iron and vitamin A are prevalent worldwide . Single-micronutrient supplementation is widely used to combat these deficiencies . However , micronutrient deficiencies often occur concurrently , and there are many interactions between micronutrients . OBJECTIVE This study investigated interactions among 3 important micronutrients -- iron , vitamin A , and zinc -- when they are given as supplements . DESIGN In a r and omized , double-blind , placebo-controlled supplementation trial , 387 Indonesian infants aged 4 mo were supplemented 5 d/wk for 6 mo with 10 mg Fe , 10 mg Zn , 2.4 mg beta-carotene , 10 mg each of Fe and Zn , 10 mg Zn + 2.4 mg beta-carotene , or placebo . Complete data on micronutrient status , including hemoglobin , ferritin , retinol , zinc , and the modified relative dose response ( a measure of liver retinol stores ) , were available from 256 infants at the end of the study . RESULTS Iron-supplemented infants had significantly lower plasma retinol concentrations and a significantly higher prevalence of vitamin A deficiency , as defined by a plasma retinol concentration < 0.70 micromol/L , than did the non-supplemented infants . In contrast , the modified relative dose response of the iron-supplemented infants indicated greater liver stores of vitamin A.  Iron supplementation improved iron status , and zinc supplementation improved zinc status , but beta-carotene supplementation did not significantly improve vitamin A status . CONCLUSIONS In this study , iron supplementation in infants with marginal vitamin A status led to lower plasma vitamin A concentrations and simultaneously to greater vitamin A liver stores . This implies a redistribution of retinol after iron supplementation , which might induce vitamin A deficiency . Therefore , iron supplementation in infants should be accompanied by measures to improve vitamin A status Iron supplements are often prescribed during infancy but their benefits and risks have not been well documented . We examined whether iron supplements affect growth or morbidity of breast-fed infants . Full-term infants in Sweden ( n = 101 ) and Honduras ( n = 131 ) were r and omly assigned to three groups at 4 mo of age : 1 ) placebo from 4 to 9 mo ; 2 ) placebo from 4 to 6 mo and iron supplements [ 1 mg/(kg . d ) ] from 6 to 9 mo ; or 3 ) iron supplements from 4 to 9 mo . All infants were exclusively or nearly exclusively breast-fed to 6 mo and continued to be breast-fed to at least 9 mo . Growth was measured monthly and morbidity data were collected every 2 wk . Among the Swedish infants , gains in length and head circumference were significantly lower in those who received iron than in those given placebo from 4 to 9 mo . The same effect on length was seen in Honduras , but only at 4 - 6 mo among those with initial hemoglobin ( Hb ) > or = 110 g/L. There was no significant main effect of  iron supplementation on morbidity , nor any significant interaction between iron supplementation and site , but for diarrhea ( with both sites combined ) , there was an interaction between iron supplementation and initial Hb . Among infants with Hb < 110 g/L at 4 mo , diarrhea was less common among those given iron than in those given placebo from 4 - 9 mo , whereas the opposite was true among those with Hb > or = 110 g/L ( P < 0.05 ) . We conclude that routine iron supplementation of breast-fed infants may benefit those with low Hb but may present risks for those with normal Hb This study attempted to define the possible contribution of zinc nutrition to immunocompetence and growth in severely malnourished infants . The effect of zinc supplementation was evaluated in marasmic infants during nutritional rehabilitation by using a controlled double-blind design in which 19 infants fed a zinc-fortified formula were compared with 20 infants fed the same non-supplemented formula .  Evaluation of immunocompetence , growth , and zinc , copper , and iron status was performed on admission and at 30 , 60 , and 105 d of nutritional rehabilitation . Although energy intake was similar in both groups , the zinc-supplemented infants had significantly higher linear growth gain , and their immune function improved as demonstrated by conversion of their delayed hypersensitivity skin reactions , enhanced lymphoproliferative response to PHA , and increased salivary IgA concentrations . Thus , the use of a zinc-fortified formula during nutritional rehabilitation can prevent the development of zinc deficiency and improve growth and immune function Persistent diarrhea ( PD ) and dysentery ( DD ) account for most diarrhea-associated deaths among children in developing countries . Zinc deficiency can cause stunting and impaired immune function , both of which are risk factors for these diarrheal illnesses . We investigated the effect of zinc supplementation on the incidence of PD and DD in a community-based , double-blind r and omized trial in children 6 - 35 mo of age . Increase over baseline in plasma zinc concentrations in the supplemented group compared with a control group ( 3.61 vs. 0.009 mumol . L-1 ) , indicated successful supplementation . The overall reductions in the zinc supplemented group of 21 % in the incidence of PD ( 95 % CI -6 to 42 % ) and 14 % in the incidence of dysentery ( 95 % CI -15 to 36 % ) were not significant . There was a significant interaction of treatment effect with baseline plasma zinc concentration and age for PD and with gender for DD . In the zinc-supplemented group compared with the control group , the incidence of PD was reduced by 73 % ( P < 0.05 ; 95 % CI 34 to 91 % ) in children with a baseline zinc < 7.65 mumol . L-1 and by 49 % ( P < 0.05 ; 95%CI 24 to 66 % ) in children > 11 mo of age . Zinc supplementation result ed in a 38 % ( P < 0.05 95%CI 8 to 59 % ) reduction in the incidence of DD in boys . There was no effect on PD among children 6 - 11 mo old or on DD in girls . In conclusion , zinc supplementation had a significant impact on the incidence of persistent diarrhea in children > 1 y old and in children with low plasma zinc , as well as on dysentery in boys . These findings may have important implication s for reducing diarrhea-related morbidity and mortality BACKGROUND Maternal zinc deficiency during pregnancy may be widespread among women in developing countries , but few data are available on whether prenatal zinc supplementation improves maternal and neonatal zinc status . OBJECTIVE We studied whether maternal zinc supplementation improved the zinc status of mothers and neonates participating in a supplementation trial in a shantytown in Lima , Peru . DESIGN Beginning at gestation week 10 - 24 , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg Fe and 250 microg folate , with or without 15 mg Zn .  Venous blood and urine sample s were collected at enrollment , at gestation week 28 - 30 , and at gestation week 37 - 38 . At birth , a sample of cord vein blood was collected . We measured serum zinc concentrations in 538 women , urinary zinc concentrations in 521 women , and cord zinc concentrations in 252 neonates . RESULTS At 28 - 30 and 37 - 38 wk , mothers receiving zinc supplements had higher serum zinc concentrations than mothers who did not receive zinc ( 8.8 + /- 1.9 compared with 8.4 + /- 1.5 micromol/L and 8.6 + /- 1.5 compared with 8.3 + /- 1.4 micromol/L , respectively ) . Urinary zinc concentrations were also higher in mothers who received supplemental zinc ( P < 0.05 ) . After adjustment for covariates and confounding factors , neonates of mothers receiving zinc supplements had higher cord zinc concentrations than neonates of mothers who did not receive zinc ( 12.7 + /- 2.3 compared with 12.1 + /- 2.1 micromol/L ) . Despite supplementation , maternal and neonatal zinc concentrations remained lower than values reported for well-nourished population s. CONCLUSION Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status , but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population BACKGROUND Undernourished children have poor levels of development that benefit from stimulation . Zinc deficiency is prevalent in undernourished children and may contribute to their poor development . OBJECTIVE We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children . DESIGN This was a r and omized controlled trial with 4 groups : stimulation alone , zinc supplementation alone , both interventions , and control ( routine care only ) .  Subjects were 114 children aged 9 - 30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics . Clinics were r and omly assigned to receive stimulation or not ; individual children were r and omly assigned to receive zinc or placebo . The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged . The supplementation was 10 mg Zn as sulfate daily or placebo .  Development ( assessed by use of the Griffiths Mental Development Scales ) , length , and weight were measured at baseline and 6 mo later . Weekly morbidity histories were taken . RESULTS Significant interactions were found between zinc supplementation and stimulation . Zinc benefited the developmental quotient only in children who received stimulation , and benefits from zinc to h and and eye coordination were greater in stimulated children . Zinc supplementation alone improved h and and eye coordination , and stimulation alone benefited the developmental quotient , hearing and speech , and performance . Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth . CONCLUSION Zinc supplementation benefits development in undernourished children , and the benefits are enhanced if stimulation is also provided Multiple micronutrient deficiencies are highly prevalent in Indonesia , but the interventions are still focused on single micronutrients . This study aim ed to investigate the efficacy of multiple micronutrient supplements for improving micronutrient status , anemia , growth , and morbidity of Indonesian infants . In this double-blind , placebo-controlled trial , 284 infants aged 6 - 12 mo were r and omly allocated to 4 treatment groups for 23 wk ; 260 ( 92 % ) infants completed the study . Group 1 ( DMM ) received one adequate intake of multiple micronutrient supplements daily ( n = 66 ) ; group 2 ( WMM ) received 2 adequate intakes of multiple micronutrient on 1d plus 6 d of placebo ( n = 60 ) ; group 3 ( DI ) received 10 mg of iron supplement daily ( n = 69 ) ; group 4 received a placebo supplement daily ( n = 65 ) . Blood sample s were collected at baseline and at posttreatment to assess anemia and micronutrient status . Anthropometric measurements were taken monthly , and morbidity was recorded daily . At baseline , 58.1 % of infants were anemic , 34.2 % were iron deficient , 21.3 % were vitamin A deficient , and 11 % were zinc deficient . The DMM and DI supplements both corrected iron deficiency , but DMM supplements were more efficacious in improving hemoglobin levels of anemic infants than the other supplements . However , anemia still persisted in one-third of DMM infants posttreatment . The DMM supplement was more efficacious than WMM or DI supplementation in improving infant status of other micronutrients , including zinc , tocopherol , and riboflavin , whereas DI exacerbated zinc deficiency . There were no significant differences in growth and morbidity among treatment groups , and growth faltering was not prevented To determine whether zinc deficiency might be involved in the failure to thrive observed in undernourished Vietnamese children , we assessed growth , incidence of infections , and circulating insulin-like growth factor I ( IGF-I ) concentrations in a double-blind study of zinc supplementation .  Growth-retarded children ( n=146 ) aged 4 - 36 mo were paired according to age , sex , commune , Z scores for weight ( WAZ ) and for height ( HAZ ) , and number of siblings , and were r and omly assigned to receive either 153 micromol ( 10 mg ) Zn/d or a placebo for 5 mo . Weight , height , and episodes of infection were recorded each month and plasma IGF-I was measured 1 and 5 mo after the start of zinc supplementation . Multiple-linear-regression analysis for paired data showed that zinc supplementation increased weight ( + 0.5 + /- 0.1 kg ; P<0.001 ) and height ( + 1.5+/-0.2 cm ; P<0.001 ) after 5 mo compared with placebo treatment . The relative risk of infectious episodes in the zinc-treated subjects was reduced 3-fold for diarrhea ( P=0.012 ) and 2.5-fold for respiratory infections ( p=0.057 ) . The probability of having at least two episodes of diarrhea or respiratory infection was 2.9- and 3.2-fold lower , respectively , in zinc-treated subjects between 1 and 5 mo ( P=0.018 ) , whereas they did not change in placebo-treated subjects ( P-0.584 ) . After 1 mo , IGF-I concentration ( -x+/-SD ) in zinc-treated subjects was 2.8+/-0.3 nmol/L compared with 1.9+/-0.2 nmol/L in placebo-treated subjects ( P=0.021 ) . After 5 mo , the values were 3.4+/-0.5 nmol/L ( zinc-treated ) and 2.0+/-0.3 nmol/L ( placebo-treated ; P=0.044 ) . Our study suggests that zinc deficiency may limit growth in nutritionally deprived children . Because the increase in growth velocity result ing from zinc supplementation was associated with increased plasma IGF-I concentrations , we suggest that the growth-stimulating effect of zinc might be mediated through changes in circulating BACKGROUND Multiple studies have shown the benefits of zinc supplementation among young children in high-risk population s. However , the optimal dose and safe upper level of zinc have not been determined . OBJECTIVES The objectives of this study were to measure the effects of different doses of supplemental zinc on the plasma zinc concentration , morbidity , and growth of young children ; to detect any adverse effects of 10 mg supplemental Zn on markers of copper or iron status ; and to determine whether any adverse effects are alleviated by providing copper with zinc . DESIGN This r and omized , double-masked , community-based intervention trial was conducted in 631 Ecuadorian children who were 12 - 30 mo old at baseline and who had initial length-for-age z scores < -1.3 . Children received 1 of 5 daily supplements for 6 mo : 3 , 7 , or 10 mg Zn as zinc sulfate , 10 mg Zn + 0.5 mg Cu as copper sulfate , or placebo . RESULTS The change in plasma zinc concentration from baseline was positively related to the zinc dose ( P < 0.001 ) . Zinc supplementation , including doses as low as 3 mg/d , reduced the incidence of diarrhea by 21 - 42 % ( P < 0.01 ) . There were no other significant group-wise differences . CONCLUSIONS Zinc supplementation with a dose as low as 3 mg/d increased plasma zinc concentrations and reduced diarrhea incidence in the study population . There were no observed adverse effects of 10 mg Zn/d on indicators of copper or iron status . The current tolerable upper level of zinc recommended by the Institute of Medicine should be reassessed for young children BACKGROUND Zinc supplementation decreases morbidity from infections and increases growth of stunted children  , but there is little information on functional responses to zinc delivered in fortified foods . OBJECTIVE The aim was to examine the effects of zinc fortification on the growth , morbidity from infections , and plasma zinc concentrations of young children . DESIGN We compared the physical growth , morbidity , and micronutrient status of 6 - 8-mo-old Peruvian children with initial length-for-age z score ( LAZ ) < -0.50 who were r and omly assigned to receive one of the following treatments daily for 6 mo : 1 ) 30 g dry weight of an iron-fortified cereal porridge and a separate dose of an aqueous multivitamin ( MV ) supplement between meals ( control group ) , 2 ) the same porridge and MV with 3 mg Zn added to the supplement dose ( ZnSuppl group ) , or 3 ) the porridge with added zinc ( 150 mg/kg dry weight ) and MV without zinc ( ZnFort group ) . RESULTS The children consumed a mean of 22 - 26 g dry porridge/d and 96 % of the possible MV doses . After adjustment for small baseline differences in socioeconomic status and morbidity , no significant differences in weight or length increments were observed between the groups , even among the subset with an initial LAZ < -1.5 , and no significant differences in the rates of common illnesses were observed . Mean plasma zinc concentrations decreased in the control group ( -3.9 microg/dL ) , increased in the ZnSuppl group ( 4.3 microg/dL ) , and did not change significantly in the ZnFort group ( -1.5 microg/dL ; P < 0.001 for group-wise comparison ) . CONCLUSIONS Provision of additional zinc , either in an aqueous supplement or a fortified porridge , did not significantly affect the children 's physical growth or morbidity from infections , possibly because they were not sufficiently growth-restricted or zinc-deficient initially or because the level of zinc intake or absorption was inadequate . Additional studies of the functional effect of zinc-fortified foods are needed in population s that are known to respond to zinc supplements The impact of zinc supplementation on the growth and body composition of Guatemalan infants was assessed in a community-based , double-blind intervention trial . Infants aged 6 - 9 mo were assigned r and omly to receive 4 mL of a beverage containing 10 mg of zinc as zinc sulfate ( n = 45 ) or a placebo ( n = 44 ) daily ( 7 d/wk ) for an average of 6.9 mo . The children 's weight , length , mid-upper arm and head circumferences , and triceps skinfolds were measured at baseline and at 1 - 2 mo intervals until the end of supplementation . Midarm muscle area ( MMA ) was derived from the mid-upper arm circumference and triceps skinfolds measurements . Maternal anthropometry and family socioeconomic and demographic characteristics also were obtained . Zinc supplementation was associated with an overall increase of 0.61 cm2 in MMA ( P = 0.02 ) . Children who received zinc supplements had a mean length increment that was 0.75 cm greater than those who did not ( P = 0.12 ) . However , there was a significant interaction between treatment group and initial length-for-age status ( P = 0.04 ) , such that supplemented children who were stunted at baseline ( length-for-age Z score less than -2 ) gained 1.40 cm more than stunted children who received the placebo . We conclude that zinc supplementation of these rural Guatemalan infants during 6 . 