Addition of microencapsulated iron to iodized salt improves the efficacy of iodine in goitrous, iron-deficient children: a randomized, double-blind, controlled trial. Clinical Safety of Iron-Fortified Formulas Effect of an improved local ingredient-based complementary food fortified or not with iron and selected multiple micronutrients on Hb concentration. Haematological response to haem iron or ferrous sulphate mixed with refried black beans in moderately anaemic Guatemalan pre-school children. Iron-fortified rice is as efficacious as supplemental iron drops in infants and young children. Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania. Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. Thyroid size and goiter prevalence after introduction of iodized salt: a 5-y prospective study in schoolchildren in Côte d'Ivoire. Bread fortified with cholecalciferol increases the serum 25-hydroxyvitamin D concentration in women as effectively as a cholecalciferol supplement. Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: a double-blind randomized controlled trial. A multimicronutrient-fortified seasoning powder enhances the hemoglobin, zinc, and iodine status of primary school children in North East Thailand: a randomized controlled trial of efficacy. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. A micronutrient-fortified seasoning powder reduces morbidity and improves short-term cognitive function, but has no effect on anthropometric measures in primary school children in northeast Thailand: a randomized controlled trial. Prevention of iron deficiency by milk fortification. II. A field trial with a full-fat acidified milk. Fortifying milk with ferrous gluconate and zinc oxide in a public nutrition program reduced the prevalence of anemia in toddlers. Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized ferric pyrophosphate and encapsulated ferrous fumarate in southern India. Breakfast cereal fortified with folic acid, vitamin B-6, and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations: a randomized trial. Effect of a zinc-fortified formula on immunocompetence and growth of malnourished infants. Growth of infants fed a zinc supplemented formula. Fortification of curry powder with NaFe(111)EDTA in an iron-deficient population: report of a controlled iron-fortification trial. Consumption of folic acid-fortified bread improves folate status in women of reproductive age in Chile. Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women. 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. Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition. Nutritional efficacy of a fortified weaning rusk in a rural area near Beijing. Treatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods. Iron intake and iron nutritional status of infants fed iron-fortified beikost with meat. Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Fortifying brown bread with sodium iron EDTA, ferrous fumarate, or electrolytic iron does not affect iron status in South African schoolchildren. Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. Zinc nutritional status of young middle-income children and effects of consuming zinc-fortified breakfast cereals. Randomized outcome trial of human milk fortification and developmental outcome in preterm infants. Dual fortification of salt with iodine and microencapsulated iron: a randomized, double-blind, controlled trial in Moroccan schoolchildren. Efficacy of a vitamin A-fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren. Growth and micronutrient status in children receiving a fortified complementary food. Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y. Comparison of the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced elemental iron: randomized, double-blind, controlled trial in Thai women. Plasma folate, vitamin B-6, vitamin B-12, and risk of breast cancer in women. The use of NaFeEDTA-fortified fish sauce is an effective tool for controlling iron deficiency in women of childbearing age in rural Vietnam. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants. Effect of Consuming Zinc-fortified Bread on Serum Zinc and Iron Status of Zinc-deficient Women: A Double Blind, Randomized Clinical Trial Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren Effect of calcium fortified milk supplementation with or without vitamin K on biochemical markers of bone turnover in premenopausal women. Long-term evaluation of a micronutrient-fortified biscuit used for addressing micronutrient deficiencies in primary school children. Effect of a mandatory iodization program on thyroid gland volume based on individuals' age, gender, and preceding severity of dietary iodine deficiency: a prospective, population-based study. The Danish investigation on iodine intake and thyroid disease, DanThyr: status and perspectives. Iron Fortification Reduces Blood Lead Levels in Children in Bangalore, India Efficacy of iron-fortified whole maize flour on iron status of schoolchildren in Kenya: a randomised controlled trial Randomized, double-blind, placebo-controlled trial of an iron-fortified food product in female soldiers during military training: relations between iron status, serum hepcidin, and inflammation. Effects of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on preschool children in a suburb of Chongqing, China. An increased incidence of overt hypothyroidism after iodine fortification of salt in Denmark: a prospective population study. Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population. Nutrition of Very Low Birth Weight Infants Fed Human Milk with or without Supplemental Trace Elements: A Randomized Controlled Trial Effect of iron fortification of nursery complementary food on iron status of infants in the DPRKorea. Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial Repleting hemoglobin in iron deficiency anemia in young children through liquid milk fortification with bioavailable iron amino acid chelate. Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women. Rich micronutrient fortification of locally produced infant food does not improve mental and motor development of Zambian infants: a randomised controlled trial. The effect of iron in formula milk after 6 months of age. Micronutrient Fortified Milk Improves Iron Status, Anemia and Growth among Children 1–4 Years: A Double Masked, Randomized, Controlled Trial Epidemiology of subtypes of hypothyroidism in Denmark. Effects of two years' milk supplementation on size-corrected bone mineral density of Chinese girls. Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal. Efficacy of a microencapsulated iron pyrophosphate-fortified fruit juice: a randomised, double-blind, placebo-controlled study in Spanish iron-deficient women. Red meat and a fortified manufactured toddler milk drink increase dietary zinc intakes without affecting zinc status of New Zealand toddlers. Calcium-enriched foods and bone mass growth in prepubertal girls: a randomized, double-blind, placebo-controlled trial. Mineral water fortified with folic acid, vitamins B6, B12, D and calcium improves folate status and decreases plasma homocysteine concentration in men and women Inhibition of markers of bone resorption by consumption of vitamin D and calcium-fortified soft plain cheese by institutionalised elderly women. Randomized trial of fortified milk and supplements to raise 25-hydroxyvitamin D concentrations in schoolchildren in Mongolia. A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children Zinc supplementation in very-low-birth-weight infants. Whole cowpea meal fortified with NaFeEDTA reduces iron deficiency among Ghanaian school children in a malaria endemic area. The effects of iron fortification on the gut microbiota in African children: a randomized controlled trial in Cote d'Ivoire. Double-blind randomized controlled trial of rolls fortified with microencapsulated iron. Iodine prophylaxis using iodized salt and risk of maternal thyroid failure in conditions of mild iodine deficiency. Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico. Effect of biscuits fortified with different doses of vitamin A on indices of vitamin A status, haemoglobin and physical growth levels of pre-school children in Chongqing. The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. Efficacy of Iron-Fortified Ultra Rice in Improving the Iron Status of Women in Mexico The effect of zinc-supplemented bread consumption on school children with asymptomatic zinc deficiency. Effects of calcium-fortified ice cream on markers of bone health Efficacy of wheat-based biscuits fortified with microcapsules containing ferrous sulfate and potassium iodate or a new hydrogen-reduced elemental iron: a randomised, double-blind, controlled trial in Kuwaiti women. Dual fortification of salt with iodine and micronized ferric pyrophosphate: a randomized, double-blind, controlled trial. Iron fortified follow on formula from 9 to 18 months improves iron status but not development or growth: a randomised trial Skeletal site-dependent response of bone mineral density and quantitative ultrasound parameters following a 12-month dietary intervention using dairy products fortified with calcium and vitamin D: the Postmenopausal Health Study. Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. Complementary foods fortified with micronutrients prevent iron deficiency and anemia in Vietnamese infants. A comparative intervention trial on fish sauce fortified with NaFe-EDTA and FeSO4+citrate in iron deficiency anemic school children in Kampot, Cambodia. Milk fortified with the current adequate intake for vitamin D (5 microg) increases serum 25-hydroxyvitamin D compared to control milk but is not sufficient to prevent a seasonal decline in young women. Randomized Controlled Trial of Iron-Fortified Drinking Water in Preschool Children Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. The use of sweet rolls fortified with iron bis-glycinate chelate in the prevention of iron deficiency anemia in preschool children. School-milk intervention trial enhances growth and bone mineral accretion in Chinese girls aged 10-12 years in Beijing. Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: randomised study. Follow‐on formula in the prevention of iron deficiency: a multicentre study The effect of zinc supplementation on linear growth, body composition, and growth factors in preterm infants. Iron‐fortified and unfortified cow's milk: Effects on iron intakes and iron status in young children Therapeutic effects of NaFeEDTA-fortified soy sauce in anaemic children in China. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Iodine status as determined by urinary iodine excretion in Lesotho two years after introducing legislation on universal salt iodization. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. Use of iron-fortified rice reduces anemia in infants. Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Thyroid and the environment: exposure to excessive nutritional iodine increases the prevalence of thyroid disorders in Sao Paulo, Brazil. Randomized double-blind controlled trial on the effects on iron status in the first year between a no added iron and standard infant formula received for three months. Multi-micronutrient-fortified biscuits decreased prevalence of anemia and improved micronutrient status and effectiveness of deworming in rural Vietnamese school children. Milk Fortif Ed with Iron Or Iron Supplementation to Improve Nutritional Status of Pregnant Women: An Intervention Trial from Rural Vietnam Fortification of maize meal improved the nutritional status of 1-3-year-old African children. Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. Treatment of iodine deficiency in school-age children increases insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations and improves somatic growth. 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 Milk-based cornstarch porridge fortified with iron is effective in reducing anemia: a randomized, double-blind, placebo-controlled trial. Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food Vitamin D status of Year 3 children and supplementation through schools with fortified milk. Effect of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on infectious morbidity of preschool children. Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India. Random serial sampling to evaluate efficacy of iron fortification: a randomized controlled trial of margarine fortification with ferric pyrophosphate or sodium iron edetate. In a randomized controlled trial of iron fortification, anthelmintic treatment, and intermittent preventive treatment of malaria for anemia control in Ivorian children, only anthelmintic treatment shows modest benefit.
OBJECTIVE In many developing countries , children are at high risk for both goiter and anemia . Iron ( Fe ) deficiency adversely effects thyroid metabolism and reduces efficacy of iodine prophylaxis in areas of endemic goiter . The study aim was to determine if co-fortification of iodized salt with Fe would improve efficacy of the iodine in goitrous children with a high prevalence of anemia . DESIGN AND METHODS In a 9-month , r and omized , double-blind trial , 6 - 15 year-old children ( n=377 ) were given iodized salt ( 25 microg iodine/g salt ) or dual-fortified salt with iodine ( 25 microg iodine/g salt ) and Fe ( 1 mg Fe/g salt , as ferrous sulfate microencapsulated with partially hydrogenated vegetable oil ) . RESULTS In the dual-fortified salt group , hemoglobin and Fe status improved significantly compared with the iodized salt group ( P<0.05 ) . At 40 weeks , the mean decrease in thyroid volume measured by ultrasound in the dual-fortified salt group ( -38 % ) was twice that of the iodized salt group ( -18 % ) ( P<0.01 ) . Compared with the iodized salt group , serum thyroxine was significantly increased ( P<0.05 ) and the prevalence of hypothyroidism and goiter decreased ( P<0.01 ) in the dual-fortified salt group . CONCLUSION Addition of encapsulated Fe to iodized salt improves the efficacy of iodine in goitrous children with a high prevalence of anemia Background . Iron-fortified formulas are recommended throughout infancy and are frequently used beyond , yet safety aspects have been inadequately studied . Iron could theoretically increase pro-oxidant stress , with potential adverse effects , including infection risk , and some clinicians suspect that iron-fortified formulas induce gastrointestinal disturbance . Objective . A planned component of a large intervention trial has been to test the hypothesis that infants receiving iron-fortified formula  do not have a higher incidence of infections ( primary outcome ) or gastrointestinal problems ( secondary outcome ) than infants on low iron-formulas or cow 's milk . Methods . Children ( n = 493 ) 9 months old receiving cow 's milk were recruited in 3 UK centers and r and omized to : 1 ) cow 's milk as before , 2 ) formula containing .9 mg/L of iron  , or 3 ) an  otherwise identical formula but  containing 12 mg/L of iron . Children were followed at 3 monthly intervals and the episodes of infections , diarrhea and constipation , and general morbidity to 18 months old were recorded . Hematologic indices of iron status were determined at 18 months old . Results . Serum ferritin concentrations were increased in infants receiving iron-fortified formula but there were no intergroup differences in incidence of infection , gastrointestinal problems , or in general morbidity or weight gain . Conclusions . We were unable to identify adverse health effects in older infants and toddlers consuming a high iron-containing formula ( 12 mg/L ) even when used in population s with a low incidence of iron deficiency OBJECTIVE To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients ( MM ) on  Hb concentration of young children . DESIGN In a nutrition centre that we opened in their villages , children received either MM supplement ( containing iron , zinc , vitamin A , vitamin C and iodine ) with the improved gruel ( MMGG ) or the improved gruel only ( GG ) , twice daily , 6 d/week , for 6 months . We assessed baseline and endpoint Hb concentration and anthropometric indices . SETTING Kongoussi , a rural and poor district of Burkina Faso . SUBJECTS In a community-based trial , we r and omly assigned 131 children aged 6 - 23 months with Hb concentrations in the range of 80 - 109 g/l into two groups . RESULTS The groups did not differ significantly at baseline . Mean baseline Hb concentration was 89·2 ( sd 6·5 ) g/l and 90·3 ( sd 8·4 ) g/l in the GG and the MMGG , respectively ( P = 0·42 ) . It increased to 104·1 ( sd 11·4 ) g/l in the GG ( P < 0·001 ) and 107·6 ( sd 14·7 ) g/l in the MMGG ( P < 0·001 ) . The between-group difference of 3·5 ( 95 % CI -1·0 , 8·1 ) g/l in mean ( sd ) endpoint Hb concentration was not significant ( P = 0·13 ) . The endpoint anthropometric indices were not different between the groups . CONCLUSIONS This MM supplement  had no additional effect on Hb concentration . Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine OBJECTIVE Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets . For this purpose , a new haem iron preparation was developed . The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate ( FeSO4 ) . DESIGN In a masked , stratified-r and omised intervention trial , children received five 156-g cans of refried black beans per week for 10 consecutive weeks . The beans-only ( control ) , FeSO4 and haem iron groups were offered a cumulative dose of 155 mg , 1625 mg and 1700 mg of iron from the bean intervention , respectively . Haemoglobin ( Hb ) and ferritin concentrations were determined at baseline and after 5 and 10 weeks . Compliance was examined weekly . SETTING A low-income community in Guatemala City . SUBJECTS One hundred and ten children aged 12 - 36 months with initial Hb values between 100 and 115 g l(-1 ) . RESULTS The cumulative intake of beans was approximately 80 % of that offered , signifying an additional approximately 1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks . Hb concentrations increased by the order of 7.3 - 11.4 g l(-1 ) during the intervention , but without significant differences across treatments . Average ferritin concentrations were unaffected by treatment assignment . However , post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group ( 13.1+/-7.7 g l(-1 ) ) to be significantly greater than the respective increases ( 6.8+/-11.2 and 6.4+/-8.5 g l(-1 ) ) in the inorganic iron and beans-only groups . CONCLUSIONS Canned refried beans are a c and i date vehicle for fortificant iron . Given the improved colour and organoleptic properties imparted by haem iron added to refried beans , its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4 How to improve iron status among infants and young children is of continued concern in low- to middle-income countries , including Brazil . In a double blind , 5-mo , home-based , r and omized trial in Brazil , we gave one group of mildly anemic 6- to 24-mo-old children ( n = 175 )  rice fortified with micronized ferric pyrophosphate using the Ultra Rice technology and a placebo solution ( URG ) and another group identical nonfortified rice and iron drops . We instructed parents on the correct dosage of iron drops and to feed their children rice as they normally would . We measured serum ferritin ( SF ) and hemoglobin ( Hb ) concentrations at baseline and at 5 mo . At baseline , the prevalences of iron deficiency and anemia in the total sample were 73.1 and 100 % , respectively . At 5 mo , SF and Hb increased in both groups , although the change in the URG was larger ( P < 0.01 ) . Adult participants were unable to distinguish cooked fortified rice from unfortified rice in terms of smell , color , or taste . As rice is normally consumed at home , MPF-fortified rice increased iron stores and reduced anemia in a group of mildly anemic children 6 - 24 mo old . In population s where young children are routinely fed approximately 100 g of cooked rice daily , fortifying it with iron may improve iron status at least as well as providing free iron drops BACKGROUND Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies . OBJECTIVE We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children ( aged 6 - 11 y ) attending primary schools . DESIGN In this r and omized , double-blind , placebo-controlled efficacy trial , children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo . RESULTS There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status , serum retinol , and anthropometry . At the 6-mo follow-up , among children with anemia ( hemoglobin < 110 g/L ) , there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group ( 9.2 and 0.2 g/L , respectively ) . Of those who were anemic at baseline , 69.4 % in the nonfortified group and 55.1 % in the fortified group remained anemic at follow-up ( RR : 0.79 ) , a cure rate of 21 % . The prevalence of children with low serum retinol concentrations ( < 200 microg/L ) dropped significantly from 21.4 % to 11.3 % in the fortified group compared with a nonsignificant change ( 20.6 % to 19.7 % ) in the nonfortified group . At follow-up , mean incremental changes in weight ( 1.79 compared with 1.24 kg ) , height ( 3.2 compared with 2.6 cm ) , and BMI ( 0.88 compared with 0.53 ) were significantly higher in the fortified group than in the nonfortified group . CONCLUSION The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency BACKGROUND Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia BACKGROUND The long-term goal of salt iodization is elimination of iodine deficiency and reduction of the goiter rate to < 5 % in school-aged children . Normalization of the goiter rate probably indicates disappearance of iodine deficiency disorders as a public health problem . However , thyroid size may not return to normal for months or years after correction of iodine deficiency . OBJECTIVE We described the time course and pattern of changes in thyroid size and goiter rate in response to the introduction of iodized salt in an area of severe endemic goiter . DESIGN In a 5-y prospect i ve study , we measured thyroid size by ultrasonography and urinary iodine and thyroid hormone concentrations in schoolchildren 6 mo before the introduction of iodized salt  and annually for 4 y thereafter . RESULTS Four years after the introduction of iodized salt and normalization of the median urinary iodine concentration , mean thyroid size had decreased 56 % ( P < 0.0001 ) . However , 29 % of the children remained goitrous , with a significant age shift in the distribution of goiter . At baseline , the goiter rate was significantly higher in younger ( age : 5 - 9 y ) than in older ( age : 10 - 14 y ) children ( P < 0.0001 ) . At 2 , 3 , and 4 y after salt iodization , the goiter rate was significantly higher in the older than in the younger children ( at 4 y : 52 % compared with 19 % ) , and the difference increased with time ( P < 0.0001 ) . CONCLUSION The goiter rate in school-aged children may remain sharply elevated for up to 4 y after successful introduction of iodized salt , primarily because of persistent goiter in older children Fortification of foods is a feasible way of preventing low vitamin D status .  Bread could be a suitable vehicle for fortification because it is a common part of diets worldwide . The bioavailability of cholecalciferol from bread is not known . We studied cholecalciferol stability , the concentration of the added cholecalciferol , the dispersion of cholecalciferol in bread , and the bioavailability of cholecalciferol from fortified bread . Three batches of fortified low-fiber wheat and high-fiber rye breads were baked ; from each batch , 3 sample s of dough and bread were analyzed for their cholecalciferol content . In a single-blind bioavailability study , 41 healthy women , 25 - 45 y old , with mean serum 25-hydroxyvitamin D concentration 29 nmol/L ( range 12 - 45 nmol/L ) , were r and omly assigned to 4 study groups . Each group consumed fortified wheat bread , fortified rye bread , regular wheat bread ( control ) , or regular wheat bread and a cholecalciferol supplement ( vitamin D control ) daily for 3 wk . The daily dose of vitamin D was 10 mug in all groups except the control group . The vitamin dispersed evenly in the breads and was stable . Both fortified breads increased serum 25-hydroxyvitamin D concentration as effectively as the cholecalciferol supplement . Supplementation or fortification did not affect serum intact parathyroid hormone concentration or urinary calcium excretion . In conclusion , fortified bread is a safe and feasible way to improve vitamin D nutrition BACKGROUND Iron fortification of rice could be an effective strategy for reducing iron deficiency anemia in South Asia . OBJECTIVE We aim ed to determine whether extruded rice grains fortified with micronized ground ferric pyrophosphate ( MGFP ) would increase body iron stores in children . DESIGN In a double-blind , 7-mo , school-based feeding trial in Bangalore , India , iron-depleted , 6 - 13-y-old children ( n = 184 ) were r and omly assigned to receive either a rice-based lunch meal fortified with 20 mg Fe as MGFP or an identical but unfortified control meal . The meals were consumed under direct supervision , and daily leftovers were weighed . All children were dewormed at baseline and at 3.5 mo . Iron status and hemoglobin were measured at baseline , 3.5 mo , and 7 mo . RESULTS At baseline , the prevalences of iron deficiency and iron deficiency anemia in the total sample were 78 % and 29 % , respectively . After 7 mo of feeding , there was a significant increase in body iron stores in both study groups ( P < 0.001 ) , with a greater increase in the iron group than in the control group ( P < 0.05 ) . There was a significant time x treatment interaction for iron deficiency , which fell from 78 % to 25 % in the dewormed iron group and from 79 % to 49 % in the dewormed control group . Iron deficiency anemia decreased from 30 % to 15 % ( NS ) in the iron group but remained virtually unchanged in the control group ( 28 % and 27 % ) . In sensory tests , the MGFP-fortified rice ( fortified at 3 and 5 mg Fe/100 g ) was indistinguishable from natural rice , in both cooked and uncooked form . CONCLUSIONS Extruded rice fortified with MGFP has excellent sensory characteristics . Fed in a school lunch meal , it increases iron stores and reduces the prevalence of iron deficiency in Indian children Anemia and co-existing deficiencies of zinc , iron , iodine , and vitamin A occur among children in many developing countries including NE Thail and , probably contributing to impairments in growth , immune competence , and cognition . Sustainable strategies are urgently required to combat these deficiencies . We assessed the efficacy of a micronutrient-fortified seasoning powder served with a school lunch on reducing anemia and improving the micronutrient status of rural NE Thai children . Children ( n = 569 ) aged 5.5 - 13.4y from 10 schools were r and omly assigned to receive a seasoning powder either unfortified or fortified with zinc ( 5 mg ) , iron ( 5 mg ) , vitamin A ( 270 microg ) , and iodine ( 50 microg ) ( per serving ) and incorporated into a school lunch prepared central ly and delivered 5 d/wk for 31 wk . Teachers monitored school lunch consumption . Baseline and final micronutrient status , hemoglobinopathies , and infection or inflammation were assessed from blood and urine sample s. For the primary outcome , anemia ( based on hemoglobin ) , no intervention effect was apparent ( odds ratio : 1.02 95 % CI : 0.69 , 1.51 ) after adjustment for design strata . The odds of zinc ( based on serum zinc ) and urinary iodine deficiency in the fortified group were 0.63 ( 0.42 , 0.94 ) and 0.52 ( 0.38 , 0.71 ) times those in the unfortified group , respectively . Fortification had no effect on serum retinol ( 0.61 : 0.25,1.51 ) , ferritin ( 1.12 : 0.43 , 2.96 ) , or mean red cell volume ( 1.16 : 0.82 , 1.64 ) . Therefore , a micronutrient-fortified seasoning powder is a promising vehicle for improving zinc , iodine , and hemoglobin status , and its potential for incorporation into lunch programs in day care centers and schools in NE Thail and warrants investigation BACKGROUND Koko , a fermented maize porridge used as the primary complementary food in Ghana , has been implicated in the high prevalence of child malnutrition . Weanimix , a cereal-legume blend developed by the United Nations Children 's Fund and the Ghanaian government , has been promoted as an alternative . OBJECTIVE We evaluated the effect of feeding Weanimix and 3 other locally formulated , central ly processed complementary foods on the nutritional status of 208 breast-fed infants . DESIGN Infants were r and omly assigned to receive 1 of 4 foods from 6 to 12 mo of age : Weanimix ( W ) , Weanimix plus vitamins and minerals ( WM ) , Weanimix plus fish powder ( WF ) , and koko plus fish powder ( KF ) . Dietary and anthropometric data were collected regularly . Blood was collected at 6 and 12 mo of age to assess iron , zinc , vitamin A , and riboflavin status . Before and after the intervention , cross-sectional data on the anthropometric status of infants not included in the intervention ( NI ; n = 464 ) were collected . RESULTS There were no significant differences between intervention groups in weight or length gain or in hemoglobin , hematocrit , transferrin saturation , plasma zinc , or erythrocyte riboflavin values between 6 and 12 mo of age . From 9 to 12 mo of age , z scores were lower in NI infants than in the combined intervention groups [ at 12 mo : -1.71 + /- 0.90 compared with -1.19 + /- 0.93 for weight and -1.27 + /- 1.02 compared with -0.63 + /- 0.84 for length ( P < 0.001 for both ) , respectively ] . The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W , WF , and KF but not in group WM . Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined ( 0.14 + /- 0.3 compared with -0.04 + /- 0.3 micromol/L , P = 0 . 003 ) . CONCLUSIONS All 4 foods improved growth relative to the NI group . Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods BACKGROUND Reductions in iodine and zinc deficiencies and improvements in hemoglobin were achieved from a micronutrient-fortified seasoning powder consumed in school lunches by children in northeast Thail and . OBJECTIVE The objective was to determine whether fortification with 4 micronutrients in a school lunch results in changes in children 's growth , morbidity , and cognitive function compared with no fortification . DESIGN In a r and omized controlled trial of 569 children aged 5.5 - 13.4 y from 10 schools , we compared the efficacy of a seasoning powder fortified with or without 5 mg Fe , 5 mg Zn , 50 mug I , and 270 mug vitamin A per serving consumed with a school lunch 5 d/wk . Here we report on results of the secondary functional outcomes . RESULTS The groups were comparable concerning compliance and loss to follow-up . The intervention had no statistically significant effect on anthropometric measures over 31 wk , but reduced the incidence of respiratory-related illnesses [ rate ratio ( RR ) : 0.83 ; 95 % CI : 0.73 , 0.94 ] , symptoms of runny nose ( RR : 0.80 ; 95 % CI : 0.70 , 0.92 ) , cough ( RR : 0.80 ; 95 % CI : 0.66 , 0.96 ) , and diarrhea ( RR : 0.38 ; 95 % CI : 0.16 , 0.90 ) . For the visual recall test , those in the fortified group recalled 0.5 more items ( 95 % CI : 0.1 , 0.9 ) than did the controls . There were no statistically significant differences between groups in the results of the digits forward and backward tests or in school grade s at the conclusion of the 2 semesters . CONCLUSION The beneficial effects on morbidity and visual recall over a short period , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a school lunch . This trial was registered at clinical trials.gov as ACTRN12605000341628 In a longitudinal study from age 3 to 15 mo , 276 term , healthy , spontaneously weaned infants received a full-fat acidified milk fortified with 15 mg of elemental Fe as ferrous sulfate and 100 mg of ascorbic acid/100 g of powder and  278 control infants received milk without additives . At ages 9 and 15 mo significant differences were encountered in all measures of Fe nutriture in favor of the fortified group ( p less than 0.001 ) . Anemia ( Hg less than 110 g/L ) was present in 25.7 % of unfortified infants compared with only 2.5 % in those fortified at age 15 mo . Saturation of transferrin less than 9 % was present in 33.8 % and serum ferritin less than 10 micrograms/L in 39.1 % of the nonfortified infants . The figures for the fortified group were 7 and 8.5 % respectively . The efficiency of the fortified acidified milk in eradicating Fe deficiency in the infants while discouraging use by other family members make this milk a useful targeted product in programs of supplementary food distribution in the underdeveloped world We aim ed to assess the efficacy of whole cow 's milk fortified with ferrous gluconate and zinc oxide , along with ascorbic acid , in reducing the prevalence of anemia and improving iron  status of low income children 10 - 30 mo of age . Healthy children were r and omly assigned to drink 400 mL/d of cow 's whole milk , either fortified milk ( FM ) with 5.8 mg/400 mL of iron as ferrous gluconate , 5.28 mg/400 mL of zinc as zinc oxide , and 48 mg/400 mL of ascorbic acid , or nonfortified milk ( NFM ) with 0.2 mg iron/400 mL , 1.9 mg zinc/400 mL , and 6.8 mg ascorbic acid/400 mL. Hemoglobin , serum ferritin , soluble transferrin receptors ( TfR ) , and C-reactive protein concentrations were measured at baseline and 6 mo after intervention . The prevalence of anemia declined from 41.4 to 12.1 % ( P < 0.001 ) , or 29 percentage points , in the FM group ; there was no change in the NFM group . Hemoglobin ( coefficient = 0.22 , P < 0.01 ) was positively and TfR ( coefficient = -0.29 , P < 0.001 ) negatively associated with treatment , controlling for their respective baseline values , age , and gender . Treatment with FM was negatively associated with the likelihood of being anemic ( pseudo R(2 ) = 0.085 , P < 0.03 ) after 6 mo of intervention . Ferrous gluconate added to whole cow 's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status  of Mexican toddlers . The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1 - 11 y of age in Mexico BACKGROUND Dual fortification of salt with iodine and iron could be a sustainable approach to combating iodine and iron deficiencies . OBJECTIVE We compared the efficacy of dual-fortified salt ( DFS ) made by using 2 proposed contrasting formulas-one fortifying with iron as micronized ground ferric pyrophosphate ( MGFePP ) and the other with iron as encapsulated ferrous fumarate (EFF)-with the efficacy of iodized salt ( IS ) in schoolchildren in rural southern India . DESIGN After stability and acceptability testing , a double-blind , household-based intervention was conducted in 5 - 15-y-old children ( n = 458 ) r and omly assigned into 3 groups to receive IS or DFS with iron as MGFePP or EFF , both at 2 mg/g salt . We measured hemoglobin , iron status , and urinary iodine at baseline , 5 mo , and 10 mo . RESULTS Median serum ferritin and calculated median body iron improved significantly in the 2 groups receiving iron . After 10 mo , the prevalence of anemia decreased from 16.8 % to 7.7 % in the MGFePP group ( P < 0.05 ) and from 15.1 % to 5.0 % in the EFF group ( P < 0.01 ) . The median urinary iodine concentration increased significantly in the IS and EFF groups ( P < 0.001 ) but not in the MGFePP group . Losses of iodine in salt with 1.8 % moisture were high for MGFePP , whereas the EFF segregated in salt with 0.5 % moisture and caused color changes in some local foods . CONCLUSIONS Both DFSs were efficacious in reducing the prevalence of anemia and iron deficiency in school-age children . Local salt characteristics should be taken into consideration when choosing an iron fortificant for DFS to achieve optimal iodine stability and color BACKGROUND High homocysteine and low B vitamin concentrations have been linked to the risk of vascular disease , stroke , and dementia and are relatively common in older adults . OBJECTIVE We assessed the effect of breakfast cereal fortified with folic acid , vitamin B-6 , and vitamin B-12 on vitamin and homocysteine status . DESIGN A r and omized , double-blind trial was conducted in 189 volunteers aged 50 - 85 y. The subjects had no history of hypertension , anemia , asthma , cancer , or cardiovascular or digestive disease and did not regularly consume multiple or B vitamin supplements or highly fortified breakfast cereal . Subjects were r and omly assigned to consume 1 cup ( 0.24 L ) breakfast cereal fortified with 440 microg folic acid , 1.8 mg vitamin B-6 , and 4.8 microg vitamin B-12 or placebo cereal for 12 wk . Blood was drawn at 0 , 2 , 12 , and 14 wk . Methionine-loading tests were conducted at baseline and week 14 . RESULTS Final baseline-adjusted plasma homocysteine concentrations were significantly lower and B vitamin concentrations were significantly higher in the treatment group than in the placebo group ( P < 0.001 ) . The percentage of subjects with plasma folate concentrations < 11 nmol/L decreased from 2 % to 0 % , with vitamin B-12 concentrations < 185 pmol/L from 9 % to 3 % , with vitamin B-6 concentrations < 20 nmol/L from 6 % to 2 % , and with homocysteine concentrations > 10.4 micromol/L ( women ) or > 11.4 micromol/L ( men ) from 6.4 % to 1.6 % . The percentage of control subjects with values beyond these cutoff points remained nearly constant or increased . CONCLUSIONS In this relatively healthy group of volunteers , consumption of 1 cup fortified breakfast cereal daily significantly increased B vitamin and decreased homocysteine concentrations , including post-methionine-load homocysteine concentrations 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 Some infant milk formulae have a lower zinc content than the original cow 's milk . Zinc is a nutrient necessary for growth and , in this double-blind controlled study , the effects of supplementing Similac with iron with 4 mg/liter of zinc were determined . By 6 months of age , mean growth increments for the supplemented male infants were 2.1 cm greater in length ( P less than 0.025 ) and 535 g greater in weight ( P less than 0.05 ) than for male controls . Growth increments for female test and control infants did not differ significantly . Plasma zinc levels were , at 3 months of age , significantly higher for both male and female supplemented infants . By 6 months , only the male supplemented infants maintained significantly higherplasma zinc levels ( P less than 0.025 ) . The addition of zinc was associated with a lower incidence of disturbed gastrointestinal function ( P less than 0.005 ) and not accompanied by any signs of toxicity A targeted , double-blind controlled iron fortification trial using Fe(111)-EDTA in masala ( curry powder ) was directed towards an Fe-deficient Indian population for 2 y. The Fe status of the fortified group improved more than that of control subjects . Improvement reached significance over control subjects for females in hemoglobin ( p = 0.0005 ) , ferritin ( p = 0.0002 ) , and body Fe stores ( p = 0.001 ) and for males in ferritin ( p = 0.04 ) . The prevalence of Fe-deficiency anemia ( IDA ) decreased from 22 to 5 % in fortified females . Premenopausal women , multipara women , and women with prolonged menstruation or initial IDA benefitted most from fortification . The mean increase in body Fe stores in females with initial IDA was 9.0 + /- 1.3 mmol , representing an increased absorption of 12 mumol/d . Fortified subjects with normal Fe status did not accumulate excessive body Fe and there was no alteration in serum Zn concentrations . Targeted fortification is a safe and effective means of combatting Fe deficiency Since January 2000 the Chilean Ministry of Health has required the fortification of wheat flour with folic acid ( FA ) at a concentration of 2.2 mg FA/kg in order to reduce the risk of neural tube defects ( NTD ) in newborns . This policy was expected to result in a mean additional intake of approximately 400 microg FA/d . We assessed the effectiveness of the FA flour fortification program on bread folate content and on blood folate concentration in women of childbearing age in Santiago , Chile . The prefortification folate status of 751 healthy women of reproductive age was assessed . The folate content of 100 bread sample s bought at retail bakeries was measured , average wheat flour consumption was estimated and postfortification FA dietary intake was calculated . The effect of flour fortification on blood folate concentration in this group of women ( n = 605 ) was evaluated in a follow-up study . Blood folate concentrations of the 605 women in the follow-up group increased ( P < 0.0001 ) following fortification . Before fortification the mean serum and red blood cell folate concentrations were 9.7 + /- 4.3 and 290 + /- 102 nmol/L , respectively , compared with 37.2 + /- 9.5 and 707 + /- 179 nmol/L postfortification , respectively . The mean FA content of bread was 2020 + /- 940 micro g/kg . The median FA intake of the group evaluated postfortification was 427 microg/d ( 95 % CI 409 - 445 ) based on an estimated intake of 219 g/d ( 95 % CI 201 - 229 ) of wheat flour , mainly as bread . Fortification of wheat flour substantially improved folate status in a population of women of reproductive age in Chile . The effect of the FA fortification program on the occurrence of NTD is currently being assessed BACKGROUND Fish sauce is consumed daily by a large proportion of the Vietnamese population and could therefore be a potentially useful food vehicle for iron-fortification programs . OBJECTIVE We evaluated the efficacy of iron-fortified fish sauce in improving the iron status of anemic women . DESIGN In a r and omized , double-masked study of 152 anemic ( hemoglobin concentration of 81 - 119 g/L ) women , a meal based on noodles or rice was served 6 d/wk with 10 mL fish sauce containing either 10 mg Fe as NaFeEDTA ( iron-fortified group ) or no added iron ( control group ) . Concentrations of hemoglobin , serum ferritin ( SF ) , and serum transferrin receptor ( TfR ) were measured at baseline and after 3 and 6 mo . RESULTS After 6 mo , hemoglobin and SF concentrations were higher and TfR concentrations were lower in the iron-fortified group than in the control group [ hemoglobin : 116.3 + /- 8.7 ( + /- SD ) compared with 107.6 + /- 11.0 g/L ( P < 0.0001 ) ; SF : 30.9 ( 95 % CI : 23.4 , 40.6 ) compared with 14.6 ( 11.3 , 19.0 ) micro g/L ( P = 0.0002 ) ; TfR : 7.2 ( 6.4 , 7.9 ) compared with 9.0 ( 8.1 , 9.9 ) mg/L ( P = 0.002 ) ] . The prevalence of iron deficiency ( SF < 12 micro g/L or TfR > 8.5 mg/L ) and iron deficiency anemia ( iron deficiency with hemoglobin < 120 g/L ) was lower in the iron-fortified group than in the control group [ 32.8 % compared with 62.5 % ( P = 0.0005 ) and 20.3 % compared with 58.3 % ( P < 0.0001 ) , respectively ] . CONCLUSIONS Regular consumption of iron-fortified fish sauce significantly reduced the prevalence of iron  deficiency anemia in Vietnamese women during the 6-mo intervention . Fortifying fish sauce with iron by using a water-soluble , highly bioavailable compound ( NaFeEDTA ) is a promising strategy for combating iron deficiency anemia in Vietnam 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 BACKGROUND Despite the theoretical benefits of nutrient-enriched formula given to preterm infants after hospital discharge , its role in reversing growth deficits after hospital discharge remains poorly defined . OBJECTIVE The aim was to determine the effect of different formulas on the growth , bone mass , and body composition of preterm infants after hospital discharge . DESIGN This was a r and omized , double blind comparison of a nutrient-enriched formula ( EF ) and a formula for term infants ( TF ) given for 1 y after hospital discharge . Compared with the TF , the EF had a higher energy density and higher contents of protein , calcium , and phosphorus ( by 10 % , 21 % , 44 % , and 11 % , respectively ) and higher contents of almost all other nutrients ( by > or=10 % ) . RESULTS  Birth weights of the infants were 630 - 1620 g ( median : 1250 g ) and gestational ages were 24 - 34 wk ( median : 29 wk ) . TF result ed in significantly greater weight , length , head circumference measurements , and their respective z scores on the basis of age- and sex-specific norms . At the end of the study , the mean z scores for the corrected age of infants in the TF group were -0.37 for weight , 0.001 for length , and 0.50 for head circumference . The TF group also had significantly greater dual-energy X-ray absorptiometry measured bone and lean and fat mass than did the EF group ( P < 0.05 for all comparisons ) . CONCLUSIONS The use of EF for preterm infants after hospital discharge shows no advantage over TF in growth , bone mineralization , and body composition . More studies are needed to determine the optimal postdischarge nutrition support for preterm infants A micronutrient-fortified rusk for weanling children was tested in a rural area near Beijing . Two hundred twenty-six children aged 6 - 13 mo were r and omly assigned by village to either a micronutrient-fortified or an unfortified rusk , daily for 3 mo . The fortified rusk contained extra zinc ; iron ; calcium ; vitamins A , D , and B-12 ; thiamin , riboflavin , niacin , and folic acid . Infants receiving the fortified rusk exhibited no decline in hemoglobin concentrations during the study whereas those receiving the unfortified rusk exhibited a significant decline . Improvements were also seen in erythrocyte porphyrin , plasma vitamin A , and riboflavin status , but these improvements were seen in both of the groups . Micronutrient fortification was probably beneficial for iron status and the fortified rusk promises to be an effective vehicle for supplementation BACKGROUND St and ard therapy for anemia in infants is ferrous sulfate drops administered 3 times/d . Adherence to treatment , however , is often poor . One likely reason for poor adherence is the unpleasant side effects associated with drops . OBJECTIVE The objective was to evaluate the use of a new form of iron and a delivery system to treat anemia in infants that is likely to produce better adherence to treatment . DESIGN Using a prospect i ve , r and omized , controlled design , we studied 557 anemic children aged 6 - 18 mo ( hemoglobin : 70 - 99 g/L ) in rural Ghana . One group received a daily sachet of microencapsulated ferrous fumarate ( 80 mg elemental Fe ) in powder form plus ascorbic acid to be sprinkled onto any complementary food eaten ( sprinkles group ) ; a control group received ferrous sulfate drops 3 times/d for 2 mo ( total dose : 40 mg elemental Fe ) . Hemoglobin and serum ferritin concentrations were measured at baseline and at the end of treatment . RESULTS Successful treatment of anemia ( hemoglobin > 100 g/L ) occurred in 58 % of the sprinkles group and in 56 % of the drops group , with minimal side effects in both groups . Geometric mean ferritin concentrations increased significantly in each group from baseline to the end of treatment ( P < 0.001 ) . CONCLUSION Use of ferrous sulfate drops or a single daily dose of microencapsulated ferrous fumarate sprinkles plus ascorbic acid result ed in a similar rate of successful treatment of anemia without side effects . To our knowledge , this is the first demonstration of the use of microencapsulated iron sprinkles to treat anemia . Improved ease of use may favor the use of sprinkles to deliver iron 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 BACKGROUND Deficiencies of iron , iodine , and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren . OBJECTIVE The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children . DESIGN Micronutrient status was assessed in 115 children aged 6 - 11 y before and after consumption of biscuits ( fortified with iron , iodine , and beta-carotene ) for 43 wk over a 12-mo period and was compared with that in a control group ( n = 113 ) who consumed nonfortified biscuits .  Cognitive function , growth , and morbidity were assessed as secondary outcomes . RESULTS There was a significant between-group treatment effect on serum retinol , serum ferritin , serum iron , transferrin saturation , and urinary iodine ( P < 0.0001 ) and in hemoglobin and hematocrit ( P < 0.05 ) . The prevalence of low serum retinol concentrations ( < 0.70 micromol/L ) decreased from 39.1 % to 12.2 % , of low serum ferritin concentrations ( < 20 microg/L ) from 27.8 % to 13.9 % , of anemia ( hemoglobin < 120 g/L ) from 29.6 % to 15.6 % , and of low urinary iodine concentrations ( < 100 microg/L ) from 97.5 % to 5.4 % . There was a significant between-group treatment effect ( P < 0.05 ) in cognitive function with the digit span forward task ( short-term memory ) . Fewer school days were missed in the intervention than in the control group because of respiratory- ( P = 0.097 ) and diarrhea-related ( P = 0.013 ) illnesses . The intervention had no effect on anthropometric status [ corrected ] . CONCLUSIONS Fortified biscuits result ed in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [ corrected ] The choice of iron fortificant usually represents a balance between bioavailability of the compound and its tendency to cause organoleptic problems . The aim of this study was to evaluate the efficacy of sodium iron EDTA ( NaFeEDTA ) and ferrous fumarate at levels compatible with South African brown bread ( 10 mg/kg flour for NaFeEDTA and 20 mg/kg flour for ferrous fumarate ) in a r and omized controlled trial ; electrolytic iron was evaluated at the level currently used in South Africa ( 35 mg/kg flour ) . Schoolchildren ( n = 361 ) , aged 6 - 11 y , from a low socioeconomic community with hemoglobin ( Hb ) < or = 125 g/L were r and omly assigned to 1 of 4 groups that received 4 slices of brown bread supplying either : 1 ) no fortification iron 2 ) 2.35 mg iron as NaFeEDTA ; 3 ) 4.70 mg iron as ferrous fumarate ; and 4 ) 8.30 mg iron as electrolytic iron per intervention day . These amounts simulated a bread intake of 6 slices per day over the 34-wk study period at fortification levels of 0 , 10 , 20 , and 35 mg/kg flour , respectively . Hb concentration and iron status were assessed at baseline and after 34 wk of intervention . The iron interventions did not affect Hb concentration , transferrin saturation , or serum ferritin , iron , or transferrin receptor concentrations relative to the control group . Our results suggest that electrolytic iron at the level currently used in South Africa is not effective in improving iron or Hb status . Neither do NaFeEDTA or ferrous fumarate appear to be suitable alternatives for the fortification of wheat flour when included at levels that do not cause color changes BACKGROUND Iron deficiency anemia is the most prevalent nutrition problem in young children . One possible strategy to prevent iron deficiency anemia in this population group is the fortification of affordable food . OBJECTIVE This study was design ed to assess whether iron-fortified c and ies can improve iron status and