9 mo increased accretion of fat-free mass and enhanced the linear growth of those who were stunted at baseline . Further research is required to determine whether zinc supplementation during longer periods of time may achieve larger and more generalized effects on physical growth BACKGROUND Little is known about the benefits of prenatal multivitamin and mineral supplements in reducing  low birth weight .  OBJECTIVE We conducted a r and omized , double-blind clinical trial in semirural Mexico to compare the effects of multiple micronutrient ( MM ) supplements with those of iron supplements during pregnancy on birth size . DESIGN Pregnant women ( n = 873 ) were recruited before 13 wk of gestation and received supplements 6 d/wk at home , as well as routine antenatal care , until delivery . Both supplements contained 60 mg Fe , but the MM group also received 1 - 1.5 times the recommended dietary allowances of several micronutrients . RESULTS At recruitment , the women in the 2 groups were not significantly different in age , parity , economic status , height , or hemoglobin concentration but differed significantly in marital status ( 4.6 % and 2.0 % of women in the MM and iron-only groups , respectively , were single mothers ) and mean ( + /- SD ) body mass index ( in kg/m(2 ) ; 24.6 + /- 4.3 and 23.8 + /- 3.9 in the iron-only and MM groups , respectively ) . Losses to follow-up ( 25 % ) and compliance ( 95 % ) did not differ significantly between the groups . In intent-to-treat analyses ( MM group : n = 323 ; iron-only group : n = 322 ) , mean ( + /- SD ) birth weight ( 2.981 + /- 0.391 and 2.977 + /- 0.393 kg in the MM and iron-only groups , respectively ) and birth length ( 48.61 + /- 1.82 and 48.66 + /- 1.83 cm in the MM and iron-only groups , respectively ) did not differ significantly between the groups . CONCLUSION These findings suggest that MM supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation Studies have found a substantial reduction in diarrhea and respiratory morbidity in young children receiving zinc supplementation .  The impact of daily zinc supplementation administered with iron plus folic acid ( IFA ) in young children on all-cause hospitalizations and mortality in comparison with IFA alone was evaluated . In a double blind cluster-r and omized controlled trial , 94,359 subjects aged 1 - 23 mo were administered a daily dose of zinc plus IFA or IFA alone for a duration of 12 mo after enrollment . The intervention group tablet contained 10 mg of elemental zinc , 12.5 mg of iron , and 50 microg of folic acid . The control group tablets were similar except that they contained a placebo for zinc .  Infants aged < 6 mo were administered half a tablet , and those older received 1 tablet dissolved in breast milk or water . Hospitalizations were captured by trained study physicians through the surveillance of 8 hospitals . Deaths and hospitalizations were ascertained through visits to households by study supervisors once every 2 mo . The overall death rates did not differ significantly between the 2 groups when adjusted for cluster r and omization ( hazard ratio = 1.02 , 95 % CI 0.87 , 1.19 ) . Zinc and IFA supplementation compared with IFA alone did not affect adjusted hospitalization rates ( overall rate ratio = 1.08 , 95 % CI 0.98 , 1.19 ; diarrhea-specific rate ratio = 1.15 , 95 % CI 0.99 , 1.34 ; or pneumonia-specific rate ratio = 1.09 , 95 % CI 0.94 , 1.25 ) . The lack of impact of zinc on mortality and hospitalization rates in this study may have been due to the use of lower daily zinc dosing than used in some of the morbidity prevention trials or from an interaction between zinc and iron , where the addition of iron may have adversely affected potential effects of zinc on immune function and morbidity . Future research should address iron and zinc interaction effects on important functional outcomes BACKGROUND Little is known about how maternal zinc intake influences growth in utero and in postnatal life in humans . OBJECTIVE We aim ed to assess the effect of maternal zinc supplementation during pregnancy on infant growth through age 1 y. DESIGN A double-blind , r and omized controlled trial of prenatal zinc supplementation was conducted from 1995 to 1997 in Lima , Peru . Women ( n = 1295 ) were enrolled at 15.6 + /- 4.6 wk gestation and assigned to receive daily supplements with zinc ( 15 mg Zn + 60 mg Fe + 250 microg folic acid ) or without zinc ( 60 Fe + 250 microg folic acid ) through pregnancy to 1 mo after delivery . At birth , 546 infants were followed for 12 mo to assess growth . Anthropometric measures of body size and composition were collected monthly , and morbidity and dietary intake surveillance was carried out weekly . RESULTS No differences in maternal socioeconomic characteristics by treatment group or follow-up period were found . Infants born to mothers prenatally supplemented with zinc had significantly ( P < 0.05 ) larger average growth measures beginning in month 4 and continuing through month 12 . In longitudinal regression modeling , prenatal zinc was associated with greater weight ( by 0.58 + /- 0.12 kg ; P < 0.001 ) , calf circumference ( by 1.01 + /- 0.21 cm ; P < 0.001 ) , chest circumference ( by 0.60 + /- 0.20 cm ; P = 0.002 ) , and calf muscle area ( by 35.78 + /- 14.75 mm(2 ) ; P = 0.01 ) after adjustment for a range of covariates . No effect was observed for linear growth . CONCLUSION Maternal zinc supplementation in this population was associated with offspring growth , which is suggestive of lean tissue mass accretion We compared iron intake and iron nutritional status of two groups of healthy term infants who received meat-containing baby foods fortified with ferrous sulphate ( 2 mg Fe/100 g ) . One group received an Fe-fortified formula ( 1.6 mg Fe/100 kcal ) and the other a nonfortified formula . Fe intake of the group fed the nonfortified formula was significantly lower ( p less than 0.0001 ) . These infants received Fe mainly from fortification Fe with beikost ( 75 - 86 % ) and less than 10 % met the recommended intake of 1 mg.kg-1.d-1 ; whereas 80 - 85 % of the infants fed the Fe-fortified formula did . Hb , Hct , FEP , and ferritin were similar in both groups with the exception of lower ferritin values at age 365 d ( p less than 0.05 ) in the group fed the nonfortified formula . No infant had hemoglobin less than 100 g/L. We conclude that regular consumption of commercially prepared Fe-fortified beikost with meat prevents most healthy term infants from Fe deficiency even if Fe intake is substantially below the recommended intake The effects of zinc supplementation on levels of various blood constituents and the outcome of pregnancy  in 213 Hispanic women attending a prenatal clinic in Los Angeles was assessed in this double-blind study . The women were r and omized into either a control ( C ) or a zinc-supplemented ( Z ) group and received similar vitamin and mineral supplements except that 20 mg zinc was added to the Z group 's capsules . At the final interview , women ( C + Z ) with low serum Zn levels ( less than or equal to 53 micrograms/dl ) had higher ( p less than 0.01 ) mean ribonuclease activity and lower ( p less than 0.01 ) mean delta-aminolevulinic acid dehydratase activity than women with acceptable serum zinc levels . The incidence of pregnancy-induced hypertension was higher ( p less than 0.003 ) in the C than in the Z group , but pregnancy-induced hypertension was not associated with low serum zinc levels at either the initial or final interview . The expected increase in serum copper levels was greater ( less than 0.001 ) in women with pregnancy-induced hypertension ( C + Z ) than in normotensives . Except for pregnancy-induced hypertension , there was a higher incidence of abnormal outcomes of pregnancy in the noncompliers than in the compliers ( C + Z ) INTRODUCTION Anemia is the most prevalent nutritional deficiency in the world . Attempts to improve iron indexes are affected by deficiency of and interaction between other micronutrients . OBJECTIVE Our goal was to assess whether zinc added to iron treatment alone or with vitamin A improves iron indexes and affects diarrheal episodes . DESIGN This was a r and omized , placebo-controlled , double-blind trial conducted in Peru . Anemic children aged 6 - 35 mo were assigned to 3 treatment groups : ferrous sulfate ( FS ; n = 104 ) , ferrous sulfate and zinc sulfate ( FSZn ; n = 109 ) , and ferrous sulfate , zinc sulfate , and vitamin A ( FSZnA ; n = 110 ) . Vitamin A or its placebo was supplied only once ; iron and zinc were provided under supervision > /=1 h apart 6 d/wk for 18 wk . RESULTS The prevalence of anemia was 42.97 % . The increase in hemoglobin in the FS group ( 19.5 g/L ) was significantly less than that in the other 2 groups ( 24.0 and 23.8 g/L in the FSZn and FSZnA groups , respectively ) . The increase in serum ferritin in the FS group ( 24.5 mug/L ) was significantly less than that in the other 2 groups ( 33.0 and 30.8 mug/L in the FSZn and FSZnA groups , respectively ) . The median duration of diarrhea and the mean number of stools per day was significantly higher in the FS group than in other 2 groups ( P < 0.005 ) . CONCLUSION Adding zinc to iron treatment increases hemoglobin response , improves iron indexes , and has positive effects on diarrhea . No additional effect of vitamin A was found BACKGROUND It has been documented that growth patterns differ between breastfed and formula-fed infants . Some investigators have suggested that these differences may be related to differences in zinc nutriture . OBJECTIVE The objective of this study was to examine the effect of zinc supplementation on growth , morbidity , and motor development in healthy , term , breastfed infants . DESIGN We conducted a r and omized double-blind intervention comparing zinc supplementation ( 5 mg/d as zinc sulfate ) with placebo in breastfed infants aged 4 - 10 mo .  Growth and indexes of body composition and gross motor development were measured monthly from 3 to 10 mo . Morbidity data were collected weekly . RESULTS Eighty-five infants were enrolled , and 70 completed the study . The baseline characteristics , attained weight or length at 10 mo , growth velocity , gross motor development , and morbidity did not differ significantly between groups , even after control for potentially confounding variables . CONCLUSIONS The dietary zinc intake of these breastfed infants appeared to be adequate , given that zinc supplementation did not affect growth , development , or risk of infection ( although sample size for detection of differences in development or infection was limited ) . Previously described differences in growth between breastfed and formula-fed infants in such population s do not appear to be due to differences in zinc nutriture A r and omized , double-blind , placebo-controlled trial was performed to assess the efficacy of different micronutrient supplementation regimes for improving micronutrient status , preventing anemia , and growth faltering of Vietnamese infants . A population -based sample of 306 infants aged 6 - 12 mo , split in 4 treatment groups , received daily multiple micronutrient ( DMM ) , daily placebo ( P ) , weekly multiple micronutrient ( WMM ) , or daily iron ( DI ) supplements for 6 mo , 7 d/wk , under supervision . Weight and length were measured monthly , and anemia and plasma levels of ferritin , zinc , riboflavin , retinol , tocopherol , and homocysteine were determined before and after the supplementation . Z-scores for length-for-age and weight-for-age worsened significantly in all groups , but the length-for-age Z-score decreased significantly less in the DMM group ( -0.32 + /- 0.05 ) than in the P and WMM groups ( -0.49 + /- 0.05 and -0.51 + /- 0.05 , respectively , P = 0.001 ) . Hemoglobin levels increased significantly more in the DMM group [ mean ( 95%CI ) : 16.4 g/L ( 12.4 - 20.4 ) ] than in the P group [ 8.6 g/L ( 5.0 - 12.2 ) , P = 0.04 ) , with intermediate nonsignificant increases in the WMM [ 15.0 g/L ( 11.5 - 18.5 ) ] and the DI [ 12.9 g/L ( 8.4 - 17.3 ) ] groups . Ferritin changes were significantly greater in DMM ( 12.1 microg/L ) and DI ( 9.5 microg/L ) than in P ( -14.7 microg/L ) and WMM groups ( -9.7 microg/L ) . Of the other micronutrients , only tocopherol showed a significantly greater level in the DMM group compared with P. Anemia still affected a quarter and zinc deficiency affected a third of infants although there was no iron deficiency after 6 mo of supplementation with DMM , suggesting that multiple factors are causing anemia and that the dose of zinc is too small BACKGROUND Combined supplementation with iron and zinc during infancy may be effective in preventing deficiencies of these micronutrients , but knowledge of their potential interactions when given together is insufficient . OBJECTIVE The goal was to compare the effect in infants of combined supplementation with iron and zinc  and of supplementation with single micronutrients on  iron and zinc status . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe + 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Venous blood sample s were collected at the start and end of the study . Five hundred forty-nine infants completed the supplementation and had both baseline and follow-up blood sample s available for analysis . RESULTS Baseline prevalences of anemia , iron deficiency anemia ( anemia and low serum ferritin ) , and low serum zinc ( < 10.7 micromol/L ) were 41 % , 8 % , and 78 % , respectively . After supplementation , the Fe group had higher hemoglobin ( 119.4 compared with 115.3 g/L ; P < 0.05 ) and serum ferritin ( 46.5 compared with 32.3 microg/L ; P < 0.05 ) values than did the Fe+Zn group , indicating an effect of zinc on iron absorption . The Zn group had higher serum zinc ( 11.58 compared with 9.06 micromol/L ; P < 0.05 ) than did the placebo group . There was a dose effect on serum ferritin in the Fe and Fe+Zn groups , but at different levels . There was a significant dose effect on serum zinc in the Zn group , whereas no dose effect was found in the Fe+Zn group beyond 7 mg Zn/d . CONCLUSION Supplementation with iron and zinc was less efficacious than were single supplements in improving iron and zinc status , with evidence of an interaction between iron and zinc when the combined supplement was given A community-based , double-blind , r and omized trial was conducted in a population of low socioeconomic status in urban India to determine whether daily zinc supplementation reduces the incidence and prevalence of acute diarrhea , especially in those with zinc deficiency . Children 6 - 35 mo of age were r and omly assigned to  zinc ( n = 286 ) and control ( n = 293 ) groups and received a supplement daily for 6 mo . Zinc gluconate ( 10 mg elemental Zn ) was given , with both zinc and control groups also receiving multivitamins . The primary outcome measures determined by home visits every fifth day and physician examinations were the number of acute diarrheal episodes ( incidence ) and total diarrheal days ( prevalence ) .  Zinc supplementation had no effect in children 6 - 11 mo old . In children aged > 11 mo there was significantly less diarrhea in the zinc group . In boys > 11 mo old , supplementation result ed in a 26 % ( 95 % CI : 13 % , 38 % ) lower diarrheal incidence and a 35 % ( 95 % CI : 20 % , 50 % ) lower prevalence . In zinc-supplemented girls > 11 mo of age , the incidence was 17 % ( 95 % CI : 2 % , 30 % ) lower and the prevalence was 19 % ( 95 % CI : 4 % , 47 % ) lower . Overall , zinc supplementation result ed in a 17 % ( 95 % CI : 1 % , 30 % ) lower diarrheal incidence in children with plasma zinc concentrations < 9.18 mumol/L at enrollment and a 33 % ( 95 % CI : 6 % , 52 % ) lower incidence in children with concentrations < 50 mumol/L. In conclusion , zinc supplementation had a significant effect on acute diarrheal morbidity in children > 11 mo old and in children with low plasma zinc concentrations Anemia , micronutrient deficiencies , and growth faltering are still common in Peru . The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure , anemia , and  micronutrient deficiencies  in Peruvian infants . Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind , masked , controlled trial in which they were r and omly assigned to receive either a daily dose of iron ( DI ) , a daily dose of multiple micronutrients ( DMM ) , a weekly dose of multiple micronutrients , or a placebo ( P ) for 6 mo . None of the supplements tested prevented growth faltering or the morbidities common during infancy . Anemia and plasma homocysteine concentrations fell significantly in all groups during the study , but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups , and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups . Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron ( DI and DMM ) . There were no significant differences among groups in mean final values or changes in plasma zinc , retinol , tocopherol , or riboflavin . Although the DMM intervention was the most efficacious for preventing anemia , iron , and zinc deficiencies , 15 % , 20 % , and 50 % of this group still remained anemic , zinc deficient , and iron deficient , respectively , at the end of the study . Further research thus should investigate whether higher doses of iron and zinc , together with infection control measures , are more efficacious Iron and zinc deficiencies have been associated with delayed motor development in nutritionally at-risk children , albeit inconsistently . In this community-based , r and omized double-blind trial , iron+folic acid ( FeFA ) ( 12.5 mg Fe + 50 mug folic acid ) , zinc ( Zn ) ( 10 mg ) , and iron+folic acid+zinc ( FeFA+Zn ) supplements or a placebo were given daily for 1 y to nutritionally at-risk children in Pemba , Zanzibar . The effects of these treatments on attaining unassisted walking were evaluated using survival analysis for 354 children aged 5 - 11 mo at the start of supplementation . Treatment effects on changes in hemoglobin ( Hb ) and zinc protoporphyrin ( ZPP ) and height-for-age ( HAZ ) and weight-for-age ( WAZ ) Z scores were evaluated using linear regression . Attained motor milestone was recorded every 2 wk for 1 y. Hb , ZPP , HAZ , and WAZ were measured at baseline and after 6 mo of treatment . FeFA with or without Zn reduced the time it took for children to walk assisted . Children who received any iron  walked unassisted sooner than those who received no iron [ median difference approximately 15 d , P = 0.035 , risk ratio ( RR ) = 1.28 , 95 % CI = 1.02 , 1.61 ] and this effect was stronger in those who had iron deficiency anemia ( IDA ) at baseline ( median difference was approximately 30 d ; P = 0.002 ; RR = 1.68 ; 95 % CI = 1.21 , 2.32 ) . FeFA alone and Zn alone improved Hb and ZPP compared with placebo . There were no significant treatment effects on changes in HAZ or WAZ . The effects of treatment on time to walking may have been mediated by improvements in iron status or hemoglobin , but were not mediated through improvements in growth In this study the effects of supplementation of iron and zinc , alone or combined , on iron status , zinc status and growth in Indonesian infants is investigated . Micronutrient deficiencies are prevalent in infants in developing countries , and deficiencies often coexist ; thus , combined supplementation is an attractive strategy . However , little is known about interactions between micronutrients . In a r and omized , double-blind , placebo-controlled supplementation trial , 478 infants , 4 mo of age , were supplemented for 6 mo with iron ( 10 mg/d ) , zinc ( 10 mg/d ) , iron + zinc ( 10 mg of each/d ) or placebo . Anthropometry was assessed monthly , and micronutrient status was assessed at the end of supplementation . Supplementation significantly reduced the prevalence of anemia , iron deficiency anemia and zinc deficiency . Iron supplementation did not negatively affect plasma zinc concentrations , and zinc supplementation did not increase the prevalence of anemia or iron deficiency anemia . However , iron supplementation combined with zinc was less effective than iron supplementation alone in reducing the prevalence of anemia ( 20 % vs. 38 % reduction ) and in increasing hemoglobin and plasma ferritin concentrations . There were no differences among the groups in growth . The growth of all groups was insufficient to maintain the same Z-scores for height for age and weight for height . There is a high prevalence of deficiencies of iron and zinc in these infants , which can be overcome safely and effectively by supplementation of iron and zinc combined . However , overcoming these deficiencies is not sufficient to improve growth performance in these infants Iron deficiency is prevalent in children and infants worldwide . Zinc deficiency may be prevalent , but data are lacking . Both iron and zinc deficiency negatively affect growth and psychomotor development . Combined iron and zinc supplementation might be beneficial , but the potential interactions need to be verified . In a r and omized , placebo-controlled trial using 2 x 2 factorial design , 609 Thai infants aged 4 - 6 mo were supplemented daily with 10 mg of iron and /or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth . Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined . Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined .  Baseline iron deficiency was very low , and iron deficiency anemia was almost nil . After supplementation , prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc .  Serum zinc was higher in infants receiving zinc ( 16.7 + /- 5.2 micromol/L ) , iron and zinc ( 12.1 + /- 3.8 micromol/L ) or iron alone ( 11.5 + /- 2.5 micromol/L ) than in the placebo group ( 9.8 + /- 1.9 micromol/L ) . Iron and zinc interacted to affect iron and zinc status , but not hemoglobin . Iron supplementation had a small but significant effect on ponderal growth , whereas zinc supplementation did not . To conclude , in Thai infants , iron supplementation improved hemoglobin , iron status , and ponderal growth , whereas zinc supplementation improved zinc status . Overall , for infants , combined iron and zinc supplementation is preferable to iron or zinc supplementation alone BACKGROUND Zinc supplements reduce  childhood morbidity in population s in whom zinc deficiency is common . In such population s , deficiencies in other micronutrients may also occur . OBJECTIVE The objective was to determine whether the administration of other micronutrients with zinc modifies the effect of  zinc supplementation on children 's morbidity and physical growth . DESIGN Two hundred forty-six children aged 6 - 35 mo with persistent diarrhea were r and omly assigned to 1 of 3 groups to receive a daily supplement of 10 mg Zn alone ( Zn ; n = 81 ) , zinc plus vitamins and other minerals at 1 - 2 times recommended daily intakes ( Zn+VM ; n = 82 ) , or placebo ( n = 83 ) for approximately 6 mo after the diarrhea episode ended . Morbidity information was collected on weekdays . Weight , length , and other anthropometric indicators were measured monthly , and plasma zinc and other indicators of micronutrient status were measured at baseline and 6 mo . RESULTS Supplement consumption was high ( approximately 90 % ) in all groups , although slightly more vomiting was reported in the Zn+VM group ( P < 0.0001 , analysis of variance ) . The change in plasma zinc from baseline to 6 mo was greater in the 2 zinc groups ( 6.1 , 27.3 , and 16.2 micro g/dL in the placebo , Zn , and Zn+VM groups , respectively ; P < 0.0001 , analysis of variance ) . The Zn group had fewer episodes of diarrhea , dysentery , and respiratory illness and a lower prevalence of fever and cough than did the Zn+VM group and a lower prevalence of cough than did the placebo group ( P = 0.05 ) . No significant effects of supplementation on growth were observed . CONCLUSION Morbidity was greater after supplementation with zinc plus multivitamins and minerals than it was after supplementation with zinc alone BACKGROUND The need for prophylactic iron during pregnancy is uncertain . OBJECTIVE We tested the hypothesis that administration of a daily iron supplement from enrollment to 28 wk of gestation to initially iron-replete , nonanemic pregnant women would reduce the prevalence of anemia at 28 wk and increase birth weight . DESIGN Between June 1995 and September 1998 , 513 low-income pregnant women in Clevel and were enrolled in the study before 20 wk of gestation . Of these , 275 had a hemoglobin concentration > /= 110 g/L and a ferritin concentration > /= 20 micro g/L and were r and omly assigned to receive a monthly supply of capsules containing either 30 mg Fe as ferrous sulfate or placebo until 28 wk of gestation . At 28 and 38 wk of gestation , women with a ferritin concentration of 12 to < 20 micro g/L or < 12 micro g/L received 30 and 60 mg Fe/d , respectively , regardless of initial assignment . Almost all the women received some supplemental iron during pregnancy . We obtained infant birth weight and gestational age at delivery for 117 and 96 of the 146 and 129 women r and omly assigned to receive iron and placebo , respectively . RESULTS Compared with placebo , iron supplementation from enrollment to 28 wk of gestation did not significantly affect the overall prevalence of anemia or the incidence of preterm births but led to a significantly higher mean ( + /- SD ) birth weight ( 206 + /- 565 g ; P = 0.010 ) , a significantly lower incidence of low-birth-weight infants ( 4 % compared with 17 % ; P = 0.003 ) , and a significantly lower incidence of preterm low-birth-weight infants ( 3 % compared with 10 % ; P = 0.017 ) . CONCLUSION Prenatal prophylactic iron supplementation deserves further examination as a measure to improve birth weight and potentially reduce health care costs Although iron deficiency is the most common single-nutrient deficiency in infants and children , other deficiencies may develop concurrently , including zinc deficiency . In previous studies , we used home-fortification with " Sprinkles , " single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods , to successfully treat anemia . This mode of micronutrient delivery is amenable to the delivery of other micronutrients . However , the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions . Thus , we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants , compared with Sprinkles formulated with iron alone . We studied 304 anemic infants ( mean age 10.3 + /- 2.5 mo ; hemoglobin 87.4 + /- 8.4 g/L ) in rural Ghana . A combined supplementation group ( FeZn ) received daily Sprinkles containing 80 mg iron and 10 mg zinc ; a comparison group ( Fe ) received Sprinkles ( 80 mg iron ) without zinc for 2 mo . The rate of recovery from anemia was higher in the Fe group compared with the FeZn group ( 74.8 vs. 62.9 % ; P = 0.048 ) . The plasma zinc concentration decreased significantly in both groups ( P < 0.05 ) . A significant decline in the height for age Z-score was observed in the FeZn group ( P = 0.0011 ) , but there was no change in the Fe group . These results suggest that in a controlled setting , home-fortification using micronutrient Sprinkles with iron , or iron and zinc , was very successful in treating anemia ; however , this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population BACKGROUND Iron deficiency anemia ( IDA ) is common in pregnant women , but previous trials aim ed at preventing IDA used high-dose iron supplements that are known to cause gastrointestinal side effects . OBJECTIVE The objective was to assess the effect on  maternal IDA and iron deficiency ( ID , without anemia ) of supplementing pregnant women with a low dosage ( 20 mg/d ) of iron . Effects on iron status were assessed at the time of delivery and at 6 mo postpartum . Gastrointestinal side effects were assessed at 24 and 36 wk of gestation . DESIGN This was a r and omized , double-blind , placebo-controlled trial of a 20-mg daily iron supplement ( ferrous sulfate ) given from 20 wk of gestation until delivery . RESULTS A total of 430 women were enrolled , and 386 ( 89.7 % ) completed the follow-up to 6 mo postpartum . At delivery , fewer women from the iron-supplemented group than from the placebo group had IDA [ 6/198 , or 3 % , compared with 20/185 , or 11 % ; relative risk ( RR ) : 0.28 ; 95 % CI : 0.12 , 0.68 ; P < 0.005 ] , and fewer women from the iron-supplemented group had ID ( 65/186 , or 35 % , compared with 102/176 , or 58 % ; RR : 0.60 ; 95 % CI : 0.48 , 0.76 ; P < 0.001 ) . There was no significant difference in gastrointestinal side effects between groups . At 6 mo postpartum , fewer women from the iron-supplemented group had ID ( 31/190 , or 16 % , compared with 51/177 , or 29 % ; RR : 0.57 ; 95 % CI : 0.38 , 0.84 ; P < 0.005 ) . The rate of IDA between the groups did not differ significantly at 6 mo postpartum . CONCLUSION Supplementing the diet of women with 20 mg Fe/d from week 20 of pregnancy until delivery is an effective strategy for preventing IDA and ID without side effects Serum zinc and iron concentrations in a group of pregnant teen-agers supplemented with a multivitamin  were compared during pregnancy with a group supplemented with a multivitamin containing 18 mg Fe . Serum measurements were at 13 wk of gestational age ( pre study ) and during supplementation at 20 , 32 , and 38 wk , delivery , and 4 and 12 wk postpartum . Hematocrit measurements were used to adjust the measured metal concentrations for the diluting effect of the normal blood-volume increase . The non-Fe-group mean , adjusted serum Zn concentrations showed no change , but the serum Fe decreased to 28 % below pre study concentrations at 38 wk . In contrast , the Fe-supplementation group showed a progressive increase in Fe concentrations to a maximum of 38 % above pre study concentrations at 4 wk postpartum and a 35 % decrease from pre study Zn concentrations during the third trimester . The results of this study suggest that 18 mg Fe/d is adequate supplementation for nonanemic teen-age pregnancy and depresses the serum Zn concentration BACKGROUND Deficiencies of iron and zinc are associated with delayed development , growth faltering , and increased infectious-disease morbidity during infancy and childhood . Combined iron and zinc supplementation may therefore be a logical preventive strategy . OBJECTIVE The objective of the study was to compare the effects of combined iron and zinc supplementation in infancy with the effects of iron and zinc as single micronutrients on growth , psychomotor development , and incidence of infectious disease . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe and 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Anthropometric indexes , developmental indexes ( Bayley Scales of Infant Development ; BSID ) , and morbidity were recorded . RESULTS At 12 mo , two-factor analysis of variance showed a significant interaction between iron and zinc for weight-for-age z score , knee-heel length , and BSID psychomotor development . Weight-for-age z score was higher in the Zn group than in the placebo and Fe+Zn groups , knee-heel length was higher in the Zn and Fe groups than in the placebo group , and the BSID psychomotor development index was higher in the Fe group than in the placebo group . No significant effect on morbidity was found . CONCLUSIONS Single supplementation with zinc significantly improved growth , and single supplementation with iron significantly improved growth and psychomotor development , but combined supplementation with iron and zinc had no significant effect on growth or development . Combined , simultaneous supplementation with iron and zinc to infants can not be routinely recommended at the iron-to-zinc ratio used in this study OBJECTIVE The objective of this study was to evaluate the effect of daily and weekly iron supplementation compared with control on hemoglobin values and  anemia prevalence in infants . METHODS In this cluster-r and omized study , we evaluated infants aged 12 - 24 months ( n = 210 ) from three public daycare centers , during 4 months . Intervention-group A was allocated 25 mg elemental iron once weekly ; intervention-group B received 12.5 mg elemental iron once daily ; control-group C received 0.5 ml of a natural color additive .  Hemoglobin was assessed before and after intervention . RESULTS Baseline mean hemoglobin was 8.81 ± 0.89 g/dl ( group A ) , 9.70 ± 1.56 g/dl ( group B ) and 10.96 ± 0.92 g/dl ( group C ) ; after intervention , mean hemoglobin was 10.03 ± 0.78 g/dl ( p < 0.0001 ) , 10.65 ± 0.97 g/dl ( p < 0.0001 ) and 11.30 ± 0.80 g/dl ( p = 0.0034 ) for groups A , B and C , respectively . Anemia prevalence was as follows : group A , 100 % at baseline and 83.3 % at end of study , p = 0.0001 ; group , B 75.0 % and 41.7 % , p = 0.0002 ; group C , 50.0 % and 37.5 % , p = 0.182 . CONCLUSIONS Weekly and daily iron supplementation were effective in increasing hemoglobin levels and reducing anemia in infants OBJECTIVE To evaluate the impact of 4 months of daily zinc supplementation on the incidence of  severe and recurrent diarrhea in children 6 to 30 months of age . METHODS A double-blind , r and omized , placebo-controlled trial was conducted on children who were identified by a door-to-door survey to be aged 6 to 30 months and residing in the urban slum of Dakshinpuri , New Delhi . They were r and omized to receive daily zinc gluconate ( elemental zinc 10 mg to infants and 20 mg to older children  ) or placebo . A field attendant administered the syrup daily at home for 4 months except on Sundays , when the mother did so . One bottle that contained 250 mL was kept in the child 's home and replaced monthly . Field workers visited households every seventh day during the 4-month follow-up period . At each visit , information was obtained for the previous 7 days on history of fever , number and consistency of stools , and presence of cough . When the child was ill , illness characteristics and treatment seeking outside the home were determined . If the child had diarrhea or vomiting , then dehydration was assessed . At household visits , 2 packets of oral rehydration salts were given when a child had diarrhea . Children who visited the study clinic spontaneously for illness or were referred by the field workers were treated according to the st and ard national program guidelines . Antibiotics were advised only for diarrhea with bloody stools or for associated illnesses . For using generalized estimating equations for longitudinal analysis of a recurring event such as diarrhea , the follow-up data for each child was divided into 17 child-periods of 7 days each and presence or absence of an incident episode of diarrhea or severe diarrhea within each 7-day period was coded . This method of analysis does not assume independence of events and therefore prevents underestimation of variance that results because of correlation of morbidity within the same child . A logistic generalized estimating equations model with exchangeable correlation covariance-variance matrix was then used to estimate the effect size . RESULTS Zinc or placebo doses were administered on 88.8 % and 91.2 % , respectively , of study days during the 4 months of follow-up . There was a small but significant increase in the average number of days with vomiting in the zinc group ( 4.3 [ st and ard deviation ( SD ) : 5.8 ] vs 2.6 [ SD 3.9 ] days ; difference in means : 1.7 [ 95 % confidence interval ( CI ) : 1.3 - 2.1 ] days ) . At the baseline , mean plasma zinc was 62.0 microg/dL ( SD : 14.3 microg/dL ) in the zinc and 62.0 microg/dL ( SD : 11.2 microg/dL ) in the placebo group ; 45.8 % and 42 % , respectively , had low plasma zinc levels below 60 microg/dL. At the end of the study , plasma zinc levels were substantially higher in the zinc group ( ratio of geometric means : 1.94 [ 95 % CI : 1.86 - 2.03 ] ) and the proportion with low plasma zinc was lower ( difference in proportions : -46.7 % [ 95 % CI : -41.8 % to -51.4 % ] ) . The incidence of diarrhea during follow-up was lower in the zinc-supplemented as compared with the placebo group ( odds ratio [ OR ] : 0.88 ; 95 % CI : 0.82 - 0.95 ) . The beneficial impact of zinc was greater on the incidence of diarrhea with progressively increasing duration : episodes of diarrhea that lasted 1 to 6 days ( OR : 0.92 ; 95 % CI : 0.85 - 1.00 ) , 7 to 13 days ( OR : 0.79 ; 95 % CI : 0.65 - 0.95 ) , and > or = 14 days ( OR : 0.69 ; 95 % CI : 0.48 - 0.98 ) . The impact was also greater on the incidence of episodes with progressively higher stool frequency : 3 to 5 stools per day ( OR : 0.90 ; 95 % CI : 0.83 - 0.98 ) , 6 to 9 stools per day ( OR : 0.87 ; 95 % CI : 0.77 - 0.98 ) , and > or = 10 per day ( OR : 0.77 ; 95 % CI : 0.63 - 0.94 ) . In the zinc group , significantly more children experienced no diarrheal episode during the study period ( risk ratio [ RR ] : 1.22 ; 95 % CI : 1.02 - 1.44 ) . Furthermore , substantially fewer children ( RR : 0.51 ; 95 % CI : 0.36 - 0.73 ) experienced recurrent diarrhea , defined as > 6 diarrheal episodes in the follow-up period as compared with children in the placebo group . The number of children who were hospitalized for any cause tended to be lower in the zinc group , but the difference was not statistically significant ( 1.79 % vs 2.43 % ; RR : 0.74 ; 95 % CI : 0.43 - 1.27 ) . The baseline mean plasma copper ( microg/dL ) was similar in the 2 groups ( difference in means : 1.6 ; 95 % CI : -2.9 to 6.1 ) . The end study plasma copper levels were significantly lower in the zinc group ( difference in means : -15.5 ; 95 % CI : -19.9 to - 11.1 ) . CONCLUSIONS Zinc supplementation substantially reduced the incidence of severe and prolonged diarrhea , the 2 important determinants of diarrhea-related mortality and malnutrition . This intervention also substantially reduced the proportion of children who experienced recurrent diarrhea . Prompt measures to improve zinc status of deficient population s are warranted . The potential approaches to achieve this goal include food fortification , dietary diversification , cultivation of plants that are zinc dense or have a decreased concentration of zinc absorption inhibitors , and supplementation of selected groups of children . Future studies should assess the impact of increased zinc intakes on childhood  mortality in developing countries . For facilitating intervention , there is a need to obtain reliable estimates of zinc deficiency , particularly in developing countries . The functional consequences of the effect of various doses of zinc on plasma copper levels merits additional study Objective : Exclusive breastfeeding is recommended till 6 months age . Factors regulating the breastmilk iron and lactoferrin levels are incompletely known . Considering high prevalence of nutritional anemia in lactating mothers , we studied the iron status of lactating mothers , their breastmilk iron and lactoferrin levels to determine any relationship between them . Design : Prospect i ve study with 6 months follow-up . Setting : Tertiary care referral hospital . Subjects : Hundred nonanemic and 100 anemic mothers with their babies recruited at birth . Fifty-two nonanemic and 50 anemic mothers and their babies completed the 6-month follow-up . Interventions : Hemoglobin ( Hb ) , total iron binding capacity ( TIBC ) , percent transferrin saturation ( % TS ) , serum iron ( SI ) and serum ferritin measured on day 1 and 6 months postpartum . Breastmilk iron and lactoferrin  measured on day 1 , 14 weeks and 6 months after delivery . Results : Breastmilk iron decreased progressively from day 1 to 14 weeks and at 6 months in both groups , but no significant difference was noted between nonanemic and anemic mothers ( P>0.05 ) . Significant decline in breastmilk lactoferrin concentration from day 1 to 14 weeks in nonanemic and anemic mothers ( P<0.001 ) noted . Hemoglobin , TIBC , % TS , SI and serum ferritin of both groups had no correlation with breastmilk iron and lactoferrin concentration on day 1 , 14 weeks and 6 months after delivery . Conclusions : Breastmilk iron and lactoferrin concentration had no relationship with the mother 's Hb and iron status . Sponsorship : This work was carried out as part of thesis research under University of Delhi BACKGROUND Prenatal supplementation with micronutrients may increase birth weight and thus improve infant health and survival in setting s where infants and children are at risk of micronutrient deficiencies . OBJECTIVE To assess whether vitamin A and /or zinc supplementation given during pregnancy can improve birth weight , birth length , neonatal morbidity , or infant mortality . METHODS A double-blind , r and omized controlled trial supplementing women ( n = 2173 ) in Central Java , Indonesia throughout pregnancy with vitamin A , zinc , combined vitamin A+zinc , or placebo . RESULTS Out of 2173 supplemented pregnant women , 1956 neonates could be evaluated . Overall , zinc supplementation improved birth length compared to placebo or combined vitamin A+zinc ( 48.8 vs. 48.5 cm , p = 0.04 ) ; vitamin A supplementation improved birth length compared to placebo or combined vitamin A+zinc ( 48.7 vs. 48.2 cm , p = 0.04 ) . These effects remained after adjusting for maternal height , pre-pregnancy weight , and parity . There was no effect of supplementation on birth weight , the proportion of low birth weight , neonatal morbidity , or mortality . CONCLUSIONS Prenatal zinc or vitamin A supplementation demonstrates a small but significant effect on birth length , but supplementation with zinc , vitamin A or a combination of zinc and vitamin A , have no effect on birth weight , neonatal morbidity , or mortality Serum ferritin has been measured by a two-site immunoradiometnic assay employing antibody-coated polystyrene tubes . Normal values were established by performing measurements in male and female subjects between 20 and 50 years of age in whom iron-deficient erythropoiesis was excluded on the basis of transferrin saturation and red cell protoporphyrin . The serum fernitin was log-normally distributed with a geometric mean of 94 ng/ml in 174 males and 34 ng/ml in 152 females . Additional studies were performed in 83 healthy women to determine the relationshipbetween serum ferritin and iron stores measured by radioiron absorption . A high correlation between these measurements indicates that the serum ferritin is a useful survey tool for the initial assessment and prospect i ve monitoring of iron stores in a normal population . Am . J. Clin . Nutr . 27 : 681 -687 , 1974 After age 6 mo , the combination of breast-feeding and unfortified plant-based complementary feeding provides inadequate zinc ( Zn ) . Additionally , high phytate intakes compromise the bioavailability of zinc . Our principal objective in this r and omized controlled , doubly masked trial was to determine the effect of substituting low-phytate maize , a daily 5-mg zinc supplement , or both , in infants between ages 6 - 12 mo on impaired linear growth velocity , a common feature of zinc deficiency . In the Western Highl and s of Guatemala , 412 infants were r and omized to receive low-phytate or control maize .  Within each maize group , infants were further r and omized to receive a zinc supplement or placebo .  Length , weight , and head circumference were measured at 6 , 9 , and 12 mo of age . There were no significant differences between the 2 maize groups or between the Zn supplement and placebo groups and no treatment interaction was observed for length-for-age ( LAZ ) , weight-for-length ( WLZ ) or head circumference Z-scores . Overall mean ( + /- SD ) Z-scores at 6 mo for combined treatment groups were : LAZ , -2.1 + /- 1.1 ; WLZ , 0.7 + /- 1.0 ; and head circumference Z-score , -0.7.0 + /- 1.0 . At 12 mo , these had declined further to : LAZ , -2.5 + /- 1.1 ; WLZ , -0.0 + /- 0.9 ; and head circumference Z-score , -0.9 + /- 1.1 ; 83.3 % were stunted and 2 % were wasted . Low linear growth in older Guatemalan infants was not improved with either low-phytate maize or a daily 5-mg zinc supplement . Low contribution of maize to the complementary food of the infants negated any potential advantage of feeding low-phytate maize OBJECTIVE To assess zinc absorption from dispersible tablets by investigating the effects of short-term zinc supplementation , provided either as zinc ( Zn ) sulfate dispersible tablets or solution , on changes in plasma Zn concentration in young children . STUDY DESIGN We conducted a r and omized , partially-masked , placebo-controlled trial in 451 children 6 to 23 months of age in Burkina Faso , r and omly assigned to receive a dispersible tablet containing 5 mg Zn , a Zn solution containing 5 mg Zn/5 mL , or a placebo solution , daily for 3 weeks . The main outcome measure was change in plasma zinc concentration after supplementation compared with baseline . RESULTS The mean plus or minus SD change in plasma Zn concentration ( μg/dL ) was significantly greater in both Zn supplemented groups ( tablets : 16.9±13.1μg/dL , liquid : 16.6±14.2 μg/dL ) , compared with the placebo group ( 0.2±10.9 μg/dL ; P<.001 , ANOVA ) . In both Zn supplemented groups , but not in the placebo group , change in plasma Zn concentration was progressively less with increasing age in months ( -0.79 μg/dL/mo and -1.15 μg/dL/mo , respectively ; P<.001 ) ; this effect did not differ in the Zn supplemented groups ( P=.18 ) . CONCLUSIONS Short-term supplementation results in a large increase in plasma Zn concentration , regardless of whether the additional Zn is provided as a dispersible tablet or solution BACKGROUND Stunting is highly prevalent in Ethiopia and many other developing countries but the reason for it is poorly understood . Zinc is essential for growth but diets in such countries often do not contain zinc in sufficient quantity or of sufficient bioavailability . Thus zinc deficiency may play a major role in stunting . The aim of the study was to investigate whether the low rate of linear growth of apparently healthy breastfed infants in a rural village in Ethiopia could be improved by zinc supplementation . METHODS A r and omised , double-blind , placebo-controlled trial was done on apparently healthy breastfed infants aged 6 - 12 months . 100 non-stunted ( length-for-age , Z score < -2 ) were matched for age and sex with 100 r and omly selected stunted ( > -2 ) infants . Infants , both stunted and non stunted , were matched by sex , age ( within 2 months ) and recumbent length ( within 3 cm ) for r and om assignment , to receive a zinc supplement ( 10 mg zinc per day , as zinc sulphate ) or placebo , 6 days a week for 6 months . Anthropometric measurements were taken monthly , data on illness and appetite were collected daily , and sample s of serum and hair were taken at the end of the intervention for the analysis of zinc . FINDINGS The length of stunted infants increased significantly more ( p<0.001 ) when supplemented with zinc ( 7.0 cm [ SE 1.1 ] ) than with placebo ( 2.8 cm [ 0.9 ] ) ; and the effect was greater ( p<0.01 ) than in non-stunted infants ( 6.6 [ 0.9 ] vs 5.0 [ 0.8 ] cm for the zinc and placebo groups respectively , p<0.01 ) . Zinc supplementation also increased the weight of stunted children ( 1.73 [ 0.39 ] vs 0.95 [ 0.39 ] kg for the corresponding placebo group , p<0.001 ) and of non-stunted children ( 1.19 [ 0.39 ] vs 1.02 [ 0.32 ] kg for the corresponding placebo group , p<0.05 ) . Zinc supplementation result ed in a markedly lower incidence of anorexia and morbidity from cough , diarrhoea , fever , and vomiting in the stunted children . The total number of these conditions per child was 1.56 and 1.11 in the stunted and non-stunted zinc supplemented children versus 3.38 and 1.64 in the stunted and non-stunted placebo-treated children , respectively . At the end of the intervention period , the concentrations of zinc in serum and hair of stunted infants , who had not been supplemented with zinc , were lower than the respective concentrations of zinc in serum and hair of their non-stunted counterparts . INTERPRETATION Combating zinc deficiency can increase the growth rate of stunted children  to that of non-stunted infants in rural Ethiopia . This would appear to be due , at least in part , to reduction in morbidity from infection and increased appetite The aim of this study was to determine the iron status of infants who consumed porridge cooked in water with added ferrous sulphate .  A total of 234 infants , aged 6 - 12 months , were recruited from 36 nurseries in the Democratic Peoples Republic of Korea ( DPRK North Korea ) and r and omly divided into iron ( Fe ) and placebo groups . At baseline , almost half the children had Hb<110 g/L and no significant differences between the two groups were found with regard to hemoglobin concentration and anemia prevalence . The Fe group received rice porridge fortified with 10 mg of iron ( as ferrous sulfate ) per day , added to the water in which the rice was cooked and the placebo group non-fortified cereal for 6 months . After which , the hemoglobin ( Hb ) , serum ferritin ( SF ) and packed cell volume ( PCV ) were measured and it was found that the proportion of children with anemia ( Hb<110 g/L ) was lower ( 24.3 % v 48.1 % p<0.01 ) , the Hb levels ( 117.6 g/L v 109.8 g/L p<0.001 ) and serum ferritin were higher ( 40.7 v 26.8 mcg/L p<0.001 ) ; and iron deficiency anemia ( Hb<110 g/L , SF<12 mcg/L ) was lower in the Fe group ( 3 % v 22 % p<0.001 ) when compared to the placebo group . Ferrous sulphate , added to the water in which rice was cooked , lowered the prevalence of iron deficiency anemia of infants in the DPRK with no adverse reactions . This simple fortification would be suitable as a nationwide program in the DPRK and other countries with large infant nurseries Background / Objective : The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children . Potential modifying factors , such as stunting , need to be addressed . The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence , and whether this differs between the strata of stunted or HIV-infected children . Methods : We analyzed data from a r and omized , controlled , double-blinded trial ( Clinical Trials.gov NCT00156832 ) of prophylactic micronutrient supplementation to children aged 6–24 months . Three cohorts of children : 32 HIV-infected children , 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers , received vitamin A , vitamin A plus zinc or multiple micronutrients , which included vitamin A and zinc . The main outcome was incidence of diarrhoea . Poisson regression was used in intent-to-treat analyses . Stratified analyses followed testing for statistical interaction between intervention and stunting . Results : We observed no significant differences in overall diarrhoea incidence among treatment arms . Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone ( 2.04 and 2.23 vs 3.92 episodes/year , respectively , P=0.024 ) . No meaningful subgroup analyses could be done in the cohort of HIV-infected children . Conclusions : Compared with vitamin A alone , supplementation with zinc and with zinc and multiple micronutrients , reduced diarrhoea morbidity in stunted rural South African children . Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups Ninety two normal birthweight infants aged 6 months entered a double blind controlled trial which compared a follow on formula milk with no added iron against the same formula milk containing 1.2 mg of iron per 100 ml . There was no significant difference in the social class or demographic characteristics of the two treatment groups or in the proportion of each group completing the trial . There was no difference between the two groups in the quantity of milk taken but the amounts taken lessened between 6 and 18 months of age . There was no difference between the two groups with respect to mean haemoglobin and median serum ferritin at 6 , 9 , 12 , 15 , and 18 months of age . Very few infants developed iron deficiency anaemia in either group but there was a tendency for serum ferritin levels to fall between 6 and 18 months of age in both groups . The results suggest that iron added to follow on milk was not an important source of dietary iron in the infants studied BACKGROUND Although uncommon , iron deficiency ( ID ) occurs in breastfed infants . The regular provision of iron may prevent ID . OBJECTIVE The objective was to test the feasibility and effectiveness of 2 modalities of providing iron ( medicinal iron or iron-fortified cereal ) to breastfed infants . The study tested the hypothesis that regular provision of iron improves iron status of breastfed infants without adverse effects . DESIGN In this prospect i ve , r and omized , open-label trial , breastfed infants received on a regular basis either medicinal iron ( n = 48 ) or an iron-fortified fruit-cereal combination ( n = 45 ) from 4 to 9 mo or no intervention ( control group ; n = 59 ) . The interventions provided 7.0 - 7.5 mg ferrous sulfate/d . Infants were enrolled at 1 mo and were followed to 2 y. Iron-status indicators were determined periodically , stool characteristics were recorded , and growth was monitored . RESULTS The regular provision of iron led to improved iron status during and for some months after the intervention . Both sources of iron were about equally effective . Iron affected stool color but had no effect on feeding-related behavior . However , medicinal iron was associated with a small but significant reduction in length gain and a trend toward reduced weight gain . ID anemia was observed in 4 infants ( 2.3 % ) , most of whom had a low birth iron endowment .  Mild ID was common in the second year of life . CONCLUSIONS Regular provision of medicinal iron or iron-fortified cereal improves the iron status of breastfed infants and may prevent ID . Both modalities are equally effective , but medicinal iron leads to somewhat reduced growth . This trial was registered at Clinical Trials.gov as NCT00760890 We studied zinc nutrition in exclusively breast-fed infants whose growth deviated from the norm . Their number fell from 200 at birth to 116 at the age of 6 months and 36 at the age of 9 months . The mothers received 0 , 20 , or 40 mg Zn+ + as sulfate daily . Breast milk intake and concentrations of zinc in milk as well as in maternal and infant serum were measured . Individual zinc concentrations in milk showed channeling . The 20-mg supplement had no effect on the parameters measured . In contrast , 40 mg increased the maternal serum zinc concentration by 2 months and slowed the normal decline of milk zinc concentration by 6 months . Maternal supplementation had no effect on infant serum concen-trations ; they remained lower than adult levels throughout the 1st year of life .  Zinc intake was low ( about one-tenth of RDA ) , but it seemed to be adequate ; the serum concentrations of the infants were stable after the age of 2 months . Low zinc concentrations in serum were not associated with impaired growth . On the contrary , the infants with the highest rates of growth had the lowest zinc concentrations . The infant serum zinc concentrations were channeled , but they were also influenced by the zinc intake . Reference values for breast-fed infants are given OBJECTIVE To evaluate the effect of zinc supplementation on growth and development during infancy .  DESIGN We r and omized 150 term neonates of low socioeconomic status to receive supplemental zinc 5 mg/d  ( SG ) or a lactose placebo  ( PG ) ; 112 completed a 1-year follow-up . All were breast-fed and given cow milk formula after weaning ; solid foods and iron were added at 5 months . Anthropometry measured monthly , psychomotor development ( PDI ) , mental development ( MDI ) , and behavior including motor quality factor were assessed by Bayley Scales at 6 and 12 months . The groups were comparable in maternal characteristics , birth weight , home environment , and mother-infant interaction . RESULTS No effects of zinc on weight , length , and weight for length at 12 months were found controlling for sex and breast-feeding . The mean PDI ( SG : 84.5 + /- 11.5 vs PG : 87.6 + /- 9.9 ) and MDI ( 90.9 + /- 10.5 vs 88.9 + /- 9.1 ) were similar ; however , 46 of 52 infants in the PG scored < 100 in MDI vs 42 of 57 in the SG ( P < .05 ) . A smaller proportion of the SG , 2 of 57 , scored low in motor quality factor at 6 months compared with the PG , 8 of 52 ( P = .02 ) . The mean at 12 months for the SG was 31.9 + /- 2.8 and for the PG 30.8 + /- 2.9 ( P < .05 ) ; zinc supplementation entered the multiple regression at 12 months ( P = .037 ) . CONCLUSIONS Zinc supplementation may have a beneficial effect on mental development and motor quality behavior of healthy term infants In-home fortification of infants with micronutrient powders ( MNPs ) containing 12.5 mg iron may increase morbidity from infections ; therefore , an efficacious low-dose iron-containing MNP might be advantageous . Effects of iron-containing MNPs on infant growth are unclear . We assessed the efficacy of a low-iron MNP on iron status and growth and monitored safety in a r and omised , controlled , double-blind 1-year trial in 6-month-old infants ( n = 287 ) consuming daily a maize porridge fortified with either a MNP including 2.5 mg iron as NaFeEDTA ( MNP + Fe ) or the same MNP without iron ( MNP - Fe ) .  At baseline , after 6 and 12 months , we determined haemoglobin ( Hb ) , iron status [ serum ferritin ( SF ) , soluble transferrin receptor ( sTfR ) and zinc protoporphyrin ( ZPP ) ] , inflammation [ C-reactive protein ( CRP ) ] and anthropometrics . We investigated safety using weekly morbidity question naires asking for diarrhoea , cough , flu , bloody or mucus-containing stool and dyspnoea , and recorded any other illness . Furthermore , feeding history and compliance were assessed weekly . At baseline , 71 % of the infants were anaemic and 22 % iron deficient ; prevalence of inflammation was high ( 31 % had an elevated CRP ) . Over the 1 year , Hb increased and SF decreased in both groups , without significant treatment effects of the iron fortification . At end point , the weight of infants consuming MNP + Fe was greater than in the MNP - Fe group ( 9.9 vs. 9.5 kg , P = 0.038 ) . Mothers of infants in the MNP + Fe group reported more infant days spent with cough ( P = 0.003 ) and dyspnoea ( P = 0.0002 ) ; there were no significant differences on any other of the weekly morbidity measures . In this study , low-dose iron-containing MNP did not improve infant 's iron status or reduce anaemia prevalence , likely because absorption was inadequate due to the high prevalence of infections and the low-iron dose OBJECTIVES For bottle-fed babies or nursing infants who receive milk supplements , the American Academy of Pediatrics recommends the use of iron-fortified infant formula . Because these recommendations have not been universally adopted , the hematologic effects of currently available low-iron formulas need to be determined . STUDY DESIGN Healthy Chilean 6-month-old infants ( without iron-deficiency anemia , born at term weighing > or 3.0 kg ) who were totally or partially weaned from the breast were r and omly allocated in a double-blind fashion to receive high-iron ( n = 430 ) or low-iron formula ( n = 405 ) , containing an average of 12.7 mg/L or 2.3 mg/L , respectively , of elemental iron as ferrous sulfate . Iron status was determined at 12 months . RESULTS The prevalence of iron-deficiency anemia was not different in the high- and low-iron groups ( 2.8 % versus 3.8 % , p = 0.35 ) . Nevertheless , infants receiving high-iron formula had somewhat higher levels of hemoglobin and serum ferritin , greater mean cell volumes , and lower erythrocyte protoporphyrin levels ( p < 0.005 ) . CONCLUSIONS Although high-iron formulas are more efficacious in improving iron status , currently available low-iron formulas may prevent iron-deficiency anemia in selected healthy , term infant population s with otherwise poor sources of dietary iron after 6 months of life . Formulas with relatively small amounts of iron appear to prevent iron-deficiency anemia . We speculate that the optimal level of iron fortification likely lies somewhere between the current levels in high- and low-iron formulas Objective : To evaluate the effect of combined iron – zinc supplementation on micronutrient status , growth and morbidity . Design : R and omized , double-masked , placebo-controlled supplementation trial . Setting : Rural district of Que Vo , in the Red River Delta in Vietnam . Subjects : A total of 915 breast-fed infants aged 4–7 months were included and 784 completed the study . Interventions : The Fe-group received daily and for a 6-month period 10 mg of iron , the Zn-group 10 mg zinc , the Fe – Zn group 10 mg iron+10 mg zinc and the placebo group a placebo . Hemoglobin ( Hb ) , serum ferritin ( SF ) and zinc ( SZn ) , and anthropometry were measured before and at the end of the intervention . Morbidity was recorded daily . Results : Changes of Hb and SF were higher in both Fe and Fe+Zn groups ( respectively 22.6 and 20.6 g/l for Hb ; 36.0 and 24.8 μg/l for SF ) compared to Zn and placebo groups ( Hb : 6.4 and 9.8 g/l ; SF : −18.2 and −16.9 μg/l , P<0.0001 ) . SZn increased more in Zn group ( 10.3 μmol/l ) than in Fe+Zn group ( 8.0 μmol/l , P=0.03 ) and more in these groups compared to Fe and placebo groups ( 1.6 and 1.2 μmol/l , P<0.0001 ) . Weight gain was higher in the Zn group . No significant effects of supplementations on growth in length or morbidity . Conclusions : Combined iron – zinc supplementation had a positive effect on iron and zinc status in infants . However , the positive effect of zinc alone on SZn and weight would indicate a negative interaction of iron when added to zinc supplements . Sponsorship : UNICEF New York INTRODUCTION Iron deficiency is widespread in the developing world and is especially common in young children who live on the Indian subcontinent . Supplementation with iron and folic acid alleviates severe anaemia and enhances neurodevelopment in deficient population s , but little is known about the risks of mortality and morbidity associated with supplementation . METHODS We did a community-based , cluster-r and omised , double-masked , placebo-controlled , 2x2 factorial trial in children aged 1 - 36 months and residing in southern Nepal . We r and omly assigned children daily oral supplementation to age 36 months with : iron ( 12.5 mg ) and folic acid ( 50 microg ; n=8337 ) , zinc alone ( 10 mg ) , iron , folic acid , and zinc ( n=9230 ) , or placebo ( n=8683 ) ; children aged 1 - 11 months received half the dose . Our primary outcome measure was all-cause mortality , and our secondary outcome measures included cause-specific mortality and incidence and severity of diarrhoea , dysentery , and acute respiratory illness . Analyses were by intention to treat . This study is registered at , number NCT00109551 . FINDINGS The iron and folic acid-containing groups of the study were stopped early in November , 2003 , on the recommendation of the data and safety monitoring board ; mortality in these groups did not differ from placebo and there was low power to detect positive or negative effects by the time enrollment was completed . We continued to enroll children to the placebo and zinc alone groups . 25,490 children participated and analyses are based on 29,097.3 person-years of follow-up . There was no difference in mortality between the groups who took iron and folic acid without or with zinc when compared with placebo ( HR 1.03 , 95 % CI 0.78 - 1.37 , and 1.00 , 0.74 - 1.34 , respectively ) . There were no significant differences in the attack rates for diarrhoea , dysentery , or respiratory infections between groups , although all the relative risks except one indicated modest , non-significant protective effects . INTERPRETATION Daily supplementation of young children in southern Nepal with iron and folic acid with or without zinc has no effect on their risk of death , but might protect against diarrhoea , dysentery , and acute respiratory illness BACKGROUND Malaria is a major cause of infant morbidity and mortality in sub-Saharan Africa , and is often complicated by severe anaemia . Resistance of Plasmodium falciparum to most affordable antimalarial drugs is an impediment to intermittent chemotherapy . We investigated the effect of presumptive intermittent treatment with amodiaquine and daily iron supplementation in infants on malarial fevers and anaemia , in a holoendemic area of Tanzania where malaria is largely resistant to chloroquine and sulfadoxine/ pyrimethamine . METHODS 291 infants aged 12 - 16 weeks who attended three clinics were r and omised to receive amodiaquine , iron supplementation , amodiaquine plus iron supplementation , or placebo . Over 6 months , we gave amodiaquine three times with intervals of 60 days ; oral iron supplementation was given daily . Malarial fevers and anaemia were monitored at bimonthly treatment visits and by self-reporting to health centres . FINDINGS The protective efficacy of intermittent amodiaquine treatment in prevention of malarial fevers and anaemia was 64.7 % ( 95 % CI , 42.4 - 77.2 ) and 67.0 % ( 95 % CI , 34.5 - 83.4 ) , respectively . Protective efficacy was similar in the group receiving amodiaquine plus iron supplementation . Infants receiving iron supplementation only were partly protected against anaemia ( protective efficacy 59.8 % ; 95 % CI , 23.4 - 78.9 ) , but not against malarial fevers . 4 months ' follow-up did not show rebound morbidity . We noted no haematological or clinical adverse effects . INTERPRETATION Presumptive intermittent treatment for malaria with amodiaquine reduced malarial fevers and anaemia in infants , in an area with high resistance to other antimalarials . Intermittent treatment strategies for malaria in highly endemic areas could be of great benefit to public health To combat iron deficiency manifesting around six months of age , iron-fortified complementary feeding has been recommended . In developing countries , in view of the poor bioavailability of iron from predominantly cereal-based diets and the high cost of fortification , medicinal iron supplementation is an alternative intervention . This double-blind r and omized  placebo-controlled trial was conducted from April 1999 to March 2000 in the Out-patient Department of a tertiary hospital in New Delhi , India , to evaluate the haematological effects of medicinal iron supplementation to breastfed young infants initiated on complementary feeding . One hundred healthy non-low birth-weight , predominantly breastfed infants aged 4 - 6 months were r and omized into two groups to receive either iron ( 2 mg/kg/day ) ( IS group ; n=49 ) or placebo drops ( P group ; n=51 ) beginning with the initiation of home-based non-fortified complementary feeding .  Haematological parameters and anthropometry of mothers and infants were measured at baseline and repeated for infants after four and eight weeks of recruitment . Seventy-one subjects ( 35 in the IS group and the 36 in P group ) came for the first follow-up , and of these , 43 ( 19 in the IS group and 24 in the P group ) reported for the second visit . The adjusted ( for maternal and baseline infant ferritin ) serum ferritin levels were significantly higher in the IS group at both the follow-ups ( p=0.006 ) . The adjusted ( for maternal ferritin and baseline infant ferritin ) change in haemoglobin was significantly higher only at the second follow-up ( 0.7 g/dL ; 95 % confidence interval [ CI ] 0.3 - 1.0 g/dL ) . The adjusted rise in haemoglobin was higher in initially anaemic infants ( at second follow-up by 1 g/dL ; 95 % CI 0.5 - 1.6 g/dL ) . Medicinal iron supplementation , at the time of initiating complementary feeding , to breastfed young infants result ed in an elevation of serum ferritin and haemoglobin . The response was higher in initially anaemic infants . From a programmatic perspective , evidence needs to be generated on the relative merits of selective ( anaemic ) versus general supplementation and daily versus weekly supplementation A 90-day r and omized , double-blind , placebo-controlled , pre-post trial was conducted in four groups of Indonesian children aged 12 - 24 months :  placebo , probiotic , zinc , and a combination of probiotic and zinc  ( n=12 per group ) . Microencapsulated Lactobacillus plantarum IS-10506 of dadih origin was supplemented at a dose of 10(10)CFU/day as a probiotic . Zinc was supplemented as 20 mg zinc sulfate monohydrate ( 8 mg zinc elemental ) . Blood and stool sample s were collected at baseline and at the end of the study period . Fecal sIgA was assessed by ELISA and serum zinc concentrations by ICP-MS . Fecal sIgA increased significantly in the probiotic group ( 30.33±3.32μg/g ; p<0.01 ) and in the combination probiotic and zinc group ( 27.55±2.28μg/g ; p<0.027 ) , as compared with the placebo group ( 13.58±2.26μg/g ) . Changes in serum zinc concentrations in the combination probiotic and zinc group showed the highest elevation at the end of the study period . A combination of probiotic L. plantarum IS-10506 at a dose of 10(10)CFU/day and 8 mg of elemental zinc supplementation showed a potential ability to improve the zinc status of pre-school children . Taken together , supplementation with the probiotic L. plantarum IS-10506 and zinc for 90 days result ed in a significantly increased humoral immune response , as well as improved zinc status , in young children BACKGROUND Beyond perinatal folic acid supplementation , the need for additional prenatal prophylaxis of iron with or without other micronutrients remains unclear . We aim to investigate the maternal and infant health effects of iron plus folic acid and multiple micronutrient supplements vs folic acid alone when provided to pregnant women with no or mild anemia . METHODS In this r and omized double-blind controlled trial , 18,775 nulliparous pregnant women with mild or no anemia were enrolled from 5 counties of northern China from May 2006 through April 2009 . Women were r and omly assigned to daily folic acid ( 400 μg ) ( control ) , folic acid-iron ( 30 mg ) , or folic acid , iron , and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery . Primary outcome was perinatal mortality . Secondary outcomes included neonatal and infant mortality , preterm delivery , birth weight , birth length , gestational duration , and maternal hemoglobin concentration and anemia . RESULTS A total of 92.7 % of women consumed 80 % to 100 % of supplements as instructed . On average , women consumed 177 supplements . Compared with daily prenatal folic acid , supplementation with iron-folic acid with or without other micronutrients did not affect the rate of perinatal mortality ( 8.8 , 8.7 , and 8.3 , respectively ) per 1000 births , and relative risks ( RRs ) were 1.00 ( 95 % CI , 0.68 - 1.46 ; P = .99 ) and 0.94 ( 95 % CI , 0.64 - 1.39 ; P = .76 ) , respectively . Risk of other adverse maternal and infant outcomes also did not differ , except that RRs for third-trimester maternal anemia were 0.72 ( 95 % CI , 0.63 - 0.83 ; P < .001 ) and 0.71 ( 95 % CI , 0.62 - 0.82 ; P < .001 ) , respectively . CONCLUSION Prenatal iron-folic acid and other micronutrient supplements provided to Chinese women with no or mild anemia  prevented later pregnancy anemia beyond any benefit conferred by folic acid alone but did not affect perinatal mortality or other infant outcomes . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00133744 BACKGROUND Anaemia caused by iron deficiency is common in children younger than age 5 years in eastern Africa . However , there is concern that universal supplementation of children with iron and folic acid in areas of high malaria transmission might be harmful . METHODS We did a r and omised , placebo-controlled trial , of children aged 1 - 35 months and living in Pemba , Zanzibar . We assigned children to daily oral supplementation with : iron ( 12.5 mg ) and folic acid ( 50 mug ; n=7950 ) , iron , folic acid , and zinc ( n=8120 ) , or placebo ( n=8006 ) ; children aged 1 - 11 months received half the dose . Our primary endpoints were all-cause mortality and admission to hospital . Analyses were by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59549825 . FINDINGS The iron and folic acid-containing groups of the trial were stopped early on Aug 19 , 2003 , on the recommendation of the data and safety monitoring board . To this date , 24 076 children contributed a follow-up of 25,524 child-years . Those who received iron and folic acid with or without zinc were 12 % ( 95 % CI 2 - 23 , p=0.02 ) more likely to die or need treatment in hospital for an adverse event and 11 % ( 1 - 23 % , p=0.03 ) more likely to be admitted to hospital ; there were also 15 % ( -7 to 41 , p=0.19 ) more deaths in these groups . INTERPRETATION Routine supplementation with iron and folic acid in preschool children in a population with high rates of malaria can result in an increased risk of severe illness and death . In the presence of an active programme to detect and treat malaria and other infections , iron-deficient and anaemic children can benefit from supplementation . However , supplementation of those who are not iron deficient might be harmful . As such , current guidelines for universal supplementation with iron and folic acid should be revised BACKGROUND Powders containing iron and other micronutrients are recommended as a strategy to prevent nutritional anaemia and other micronutrient deficiencies in children . We assessed the effects of provision of two micronutrient powder formulations , with or without zinc , to children in Pakistan . METHODS We did a cluster r and omised trial in urban and rural sites in Sindh , Pakistan . A baseline survey identified 256 clusters , which were r and omly assigned ( within urban and rural strata , by computer-generated r and om numbers ) to one of three groups : non-supplemented control ( group A ) , micronutrient powder without zinc ( group B ) , or micronutrient powder with 10 mg zinc ( group C ) . Children in the clusters aged 6 months were eligible for inclusion in the study . Powders were to be given daily between 6 and 18 months of age ; follow-up was to age 2 years . Micronutrient powder sachets for groups B and C were identical except for colour ; investigators and field and supervisory staff were masked to composition of the micronutrient powders until trial completion . Parents knew whether their child was receiving supplementation , but did not know whether the powder contained zinc . Primary outcomes were growth , episodes of diarrhoea , acute lower respiratory tract infection , fever , and incidence of admission to hospital . This trial is registered with Clinical Trials.gov , number NCT00705445 . RESULTS The trial was done between Nov 1 , 2008 , and Dec 31 , 2011 . 947 children were enrolled in group A clusters , 910 in group B clusters , and 889 in group C clusters . Micronutrient powder administration was associated with lower risk of iron-deficiency anaemia at 18 months compared with the control group ( odds ratio [ OR ] for micronutrient powder without zinc=0·20 , 95 % CI 0·11 - 0·36 ; OR for micronutrient powder with zinc=0·25 , 95 % CI 0·14 - 0·44 ) . Compared with the control group , children in the group receiving micronutrient powder without zinc gained an extra 0·31 cm ( 95 % CI 0·03 - 0·59 ) between 6 and 18 months of age and children receiving micronutrient powder with zinc an extra 0·56 cm ( 0·29 - 0·84 ) . We recorded strong evidence of an increased proportion of days with diarrhoea ( p=0·001 ) and increased incidence of bloody diarrhoea ( p=0·003 ) between 6 and 18 months in the two micronutrient powder groups , and reported chest indrawing ( p=0·03 ) . Incidence of febrile episodes or admission to hospital for diarrhoea , respiratory problems , or febrile episodes did not differ between the three groups . INTERPRETATION Use of micronutrient powders reduces iron-deficiency anaemia in young children . However , the excess burden of diarrhoea and respiratory morbidities associated with micronutrient powder use and the very small effect on growth recorded suggest that a careful assessment of risks and benefits must be done in population s with malnourished children and high diarrhoea burdens . FUNDING Bill & Melinda Gates Foundation OBJECTIVE The hypothesis that daily use of a prenatal supplement with iron from enrollment to third trimester to initially iron-replete , nonanemic pregnant women would reduce third-trimester anemia and improve birth outcomes was tested . STUDY DESIGN Eight hundred sixty-seven women in Raleigh , North Carolina , who were at < 20 weeks of gestation were enrolled ; 429 of these women had hemoglobin levels of > or = 110 g/L and ferritin levels of > or = 40 microg/L and were assigned r and omly to receive prenatal supplements with 30 mg of iron as ferrous sulfate ( n = 218 women ) or 0 mg of iron ( n = 211 women ) until 26 to 29 weeks of gestation . Intent-to-treat analysis was used for the outcomes of third-trimester iron status , birth weight , preterm birth , and small-for-gestational age . RESULTS Mean birth weight was higher by 108 g ( P = .03 ) , and the incidence of preterm delivery was lower ( 8 % vs 14 % ; P = .05 ) in the 30-mg group compared with the control group , respectively . Iron supplementation did not affect the prevalence of small-for-gestational age infants or third-trimester iron status . CONCLUSION Prophylactic iron supplementation that is begun early in pregnancy among low income women in the United States may have benefits beyond the reduction of iron deficiency anemia during pregnancy OBJECTIVE To assess the impact of zinc supplementation on  diarrheal morbidity and growth pattern of low birth weight ( LBW ) infants . METHODOLOGY In a r and omized , double-blind , placebo-controlled , community-based study conducted in the Tiljala slum of eastern Kolkata , India , between 1999 and 2001 , a birth cohort of 100 LBW infants was r and omly allocated into either an intervention group receiving 1 mL daily dose of 5 mg of elemental zinc as zinc sulfate in vitamin B complex-based syrup or a placebo group receiving an identical placebo of 1 mL of vitamin-based syrup from birth up to 1 completed year of age . Active weekly surveillance was conducted for detection of diarrhea . Anthropometric measurements of each child were recorded once every month as close to the child 's birth date as possible . Data were analyzed by using statistical software packages SPSSPC+ 4.0 ( SPSS , Inc , Chicago , IL ) and Epi Info 6.0 ( Centers for Disease Control and Prevention , Atlanta , GA ) . RESULTS Among the zinc-supplemented group , diarrheal incidence of 1.36 episodes per child per year were observed , whereas it was 1.93 episodes per child per year among the placebo group , giving a relative risk of 1.4 ( 95 % confidence interval : 1.02 - 2.00 ) . Linear growth and weight for age showed significant differences between the supplemented and placebo groups only at the end of 1 year . Interestingly , the impact of zinc supplementation was masked to a large extent by the protective action of breastfeeding . CONCLUSIONS The study showed that zinc supplementation had a beneficial impact on the incidence of diarrhea and also weight gain among LBW infants AIMS Iron deficiency anaemia is associated , in observational studies , with developmental disadvantage . This study tested the hypothesis that feeding iron supplemented formula from 9 to 18 months of age would improve developmental performance . SUBJECTS AND METHODS 493 healthy children aged 9 months being fed pasteurised cows ’ milk were recruited from three UK centres . They were r and omised to : cows ’ milk as before , formula containing 0.9 mg/litre iron , or formula containing 1.2 mg/litre iron , until 18 months of age . Bayley mental and psychomotor developmental indices were measured at 18 months , as were growth and haematological indices . RESULTS Children fed iron fortified formula had higher plasma ferritin concentrations , but there were no significant intergroup differences in development or growth . CONCLUSIONS There are no developmental or growth advantages in children given iron supplemented formula , but a benefit for a minority who were anaemic , or the possibility that a benefit may emerge at a later age , can not be excluded OBJECTIVES To determine whether continuing with zinc supplementation after zinc treatment ( ZT ) of an acute diarrhoea episode will result in additional clinical benefits beyond ZT alone . METHODS Children 6 - 23 months of age , living in an urban slum in Dhaka , Bangladesh with acute childhood diarrhoea ( ACD ) , were enrolled in a r and omized , double-blind field trial . All children received 10 days of ZT ( 20 mg/day ) and were then r and omized to zinc ( 10 mg/day ) or placebo supplementation for 3 months . Weekly follow-up of all children occurred over a period of 9 months . RESULTS A total of 353 subjects were enrolled , with 93 % of the zinc supplemented and 96 % of the placebo children followed for 9 months . The incidence density of ACD among those receiving zinc supplementation compared to those receiving placebo was reduced by 28 % ( 2.64 vs.3.66 episodes/p-y follow-up ) over the 3 months while on supplementation and by 21 % ( 2.05 vs.2.59 episodes/p-y follow-up ) over the 9 months of follow-up . There was no observed effect on the incidence of acute respiratory infections ( ARIs ) or on growth . CONCLUSIONS Zinc supplementation after treatment provides additional preventive ACD benefits to children in early childhood . Larger , effectiveness trials of this strategy are warranted Aim : To determine the role of zinc supplementation in reducing  diarrhoeal morbidity in children . Methods : A r and omized , double‐blind , community‐based intervention study was conducted in 280 rural children aged between 6 and 41 mo . Children were r and omly allocated into three groups . One group received a daily dose of 10 mg zinc for 5 d wk−1 , another group received 50 mg zinc once weekly and the remaining group received placebo . Zinc was supplemented for 16 wk from November 1999 . Diarrhoeal episodes were detected by weekly surveillance during the supplementation period . Results : Eighty diarrhoeal episodes were detected among 59 children in all 3 groups . The groups were compared with each other at baseline and as regard to the outcome variable ( incidence of diarrhoea ) . The proportion of children suffering from diarrhoea during the period was significantly lower in the zinc‐supplemented groups ( 15.8 % in daily and 16.5 % in weekly group ) than in the placebo group ( 30.8 % ) . The incidence of diarrhoea in the daily and weekly zinc‐supplemented groups was 0.68 and 0.69 episodes child−1 y−1 , and that in the placebo group was 1.67 episodes child−1 y−1 ( relative risk 0.41 , 95 % confidence interval 0.24–0.71 ) . Diarrhoeal incidence of > 4d duration was found to occur significantly less often in the supplemented groups . There was no difference in diarrhoeal incidence between the daily and weekly zinc‐supplemented children . There were no detected adverse reactions in any of the supplemented groups OBJECTIVE . We investigated the benefits of maternal multimicronutrient supplementation during gestation on the mental and psychomotor development  of infants . METHODS . In a double-blind , r and omized , controlled trial , pregnant women ( N = 5828 ) in 2 rural counties in western China were assigned r and omly to receive multimicronutrient ( 5 minerals and 10 vitamins at levels approximating the recommended daily allowance ) , folic acid plus iron , or folic acid supplementation daily from ∼14 weeks of gestation until delivery . We assessed a subset of the newborns ( N = 1305 ) from the 3 supplementation groups by measuring their mental and psychomotor development with the Bayley Scales of Infant Development , at 3 , 6 , and 12 months of age . Multilevel analyses were used to compare the mental development and psychomotor development raw scores at 3 , 6 , and 12 months . RESULTS . Multimicronutrient supplementation was associated with mean increases in mental development raw scores for infants at 1 year of age of 1.00 and 1.22 points , compared with folic acid only and folic acid plus iron supplementation , respectively . However , supplementation did not increase significantly the psychomotor development raw scores up to 1 year of age . CONCLUSION . Compared with iron and folic acid supplementation , the administration of multimicronutrients to pregnant women  improved the mental development of their children at 1 year of age Background / Objectives : Many children have diets deficient in both iron and zinc , but there has been some evidence of negative interactions when they are supplemented together . The optimal delivery approach would maximize clinical benefits of both nutrients . We studied the effectiveness of different iron and zinc supplement delivery approaches to improve  diarrhea and anemia in a rural Bangladesh population . Study Design : R and omized , double blind , placebo-controlled factorial community trial . Results : Iron supplementation alone increased diarrhea , but adding zinc , separately or together , attenuated these harmful effects . Combined zinc and iron was as effective as iron alone for iron outcomes . All supplements were vomited < 1 % of the time , but combined iron and zinc were vomited significantly more than any of the other supplements . Children receiving zinc and iron ( together or separately ) had fewer hospitalizations . Separating delivery of iron and zinc may have some additional benefit in stunted children . Conclusions : Separate and combined administration of iron and zinc are equally effective for reducing diarrhea , hospitalizations and improving iron outcomes . There may be some benefit in separate administration in stunted children BACKGROUND Previous studies on the cognitive effects of iron treatment have focused on anemic or non-anemic iron-deficient infants . The effect of iron supplementation on cognitive development among iron-sufficient infants has not been studied . The aim of the present study was to examine the effect of iron supplementation on performance in the Bayley Scales of Infant Development ( BSID ) and anthropometric measurement in 6-month-old iron-sufficient healthy infants . METHODS Healthy , iron-sufficient infants who were 6 months of age and were attending the Well Baby Clinic were considered for enrollment . Infants were r and omly assigned to take ferrous sulfate supplementation ( 1 mg/kg per day ) or no supplementation and were followed for 3 months . Anthropometric measurement , hematologic status and BSID were evaluated on admission and after 3 months . RESULTS Seven infants in the intervention group and nine in the control group completed the study . No significant differences were observed in anthropometric measurements and complete blood counts between the two groups after the 3 month study period . The mean transferrin saturation ( TS ) level decreased significantly in the control group during the study period ( from 15.3+/-2.6 to 7.8+/-5.1 % ; P = 0.0117 ) , but no such reduction was seen in the intervention group . At the end of the study , the TS of the control group was found to be significantly lower than that of the intervention group ( 7.8+/-5.1 vs. 19.9+/-7.9 % , respectively ; P = 0.0033 ) . The BSID scores of infants in both groups were within the normal range on admission and at the end of the study period . CONCLUSIONS Short-term iron supplementation did not change developmental test scores despite the hematologic response in iron-sufficient healthy infants . The high prevelance of iron-deficiency anemia and its relationship with adverse developmental outcome suggests that prevention of iron-deficiency anemia with prophylaxis needs to be emphasized , rather than treatment BACKGROUND Iron deficiency continues to be a common problem among infants throughout the world .  Iron-fortified formula is effective in preventing iron deficiency but the benefit of iron-fortified cereal is controversial . METHODS We compared iron-fortified rice cereal to unfortified rice cereal in infants who were exclusively breast-fed for more than 4 months and to iron-fortified formula  in infants who were weaned to formula before 4 months of age . The design was double blind in respect to the presence or absence of fortification iron in the cereal or formula and included 515 infants who were followed on the protocol from 4 to 15 months of age .  Rice cereal was fortified with 55 mg of electrolytic iron per 100 g of dry cereal and infant formula with 12 mg of ferrous sulfate per 100 g of dry powder , levels approximating those in use in the United States . Measures of iron status were obtained at 8 , 12 , and 15 months . Infants with hemoglobin levels of < 105 g/L were excluded from the study and treated . RESULTS Consumption of cereal reached plateaus at means of about 30 g/d after 6 months of age in the formula-fed groups and 26 g/d after 8 months in the breast-fed groups ; these amounts are higher than the 19-g/d mean intake by the 73 % of infants who consume such cereal in the United States . Among infants weaned to formula before 4 months , the cumulative percentages of infants excluded for anemia by 15 months were 8 % , 24 % , and 4 % , respectively , in the fortified cereal , unfortified cereal and formula , and fortified formula groups ( P < .01 unfortified vs either fortified group ; the difference between the two fortified groups was not significant ) . In infants breast-fed for more than 4 months , the corresponding values were 13 % and 27 % , respectively , in the fortified and unfortified cereal groups ( P < .05 ) . Mean hemoglobin level and other iron status measures were in accord with these findings . CONCLUSION Iron-fortified infant rice cereal can contribute substantially to preventing iron deficiency anemia The aim of this study was to investigate the effects of different doses of iron on haematological status of breastfed infants . One hundred and thirteen infants were r and omized into four groups at 5 months of age .  Iron supplementation was given at doses of 1 mg/kg/day , 2 mg/kg/day , and 2 mg/kg/every other day in the first three study groups , respectively , and the last group received placebo . The hematological values , except hemoglobin , were higher in the group supplemented with iron at a dose of 2 mg/kg/day , and ferritin values were statistically higher in the group supplemented with iron at a dose of 2 mg/kg/every other day than in the group supplemented with iron at a dose of 1 mg/kg/day . We suggest that intermittent iron supplementation is more effective than a daily regimen in equal dosages Among breastfed infants , growth faltering in comparison with reference growth curves is common in both developing and developed countries . We performed a zinc supplementation trial in Paris , France , to find out whether such growth faltering is due to nutritional zinc deficiency . 57 breastfed infants aged 4 - 9 ( mean 5.7 ) months were r and omly assigned to receive either 5 mg zinc daily or a placebo for 3 months . Most of the infants were from low-income immigrant families and the majority were of African origin . Before supplementation there were no significant differences between the zinc and placebo groups in weight , length , or corresponding Z-scores for age . After 3 months ' supplementation , the length-for-age Z-score had increased in the zinc group and fallen in the placebo group ( + 0.21 vs -0.13 , p = 0.029 ) . This difference was due mainly to greater linear growth of boys in the zinc than in the placebo group ( 6.0 vs 4.6 cm , p = 0.02 ) . Weight gain was also significantly greater with zinc supplementation ( 1.64 vs 1.28 kg , p = 0.047 ) . Among infants breastfed for longer than 4 months , decreases in growth velocity result partly from inadequate zinc intake OBJECTIVE To evaluate the effect of zinc supplementation on mental and psychomotor scores in children aged 12 to 18 months . STUDY DESIGN In this double-blind , r and omized , placebo-controlled trial , children aged 6 to 30 months received daily elemental zinc ( 10 mg for infants and 20 mg for others ) or placebo for 4 months . Bayley Scales of Infant Development II were used for development assessment in the 12- to 18-month subgroup at enrollment and the end of the study . RESULTS At the end of the study , the adjusted mean mental ( P = .36 ) and psychomotor ( P = .28 ) index scores were similar in the intervention and control groups . In a multivariate model , the baseline mental development index score was positively associated with the mother 's schooling , the child 's height for age , packed cell volumes , hospital birth , and attendance at a day care center , and was negatively associated with the child 's age . Breastfeeding , the child 's weight for height , and packed cell volumes were positively associated with the baseline psychomotor index score . CONCLUSION Zinc supplementation did not affect the mental or psychomotor development index scores in a setting in which zinc deficiency is common Abstract Six‐month‐old infants were recruited at 21 centres in the UK and Irel and and r and omly assigned to receive matching iron‐fortified ( 12.3 mg/l iron ) or non‐fortified ( 1.4 mg/l iron ) formula for 9 months . Infants already receiving cow 's milk continued this feed . Haematological indices and iron status were evaluated at age 6 months , 9–10 months and 15 months . Four hundred and six infants entered and 302 completed the study . There were no differences between the groups for increases in weight , head circumference or length . Significant differences between the groups were observed at 15 months for haemoglobin , serum ferritin , serum iron and total iron binding capacity . Haemoglobin levels were < 110 g/l in 33 % of infants fed cow 's milk compared with 13 % and 11 % in those receiving non‐iron‐fortified and iron‐fortified formula respectively . The corresponding figures for serum ferritin < 10 µg/l were 43 % , 22 % and 6 % . Follow‐on formula provides an acceptable vehicle for preventing iron deficiency in this vulnerable group Iron intakes and iron status were evaluated in 36 young Swedish children given either iron‐fortified or unfortified cow 's milk . All children had good iron status and had received breast milk or ironfortified formulae during infancy . Twenty 1‐y‐old children were r and omized to a diet with iron‐fortified milk ( 7.0 or 14.9 mg Fe T−1 ) and 16 to a diet with unfortified milk . The  iron  intakes in the unfortified group at 15 and 18 mo ( mean ± SD 5.19 ± 2.29 and 5.84 ± 1.62 mg d−1 ) were low in relation to Nordic Nutrition Recommendations , while the intakes in the iron‐fortified group ( 10.20 ±2.60 and 10.87 ± 2.79 mg d−1 ) were normal in relation to recommendations . The gain ( increase ) from receiving fortified diet during the study period was at most [ upper limit for 95 % confidence interval ( CI ) ] 2.6 g T−1 in blood haemoglobin , 1.9 fl in mean corpuscular volume , 2.7 Limol in serum iron and 4.5 % in transferrin iron saturation , and the gain ( decrease ) was at most ( lower limit for 95 % CI ) 0.29 g T−1 in serum transferrin and 0.9 mgr−1 in serum transferrin receptor ( TfR ) . None of these differences was statistically significant . There was an almost significantly higher increase in serum ferritin ( 1.4 times higher relation of values at the end compared with the beginning , p= 0.06 ) and a significantly higher ( 1.2 ; p= 0.047 ) decrease in TfR/ log10 ferritin ratio in the fortified group BACKGROUND Zinc supplementation can reduce subsequent morbidity in children recovering from diarrhoea and respiratory illness in developing countries . However , whether routine supplementation would decrease morbidity and mortality in population s with zinc deficiency is unclear . We assessed the effect of daily zinc supplementation on children in southern Nepal . METHODS We did a community-based , cluster-r and omised , double-masked , placebo-controlled , 2x2 factorial trial in children aged 1 - 35 months . Treatment groups were placebo , iron and folic acid , zinc , and iron and folic acid with zinc , with daily doses of 12.5 mg iron , 50 microg folic acid , and 10 mg zinc . Study staff gave children tablets on 2 days each week and left tablets with caregivers for other days . All children received vitamin A supplementation twice per year . Results of the iron arm of the trial have been reported previously . Between October , 2001 , and January , 2006 , 41,276 children were enrolled into the placebo ( n=20,308 ) or zinc ( n=20,968 ) groups and were followed-up for 60,636.3 person-years . The primary outcome was child mortality , and analyses were by intention to treat . Daily reports of signs and symptoms of common morbidities in stratified r and om sub sample s of children were assessed every week for 12 months . This study is registered at Clinical Trials.gov , number NCT00109551 . FINDINGS 2505 children refused to continue the trial and 3219 children were lost to follow-up . There was no significant difference in mortality between the zinc and placebo groups ( 316 vs 333 deaths ; hazard ratio 0.92 , 95 % CI 0.75 - 1.12 ) . Zinc had no effect on mortality in children younger than 12 months ( 181 vs 168 deaths ; 1.04 , 0.83 - 1.31 ) ; mortality was lower , but not statistically significantly so , in older children receiving zinc ( 135 vs 165 ; 0.80 , 0.60 - 1.06 ) . The frequency and duration of diarrhoea , persistent diarrhoea , dysentery , and acute lower respiratory infections did not differ between the groups . INTERPRETATION Total mortality of children receiving zinc supplementation was not significantly different from that of children receiving placebo . Further data are needed from other population s with endemic zinc deficiency to confirm the potential age-specific effects reported in this study The objective of this study was to determine whether zinc deficiency is one of the factors involved in nutritional failure to thrive in infants and toddlers . Participants were selected on the basis of anthropometric criteria , particularly a decline in weight velocity preceding changes in length gains . The investigation was design ed as a double-blind , r and omized , pair-matched , controlled study of dietary zinc supplementation of 6 months ' duration . Anthropometric data were collected at 0 , 1 , 3 , and 6 months . Twenty-five pairs of infants completed the project . When compared with placebo-treated control children , the zinc-supplemented group ( combined sexes ) and the supplemented boys showed significant improvements in st and ard deviation scores for weight for all three intervals , the largest differences occurring for the 0- to 3-month interval ( P less than or equal to .0001 ) . The zinc-supplemented girls demonstrated a trend toward improvements in changes in st and ard deviation scores for weight ( P = .056 ) . There were no differences in length gains for either boys or girls . This improvement in weight gains after zinc supplementation demonstrates that mild zinc deficiency can be one of the etiologic factors in nutritional failure to thrive during infancy OBJECTIVE To determine the efficacy of iron-fortified infant formula in preventing  developmental delays and abnormal behavior . DESIGN Double-blind , r and omized , controlled trial . SETTING Urban hospital clinic . PARTICIPANTS A total of 283 healthy , bottle-fed infants from very low income families . Children with prematurity , low birth weight , and major anomalies and those who had received more than 2 weeks of evaporated-milk feedings were excluded . The groups were similar for sociodemographic background variables . Fifty-eight infants ( 20.5 % ) dropped out before any outcome data were gathered ; 225 , 204 , 186 , and 154 remained at 6- , 9- , 12- , and 15-month assessment s , respectively . INTERVENTION Iron-fortified formula ( 12.8 mg iron per liter ) versus regular formula ( 1.1 mg iron per liter ) . MAIN OUTCOME MEASURES Iron status was measured on venous blood by determination of hemoglobin , serum iron and iron-binding capacity , serum ferritin , and free erythrocyte protoporphyrin values . The Bayley Scales of Infant Development ( mental and psychomotor indexes ) and two factors of the Infant Behavior Record ( test affect and task orientation ) were the outcomes of interest . RESULTS All measures of iron status were significantly different between groups ( p < 0.001 ) . Psychomotor development patterns differed between groups ( F3,520 , 3.4 ; p = 0.02 ) with time . Mean values were similar at 6 months but differed at 9 and 12 months of age ( p < 0.001 ) , with a decline of 6.4 points in the regular-formula group . By 15 months of age the differences were no longer significant ( p = 0.23 ) . Mental development and behavior were not affected . CONCLUSIONS Iron-fortified formula significantly reduced iron deficiency in a high-risk group of infants and prevented a decline in psychomotor development quotients . This effect may be transient , and its long-term significance needs further study Breast milk is considered to be the best nutrient source for infants . However , nutritional compositions of breast milk in developing countries , especially among malnourished women , have not been fully investigated . This study aim ed to assess nutritional status and nutrient composition of breast milk in lactating mothers in rural Vietnam . Sixty breastfeeding mothers at 6 to 12 mo postpartum , free from any medical disorder and /or medication , and not pregnant were r and omly selected in Yen The , Bac Giang , Vietnam . Their nutritional status , breast milk concentration and dietary intakes  were assessed . Among the study participants , anemia ( 39.0 % ) and low serum zinc concentration ( 55.4 % ) were frequently observed . Dietary assessment revealed lower intakes of iron ( 10.2+/-2.5 mg/d ) and zinc ( 10.4+/-2.2 mg/d ) than estimated requirements . The breast milk concentration of iron , zinc and copper was 0.43+/-0.15 mg/L , 0.56 ( 0.37 , 0.82 ) mg/L and 0.19+/-0.05 mg/L , respectively . The breast milk concentration of iron , zinc and copper was not correlated to the serum concentration or dietary intakes . In conclusion , we uncovered a high prevalence of  anemia and zinc deficiency in lactating mothers in rural Vietnam . The findings demonstrate a low breast milk zinc concentration among the participants , but need further investigation The study attempted to determine if the bulk of dietary supplements given to pregnant women after midgestation affects fetal growth .  127 Zulu women were r and omly assigned to four groups , two of which received daily food supplements design ed to raise their energy , protein and vitamin intakes to levels recommended by the U.S. Food and Nutrition Board . One of these supplements had a high bulk , the other a low bulk . The third supplement contained only zinc and the fourth a placebo . Women in all four groups had a similar weight gain and length of gestation . Birth weights were from 6.5 to 9.5 % greater with the low bulk than with the other supplements OBJECTIVE The goal of this study was to assess the effectiveness of multivitamins with iron as prophylaxis against  iron deficiency and anemia in infancy . METHODS The study was a double-blinded , r and omized , pragmatic , clinical trial conducted at 3 urban primary care clinics . Subjects included healthy , full-term infants who were enrolled at their 6-month well-child visit . Infants were r and omly assigned to receive st and ard-dose multivitamins with or without iron ( 10 mg/day ) . Parents administered multivitamins by mouth daily for 3 months . Laboratory results at 9 months of age were analyzed for the presence of anemia and /or iron deficiency . Anemia was defined as hemoglobin level < 11.0 g/dL. Iron deficiency was initially defined as any abnormal laboratory value of the following : mean corpuscular volume combined with red cell distribution width or zinc protoporphyrin ( with blood lead level < 10 microg/dL ) for most subjects and ferritin , transferrin saturation , or reticulocyte hemoglobin content for a subset . Subsequent analyses defined iron deficiency as any 2 abnormalities of the above laboratory outcomes , except hemoglobin . RESULTS The control ( n = 138 ) and intervention ( n = 146 ) groups were equivalent with respect to all important sociodemographic and nutritional variables . At 9 months of age , anemia was found in 21 % of infants ( n = 58 ) . A total of 229 ( 81 % ) had iron deficiency on the basis of 1 abnormal laboratory indicator and 139 ( 49 % ) on the basis of 2 abnormal laboratory indicators . No difference existed in the occurrence of anemia and iron deficiency between the intervention and control groups . In the intervention group , 22 % and 78 % of 138 , respectively , were anemic or had 1 abnormal laboratory outcome indicative of iron deficiency . In the control group , 19 % and 84 % of 144 were anemic or iron deficient . When stratified by adherence , no differences in hematologic outcomes between groups were noted . However , in multivariate logistic regression , infants whose mothers were anemic during pregnancy were 2.15 times more likely than others to have any laboratory abnormality ( 95 % confidence interval : 1.14 - 4.07 ) . Increasing adherence , regardless of group assignment , was associated with a 0.56 times reduced risk of any abnormality ( 95 % confidence interval : 0.41 - 0.76 ) . CONCLUSION On the basis of intention-to-treat analysis , multivitamins with iron was not effective in preventing iron deficiency or anemia in 9-month-old infants . However , effective prevention and treatment of maternal anemia during pregnancy and giving multivitamins with or without additional iron during infancy may prove to be important approaches to the prevention of iron deficiency among high-risk children . Because of the consequences of iron deficiency and its high prevalence among low-income infants , additional investigation in these areas is warranted OBJECTIVE A community-based , r and omized , double-blind intervention trial was conducted to measure the impact of zinc supplementation on young Guatemalan children 's morbidity from diarrhea and respiratory infections .  METHODS Children aged 6 to 9 months were r and omly assigned to receive 4 mL of a beverage containing 10 mg of zinc ( as zinc sulfate ) daily ( 7 d/wk ) for 7 months ( n = 45 ) or a placebo ( n = 44 ) . Morbidity data were collected daily . Diagnoses of diarrhea , fever , and anorexia were based on mothers ' definitions . Respiratory infections were defined as the presence of at least two of the following symptoms : runny nose , cough , wheezing , difficulty breathing , or fever . RESULTS High rates of diarrhea and respiratory infections were reported . Children from the placebo group had a 20 % episodic prevalence of diarrhea , with 8 episodes/100 d , and a 7 % episodic prevalence of respiratory infections , with 3 episodes/100 d. The median incidence of diarrhea among children who received zinc supplementation was reduced by 22 % ( Wilcoxon rank test ) , with larger reductions among boys and among children with weight-for-length at baseline lower than the median of the sample ( 39 % reductions in both subgroups ) . Zinc supplementation also produced a 67 % reduction in the percentage of children who had one or more episodes of persistent diarrhea ( chi2 test ) . No significant effects were found on the episodic prevalence of diarrhea , the number of days per episode , or the episodic prevalence or incidence of respiratory infections . CONCLUSIONS The large impact of zinc supplementation on diarrhea incidence suggests that young , rural Guatemalan children may be zinc deficient and that zinc supplementation may be an effective intervention to improve their health and growth OBJECTIVE The objective was to study the effects of iron supplementation on hemoglobin and iron status in 2 different population s. STUDY DESIGN In a r and omized , placebo-controlled , masked clinical trial , we assigned term Swedish ( n = 101 ) and Honduran ( n = 131 ) infants to 3 groups at 4 months of age : ( 1 ) iron supplements , 1 mg/kg/d , from 4 to 9 months , ( 2 ) placebo , 4 to 6 months and iron , 6 to 9 months , and ( 3 ) placebo , 4 to 9 months . All infants were breast-fed exclusively to 6 months and partially to 9 months . RESULTS From 4 to 6 months , the effect of  iron  ( group 1 vs 2 + 3 ) was significant and similar in both population s for hemoglobin , ferritin , and zinc protoporphyrin . From 6 to 9 months , the effect ( group 2 vs group 3 ) was significant and similar at both sites for all iron status variables except hemoglobin , for which there was a significant effect only in Honduras . In Honduras , the prevalence of iron deficiency anemia at 9 months was 29 % in the placebo group and 9 % in the supplemented groups . In Sweden , iron supplements caused no reduction in the already low prevalence of iron deficiency anemia at 9 months ( <3 % ) . CONCLUSION Iron supplementation from 4 to 9 months or 6 to 9 months significantly reduced iron deficiency anemia  in Honduran breast-fed infants . The unexpected hemoglobin response at 4 to 6 months in both population s suggests that regulation of hemoglobin synthesis is immature at this age Objective : To assess the efficacy of ferrous sulfate ( FS ) and ferrous gluconate ( FG ) as fortificants for a complementary baby food ( Nutrisano ) to improve the iron status and to reduce the prevalence of anemia in toddlers . Patients and Methods : Toddlers 12 to 30 months old were r and omly assigned to receive either of 3 versions of Nutrisano fortified with FS or FG or not fortified ( CG ) for 6 months . In final blood sample s , the concentrations of hemoglobin , serum ferritin , and soluble transferrin receptors ( sTfR ) were determined . The effects of treatment on final hemoglobin , ferritin , and sTfR were assessed by multivariate analysis . Results : No significant changes in hemoglobin were observed within or among treatment groups . The prevalence of high sTfR decreased 7.1 percentage points in FG , increased 13.1 percentage points in FS , and increased 0.7 percentage points in CG ( P > 0.05 ) . In an interaction between treatment and total intake of Nutrisano on the concentration of ferritin , sTfR , and total iron body stores , adjusted means of serum ferritin in the medium tertiles of intake of Nutrisano for FS ( P = 0.05 ) and in the higher and medium tertiles for FG were higher ( P = 0.001 ) , and adjusted means of sTfR were significantly lower ( P < 0.001 ) , than the respective lower tertile of intake . Conclusions : Fortification of Nutrisano with FG has an acceptable level of beneficial effect on markers of iron status . The satisfactory efficacy and other sensory data has led to the political decision to substitute hydrogen-reduced iron , used formerly as a fortificant , with FG . Studies to assess the effectiveness of the reformulated Nutrisano are in order OBJECTIVE Compare milk-based , iron-fortified formulas containing 7.4 and 12.7 mg/L iron and breast-feeding during the first year of life . DESIGN Partially r and omized , double-blind trial : non-breast-fed infants r and omly assigned to receive one of two coded formulas , identical except for iron content ; infants discontinuing breast-feeding between 1 and 8 weeks of age r and omly assigned to a formula late-start group . SETTING Five general community pediatric practice s in Missouri , Indiana , Illinois , and Pennsylvania . PARTICIPANTS Sample of 347 healthy , term infants , enrolled within 1 week after birth ; 172 included in statistical analyses . OUTCOME MEASURES Length , weight , and indicators of formula intolerance recorded at clinic visits ; formula consumption , bowel movements , stool consistency , and other tolerance indicators recorded by parents on daily and weekly report forms ; hemoglobin , hematocrit , and serum ferritin , iron zinc , and copper measured at 6 and 12 months . RESULTS No significant differences between formula-fed groups in growth , attrition , formula consumption , bowel movements , hematocrit , hemoglobin level , and serum iron , zinc , and copper levels ( P > .05 ) ; first 6-month weight and length changes of the breast-fed group significantly less than in both formula-fed groups ( P < .008 ) ; serum ferritin level of the formula-fed , high-iron group significantly higher than that of the low-iron and breast-fed groups ( P < .008 ) , although all groups ' values were normal ; no apparent differences between formula groups in formula tolerance and stool characteristics but data were not analyzed statistically . CONCLUSIONS Milk-based formulas containing either 7.4 or 12.7 mg/L iron support normal growth and iron status of healthy , term , normally fed infants during the first year and both are well tolerated and accepted Objective . To investigate whether zinc supplementation during pregnancy improves maternal and fetal outcome BACKGROUND Simple , low-cost methods are needed to evaluate the effect of zinc-fortification programs . Plasma zinc concentration is a useful biomarker of zinc intake from supplementation , but responses to zinc fortification are inconsistent . OBJECTIVE The objective was to compare the change in plasma zinc concentrations in young children who received zinc from either a liquid supplement or a zinc-fortified complementary food .  DESIGN A double-blind intervention trial was conducted in 137 young Senegalese children aged 9 - 17 mo who were r and omly assigned to receive one of the following treatments for 15 d : 1 ) 30 g dry weight of an iron-fortified cereal porridge and a liquid multivitamin supplement without zinc ( control group ) , 2 ) the same porridge and multivitamin supplement with 6 mg Zn added to the supplement dose ( ZnSuppl group ) , or 3 ) the same porridge with added zinc to provide 6 mg Zn per 25 g dry weight of porridge and multivitamin without zinc ( ZnFort group ) . RESULTS Mean ( ±SD ) plasma zinc concentration ( μg/dL ) increased by 4.7 ± 1.6 ( P = 0.004 ) in the ZnSuppl group , which was significantly greater ( P = 0.009 ) than the mean change in the control group ( -1.0 ± 1.6 ; P = 0.51 ) and in the ZnFort group ( -1.8 ± 1.7 ; P = 0.29 ) . The latter 2 groups did not differ from each other ( P = 0.99 ) . CONCLUSIONS Plasma zinc concentration increased in children who received daily zinc supplementation for 15 d but not in those who received a zinc-fortified complementary food containing a similar amount of zinc . Additional longer-term studies are needed to assess the effect of zinc-fortification programs on zinc-related functional outcomes and the usefulness of plasma zinc as a biomarker of program effect . This trial was registered at www . clinical trials.gov as study NCT0094398
Adequate supply of micronutrients during the first 1000 days is essential for normal development and healthy life .
We aim ed to investigate if interventions administering dietary doses up to the recommended nutrient intake ( RNI ) of iron and zinc within the window from conception to age 2 years have the potential to influence nutritional status and development of children .