are acceptable to children aged 4 - 6 y. DESIGN A double-blind , placebo-controlled intervention study was conducted in Jakarta , INDONESIA : The children were r and omly assigned to 1 of 2 treatment groups : a fortified group ( n = 57 ) and a placebo group ( n = 60 ) . Every week for 12 wk , 30 g ( 10 pieces ) c and y was given to the children . The c and y given to the fortified group contained 1 mg elemental Fe/g and very small amounts of other vitamins and minerals . RESULTS The hemoglobin concentration of the fortified group increased by 10.2 g/L ( 95 % CI : 8.3 , 12 g/L ) whereas that of the placebo group increased by 4.0 g/L ( 2.0 , 6.0 g/L ; P < 0.001 ) . Anemia prevalence decreased from 50.9 % at the start of the intervention to 8.8 % after 12 wk of intervention in the fortified group ( P < 0.001 ) and from 43.3 % to 26.7 % in the placebo group ( P < 0.05 ) . After 12 wk of intervention , the serum ferritin concentration was 71 % higher than at baseline in the fortified group and 28 % higher in the placebo group ( P < 0.001 ) . Acceptability of the iron-fortified c and ies was good . The per capita cost of the supplement was approximately US$ 0.96 - 1.20 for the 12 wk of intervention . CONCLUSION Iron-fortified c and ies were effective for improving the iron status  of young children and might be an affordable way to combat iron deficiency in children of low-to-middle income groups The effects of consuming zinc-fortified ready-to-eat breakfast cereals were determined in a double-blind controlled study . The 96 healthy young children who participated ( mean age 58 months ) consumed either zinc-fortified cereal , providing 25 % United States Recommended Dietary Allowance per 1 ounce serving ( test children ) or nonzinc-fortified cereals ( controls ) for a 9-month period . The test children were calculated on average to receive an additional 2.57 mg of zinc per day from this fortification program . This increment increased their mean daily zinc intake to a level that approached the Recommended Dietary Allowance ( 10 mg ) of the National Academy of Sciences for children less than 10 years of age . By the end of the period , the test children ( combined sexes ) had a mean increment of plasma zinc that was 6.5 micrograms/dl greater than that of the control children ( P less than 0.02 ) . The test girls had a greater increment ( 28.5 micrograms/g ) in hair zinc content than controls girls ( P less than 0.05 ) . There were no significant differences in other biochemical parameters including plasma copper and serum cholesterol . No significant differences in food intake or growth velocity were associated with the consumption of the zinc-fortified cereal . Multiple sex and time related differences occurred in plasma , hair , urine , and parotid saliva zinc concentrations that were unrelated to the type of cereal consumed Despite potential benefits , human milk may fail to meet preterm infants ' nutrient requirements . We tested the hypothesis that fortified breast milk , fed alone or with preterm formula , would improve neurodevelopment and growth at 18-mo follow-up without adverse short-term clinical or biochemical consequences . Two hundred seventy-five preterm infants from two medical centers ( birth weight < 1850 g ; mean gestation 29.8 + /- 2.7 wk ) whose mothers chose to provide breast milk were r and omly assigned to receive for a mean of 39 d a multinutrient fortifier or control supplement containing phosphate and vitamins . Breast milk comprised 47.6 % and 46.4 % of enteral intake in fortified and control groups , respectively ; preterm formula supplements were used when insufficient breast milk was available . Overall , there were no significant growth advantages with fortification ; although , when breast milk exceeded 50 % of intake , fortification promoted faster weight gain ( an advantage of 1.6 g.kg-1.d-1 ; 95 % CI : 0.1 , 3.1 ; P < 0.05 ) . Compared with control infants , the fortified group showed 1 ) higher plasma urea from week 2 ( P = 0.04 ) , 2 ) higher plasma calcium ( mean 2.34 + /- 0.01 compared with 2.27 + /- 0.02 mmol/L ; P = 0.003 ) , 3 ) a greater rise in alkaline phosphatase by week 6 ( P = 0.04 ) , 4 ) more clinical infections ( suspected plus proven ; 43 % compared with 31 % , P = 0.04 ) , 5 ) a nonsignificantly increased incidence of necrotizing enterocolitis ( 5.8 % compared with 2.2 % , P = 0.12 ) , and 6 ) higher white cell and platelet counts . Developmental scores at 18 mo were slightly but not significantly higher in the fortified group . This study confirmed that breast milk fortifiers can improve short-term growth ( when breast milk intakes are high ) ; but beneficial effects on long-term development remained unproven . Future research is required to evaluate potential adverse consequences and explore more optimal fortification strategies BACKGROUND In many developing countries , children are at high risk of both goiter and iron deficiency anemia . OBJECTIVE In a series of studies in northern Morocco , we developed and tested a dual-fortified salt ( DFS ) containing iodine and microencapsulated iron . DESIGN To establish the DFS fortification concentration , we measured salt intake by 3-d weighed food records and estimated iron bioavailability from the local diet by using published algorithms . We then formulated a DFS containing 25 micro g iodine/g salt ( as potassium iodide ) and 1 mg iron/g salt ( as ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil ) . After storage and acceptability trials , we compared the efficacy of the DFS to that of iodized salt in a 9-mo , r and omized , double-blind trial in iodine-deficient , 6 - 15-y-old children ( n = 377 ) . RESULTS Mean salt intake in school-age children was 7 - 12 g/d , and estimated iron bioavailability from the local diet was 0.4 - 4.3 % . After storage for 20 wk , the DFS and iodized salt were not significantly different in iodine content , and color stability was acceptable when the compounds were added to local meals . During the efficacy trial , urinary iodine concentrations and thyroid volumes improved significantly ( P < 0.001 and < 0.05 , respectively ) from baseline in both groups . At 40 wk , mean hemoglobin concentrations in the DFS group had increased by 14 g/L ( P < 0.01 ) , and serum ferritin , transferrin receptor , and zinc protoporphyrin concentrations were significantly better ( P < 0.05 ) in the DFS group than in the iodized salt group . The prevalence of iron deficiency anemia in the DFS group decreased from 35 % at baseline to 8 % at 40 wk ( P < 0.001 ) . CONCLUSION A DFS containing iodine and encapsulated iron can be an effective fortification strategy BACKGROUND Wheat flour is a possible food vehicle for vitamin A fortification . OBJECTIVE This study assessed the efficacy of consumption of a vitamin A-fortified wheat-flour bun ( p and esal ) on the vitamin A status of school-age children . DESIGN This was a double-masked clinical trial conducted in 396 and 439 children aged 6 - 13 y attending 4 rural schools in the Philippines . The children were r and omly assigned to a vitamin A-fortified ( experimental ) or nonfortified ( control ) group . A 60-g vitamin A-fortified p and esal ( containing approximately 133 microg retinol equivalents ) or a nonfortified p and esal was consumed by the children 5 d/wk for 30 wk . Vitamin A status , hemoglobin concentration , anthropometric status , morbidity , and dietary intake were assessed at baseline and 30 wk later . A modified relative dose response ( MRDR ) was assessed in a sub sample of 20 % of the children ( approximately 75/group ) with the lowest initial serum retinol concentration at the 30-wk follow-up . RESULTS Baseline serum retinol significantly modified the effect of the intervention . The fortified group , whose initial serum retinol concentrations were below the median , had a 0.07 + /- 0.03-micromol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group ( P : = 0.02 ) . Improved vitamin A status was also evident in the MRDR sub sample . End-of- study differences in the MRDR showed that vitamin A- fortified p and esal intake decreased the percentage of children with inadequate liver vitamin A stores by 50 % ( 15.3 % compared with 28.6 % ; P : = 0.05 ) . CONCLUSIONS Daily consumption of vitamin A-fortified p and esal significantly improved the vitamin A status of Filipino school-age children with marginal-to-low initial serum retinol concentrations Linear growth retardation and anemia are the most prevalent nutritional problems in the world ; effective interventions are urgently needed . We evaluated Ecuador 's National Food Nutrition Program ( PANN 2000 ) that included a micronutrient-fortified complementary food ( FCF ) , Mi Papilla , in poor periurban and rural communities of Ecuador . The program is preventive and targeted to all infants and young children living in poor communities and receiving government health services . We compared dietary intake , micronutrient status , and growth over 11 mo in a cohort of children from the catchment areas of the PANN 2000 with same-age control children in nearby communities eligible to enter the program 1 y later . PANN 2000 children enrolled in the program when they were age 9 - 14 mo and were age 20 - 25 mo at the final survey . They consumed significantly more energy , protein , fat , iron , zinc , vitamin A , and calcium than control children because of their FCF consumption . Anemia , 76 % in both groups at baseline , fell to 27 % in PANN 2000 children but only to 44 % in control children ( P < 0.001 ) . The odds of being anemic were 58 % lower for PANN 2000 children ( P = 0.003 ) . The effects on linear growth and weight were limited to children who were older when the program began ( 12 - 14 mo ) and were significant for weight ( interaction with age , 0.38 kg ; P = 0.029 ) and positive but not significant for length ( 0.66 cm ; P = 0.08 ) . An FCF , including ferrous sulfate , delivered through public health services , is highly effective in improving weight and hemoglobin and reducing anemia BACKGROUND Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded linear growth and reducing anemia in stunted children . DESIGN Saharawi refugee children ( n = 374 ) aged 3 - 6 y with initial height-for-age z scores < -2 were assigned to 1 of 5 groups : fortified spread ( FS ) , fortified spread plus metronidazole ( FS+M ) , unfortified spread ( US ) , unfortified spread plus metronidazole ( US+M ) , or control . Supervised supplementation was given daily for 6 mo . Weight , height , knee-heel length , hematologic indexes , parasitic infections , and morbidity were assessed at 0 , 3 , and 6 mo . RESULTS Linear growth of children fed FS was 30 % faster at 3 mo than in US and control groups , after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups . No additional benefits from metronidazole were observed . Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups ( 37 + /- 40 , 19 + /- 15 , and 16 + /- 17 g/L , respectively ; P < 0.0001 ) , and anemia was reduced by nearly 90 % . CONCLUSIONS FS , and not US , induces catch-up growth in stunted children whose diets are poor in micronutrients . Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 BACKGROUND Although elemental iron powders are widely used to fortify cereal products , little data exist on their efficacy in humans . OBJECTIVE We compared the efficacy of wheat-based snacks fortified with ferrous sulfate , electrolytic iron , or hydrogen-reduced iron in Thai women with low iron stores . DESIGN A double-blind intervention was conducted in 18 - 50-y-old women ( n = 330 ) r and omly assigned into 4 groups to receive either no fortification iron or 12 mg Fe/d for 6 d/wk for 35 wk as ferrous sulfate , electrolytic iron , or hydrogen-reduced iron in a baked , wheat-flour-based snack . Snacks were not consumed with meals , and consumption was monitored . At baseline , 20 wk , and 35 wk , hemoglobin status and iron were measured and the groups were compared . RESULTS Between baseline and 35 wk , geometric mean serum ferritin ( SF ) increased significantly in all 3 groups receiving iron ( P < 0.01 ) , and geometric mean serum transferrin receptor ( TfR ) decreased significantly in the groups receiving ferrous sulfate and electrolytic iron ( P < 0.05 ) . Calculated mean ( + /-SD ) body iron stores increased from 1.5 + /- 2.8 to 5.4 + /- 2.9 mg/kg in the ferrous sulfate group , from 1.5 + /- 3.5 to 4.4 + /- 3.6 mg/kg in the electrolytic iron group , and from 1.3 + /- 3.2 to 3.2 + /- 4.3 mg/kg in the hydrogen-reduced iron group ( P < 0.01 for all 3 groups ) but did not change significantly in the control group . CONCLUSIONS Ferrous sulfate , electrolytic iron , and hydrogen-reduced iron , fortified into wheat-based snacks , significantly improved iron status . On the basis of the change in body iron stores during the 35-wk study , the relative efficacy of the electrolytic and hydrogen-reduced iron compared with ferrous sulfate was 77 % and 49 % , respectively BACKGROUND B vitamins such as folate , vitamin B-6 , and vitamin B-12 are coenzymes that are important for DNA integrity and stability . Deficiency in these B vitamins may promote tumor carcinogenesis . OBJECTIVE We prospect ively evaluated plasma concentrations of folate , pyridoxal 5-phosphate ( PLP ; the principal active form of vitamin B-6 ) , and vitamin B-12 in relation to breast cancer risk . DESIGN We included 848 incident cases of invasive breast cancer identified as of 31 March 2004 , and 848 individually matched control subjects from 28 345 women in the Women 's Health Study aged > or = 45 y who provided blood sample s and had no history of cancer and cardiovascular disease at baseline in 1993 .  Logistic regression controlling for matching factors and other risk factors for breast cancer was used to estimate relative risks ( RRs ) and 95 % CIs . All statistical tests were 2 sided . RESULTS Plasma concentrations of folate , PLP , and vitamin B-12 were not associated with overall risk of breast cancer . Women in the highest quintile group relative to those in the lowest quintile had multivariate RRs of 1.42 ( 95 % CI : 1.00 , 2.02 ) for plasma folate ( P for trend = 0.21 ) , 0.91 ( 95 % CI : 0.63 , 1.30 ) for plasma PLP ( P for trend = 0.48 ) , and 1.29 ( 95 % CI : 0.92 , 1.82 ) for plasma vitamin B-12 ( P for trend = 0.18 ) . However , higher plasma folate concentrations were moderately associated with an increased risk of developing premenopausal breast cancer ( P for trend = 0.04 ) and for developing estrogen receptor (ER)-positive or progesterone receptor (PR)-positive breast tumors ( P for trend < or = 0.06 ) . Conversely , an inverse association was seen between plasma PLP and postmenopausal breast cancer ( P for trend = 0.04 ) . CONCLUSIONS Data from this study suggest that B vitamins , including folate , vitamin B-6 , and vitamin B-12 , may confer little or no reduction in overall risk of developing breast cancer . The observed positive associations of folate status with risk of developing premenopausal breast cancer and ER-positive or PR-positive tumors are unexpected . Additional research is needed to eluci date the role of folate in breast cancer development One cost-effective strategy for controlling iron deficiency is the fortification of staple foods or condiments with iron . We evaluated the effectiveness of fortifying fish sauce with NaFeEDTA for improving iron status in women of childbearing age in Vietnam in a double-blind intervention with r and omization by village . All families in the selected villages were supplied with fish sauce that was either unfortified ( Group C , 10 villages ) or fortified with NaFeEDTA [ 9 mmol ( 500 mg ) Fe/L , Group F , 11 villages ] for 18 mo . The effect of fortification was assessed in the 576 women ( n = 288/group ) by measuring hemoglobin and serum ferritin ( SF ) at 6 , 12 , and 18 mo . Analysis of the group x time interaction using a repeated- measures test for each response demonstrated a significant effect of fortification on hemoglobin ( P = 0.039 ) and log SF ( P < 0.0001 ) in Group F with no significant changes in Group C. The prevalence of iron deficiency ( SF < 12 microg/L ) decreased from 22.3 to 4.0 % and the prevalence of anemia ( hemoglobin < 120 g/L ) from 24.7 to 8.5 % in Group F with no significant changes in Group C. NaFeEDTA fortification of fish sauce is an effective method for reducing the prevalence of iron deficiency in women in Vietnam 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 Maize-meal porridge is used for infant feeding in many African countries , including South Africa . A low-cost , finely milled , maize-meal porridge was fortified with beta-carotene , iron , and zinc ( 100 % of recommended dietary allowance ) , as well as ascorbic acid , copper , selenium , riboflavin , vitamin B-6 , vitamin B-12 , and vitamin E. OBJECTIVE We assessed whether the fortified porridge could reduce anemia and improve the micronutrient status and motor development of infants .  DESIGN Infants aged 6 - 12 mo ( n = 361 ) were r and omly assigned to receive either the fortified or unfortified porridge for 6 mo . Primary outcomes were hemoglobin and serum retinol , zinc , and ferritin concentrations and motor development . Growth was assessed as a secondary outcome . Primary and secondary outcomes were assessed at baseline and 6 mo . RESULTS Two hundred ninety-two infants completed the study . The fortified-porridge group had an intervention effect of 9.4 microg/L ( 95 % CI : 3.6 , 15.1 microg/L ) for serum ferritin and 9 g/L ( 95 % CI : 6 , 12 g/L ) for hemoglobin concentrations . The proportion of infants with anemia decreased from 45 % to 17 % in the fortified-porridge group , whereas it remained > 40 % in the control group . The fortified-porridge group achieved on average 15.5 of the 25 motor development score items , whereas the control group achieved 14.4 items ( P = 0.007 ) . Serum retinol concentration showed an inconsistent effect , and no intervention effect was observed for serum zinc concentrations . CONCLUSIONS This low-cost fortified porridge can potentially have a significant effect in reducing anemia and improving iron status and motor development of infants in poor setting s. The formulation needs some adjustment in terms of zinc fortification After iron deficiency , zinc deficiency is the major micronutrient deficiency in developing countries , and staple food fortification is an effective strategy to prevent and improve it among at-risk- population s. No action has been taken to reduce zinc deficiency via flour fortification so far in Iran , and little is known about the influence of zinc fortification of flour on serum zinc and the iron status , and also about the optimum and effective amount of zinc compound that is used in food fortification . The objective of this study is to evaluate the influence of consuming zinc-fortified breads on the zinc and iron status in the blood serum . In this study , three types of bread were prepared from non-fortified and fortified flours , with 50 and 100 ppm elemental zinc in the form of sulfate .  Eighty zinc-deficient women aged 19 to 49 years were r and omly assigned to three groups ; The volunteers received , daily , ( 1 ) a non-fortified bread , ( 2 ) a high-zinc bread , and ( 3 ) a low-zinc bread for one month .  Serum zinc and iron were measured by Atomic Absorption before and after the study . Results showed a significant increase in serum zinc and iron levels in all groups ( p < 0.001 ) except in the control ( p > 0.05 ) . Absorption of zinc and iron in the group that consumed high-zinc bread was significantly greater than that in the group that received low-zinc bread ( p < 0.01 ) . It was concluded that fortification of flour with 50–100 ppm zinc was an effective way to achieve adequate zinc intake and absorption in zinc-deficient people . It also appeared that consuming zinc-fortified bread improved iron absorption The effect of iron fortification is generally assumed to be less than iron supplementation ; however , the magnitude of difference in effects is not known . The present study aims to compare the efficacy of these two strategies on anaemia and iron status . After screening on low Hb , 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a r and omized , placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group , with children in all groups having been dewormed .  Blood sample s were collected before and after intervention for haemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) , C-reactive protein ( CRP ) , and haemoglobinopathies analysis . Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration , SF , TfR , body iron , and anaemic status as outcome variables . The improvement of haemoglobin , SF , and body iron level in the group receiving iron fortification was 42 % ( 2.6 g/L versus 6.2 g/L ) , 20 % ( 23.5 μg/L versus 117.3 μg/L ) , and 31.3 % ( 1.4 mg/kg versus 4.4 mg/kg ) of that in the iron supplementation group . The prevalence of anaemia dropped to 15.1 % in the control group , with an additional reduction of anaemia of 8.5 % in the iron supplementation group . The additional reduction due to iron fortification was 5.4 % , which amounts to well over 50 % of the impact of supplementation . In conclusion , the efficacy of iron fortification based on reduction of prevalence of anaemia , and on the change in haemoglobin level , is about half of the maximum impact of supplementation in case of optimal compliance . Thus , in a population of anaemic children with mild iron deficiency , iron fortification should be the preferred strategy to combat anaemia OBJECTIVE We compared the effect of supplementation with a fortified skimmed milk product ( high calcium skim milk ) with or without added phylloquinone ( vitamin K(1 ) ) on markers of bone formation and resorption in premenopausal women . METHODS Eighty-two women 20 to 35 y of age were r and omly allocated to three groups . Two groups received two daily servings of high calcium skim milk ( 1000 mg/d of extra calcium ) with or without added phylloquinone ( 80 microg/d ) for 16 wk , and a third control group received no supplementation .  Bone density was assessed at baseline and the bone markers , total osteocalcin , type I N-terminal procollagen peptide , and cross-linked C-telopeptide of type I collagen were measured at baseline and at weeks 2 , 12 , and 16 . Serum phylloquinone and undercarboxylated osteocalcin were measured in the control and vitamin K-supplemented groups at weeks 0 and 16 . RESULTS Baseline values for age , body mass index , and bone density did not differ across groups . In vitamin K-supplemented women , mean serum phylloquinone concentrations increased from 0.27 to 0.76 microg/L ( P < 0.05 ) and undercarboxylated osteocalcin concentrations decreased from 9.68 to 4.46 microg/L ( P < 0.05 ) over 16 wk . Plasma cross-linked C-telopeptide of type I collagen , total osteocalcin , and type I N-terminal procollagen peptide levels decreased significantly in both supplemented groups compared with the control group over 16 wk ( cross-linked C-telopeptide of type I collagen > 30 % , total osteocalcin and type I N-terminal procollagen peptide > 15 % ) . CONCLUSION Fortified milk supplementation  in premenopausal women reduced bone turnover significantly . Phylloquinone fortification substantially improved vitamin K status but had no demonstrable additive effect on bone turnover in this short-term study OBJECTIVE To evaluate the long-term effect on micronutrient status of a beta-carotene- , iron- and iodine-fortified biscuit given to primary school children as school feeding . DESIGN Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years ( n = 108 ) ; in addition , cross-sectional data from three subsequent surveys conducted in the same school are reported . SETTING A rural community in KwaZulu-Natal , South Africa . SUBJECTS Children aged 6 - 11 years attending the primary school where the biscuit was distributed . RESULTS There was a significant improvement in serum retinol , serum ferritin , haemoglobin , transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention . However , when the school reopened after the summer holidays , all variables , except urinary iodine , returned to pre-intervention levels . Serum retinol increased again during the next 9 months , but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays ; this pattern was repeated in two further cross-sectional surveys . Haemoglobin gradually deteriorated at each subsequent assessment , as did serum ferritin ( apart from a slight increase at the 42-month assessment at the end of the school year ) . CONCLUSIONS This study has shown that fortification of a biscuit with beta-carotene at a level of 50 % of the Recommended Dietary Allowance ( RDA ) was enough to maintain serum retinol concentrations from day to day , but not enough to sustain levels during the long school holiday break . Other long-term solutions , such as local food production programmes combined with nutrition education , should also be examined . The choice of the iron compound used as fortificant in the biscuit needs further investigation OBJECTIVE We aim ed to evaluate prospect ively the effect of 4 yr of m and atory iodization of salt ( 13 ppm iodine ) on thyroid volume in two regional areas with respectively mild and moderate iodine deficiency . METHODS Two separate cross-sectional studies were performed before ( n=4649 ) and after ( n=3570 ) the iodization in year 2000 in two areas with mild and moderate iodine deficiency . Women aged 18 - 22 , 25 - 30 , 40 - 45 , and 60 - 65 yr and men aged 60 - 65 yr were examined .  Thyroid ultrasonography was performed . RESULTS A lower median thyroid volume was seen in all age groups after iodization . The largest relative decline was found among the younger females from the area with previous , moderate iodine deficiency . Only a minor decrease was seen among the youngest participants in the area with previous , mild iodine deficiency . After iodization , there were no regional differences in median thyroid volume in the age groups younger than 45 yr . When adjusted for confounders , a lower mean volume was seen among those with multiple nodules in both areas and in the group with diffuse structure in the area with moderate iodine deficiency . Before the iodization , 17.6 % of the total cross-section had thyroid enlargement ; after the iodization , 10.9 % of the cross-section had thyroid enlargement . CONCLUSION In this prospect i ve study , we demonstrated a lower thyroid volume in all age groups after iodization of salt . The decline was largest in the area with former , moderate iodine deficiency . The equal volumes in the regions among the younger age groups indicate approximation to an optimal iodine intake OBJECTIVE Denmark was an area of iodine deficiency , and m and atory iodine fortification of table salt and salt in bread ( 13 p.p.m . iodine ) was initiated in 2000/2001 . The Danish investigation on iodine intake and thyroid disease ( DanThyr ) is the monitoring of the iodine fortification program . DESIGN AND METHODS DanThyr consists of three main parts : a study of population cohorts initialized before ( n=4649 ) and after ( n=3570 ) iodization of salt  , a prospect i ve identification of incident cases of overt hyper- and hypothyroidism in a population of around 550,000 people since 1997 , and compilation of data from the national registers on the use of thyroid medication , thyroid surgery , and radioiodine therapy . Studies were carried-out in parallel in subcohorts living in areas with differences in iodine content of ground water . RESULTS The study showed profound effects of even small differences in iodine intake level on the prevalence of goiter , nodules , and thyroid dysfunction . Mild and moderate iodine deficiency was associated with a decrease in serum TSH with age . Other environmental factors were also important for goiter development ( increase in risk , smoking and pregnancy ; decrease in risk , oral contraception and alcohol consumption ) , and the individual risk depended on the genetic background . Environmental factors had only a minor influence on the prevalence of thyroid autoantibodies in the population . There were more cases of overt hypothyroidism in mild than in moderate iodine deficiency caused by a 53 % higher incidence of spontaneous ( presumably autoimmune ) hypothyroidism . On the other h and , there were 49 % more cases of overt hyperthyroidism in the area with moderate iodine deficiency . The cautious iodine fortification program , aim ing at an average increase in iodine intake of 50 mug/day has been associated with a 50 % increase in incidence of hyperthyroidism in the area with the most severe iodine deficiency . The incidence is expected to decrease in the future , but there may be more cases of Graves ' hyperthyroidism in young people . CONCLUSION A number of environmental factors influence the epidemiology of thyroid disorders , and even relatively small abnormalities and differences in the level of iodine intake of a population have profound effects on the occurrence of thyroid abnormalities . Monitoring and adjustment of iodine intake in the population is an important part of preventive medicine OBJECTIVE . Chronic lead poisoning and iron deficiency are concentrated in urban children from lower socioeconomic strata , and both impair neurocognitive development . Our study objective was to determine if iron fortification reduces blood lead levels in urban , lead-exposed , iron-deficient children in Bangalore , India . DESIGN , SETTING , AND PARTICIPANTS . A r and omized , double-blind , controlled school-based feeding trial was done in 5- to 13-year-old iron-deficient children ( n = 186 ) . At baseline , a high prevalence of lead poisoning was found in the younger children . Subsequently , all 5- to 9-year-old children participating in the trial ( n = 134 ) were followed to determine if iron fortification would affect their blood lead levels . INTERVENTION . Children were dewormed and fed 6 days/week for 16 weeks either an iron-fortified rice meal ( ∼15 mg of iron per day as ferric pyrophosphate ) or an identical control meal without added iron . Feeding was directly supervised and compliance monitored . OUTCOME MEASURES . Hemoglobin , serum ferritin , C-reactive protein , transferrin receptor , zinc protoporphyrin , and blood lead concentrations were measured . RESULTS . The prevalence of iron deficiency was significantly reduced in the iron group ( from 70 % to 28 % ) compared with the control group ( 76 % to 55 % ) . There was a significant decrease in median blood lead concentration in the iron group compared with the control group . The prevalence of blood lead levels ≥10 μg/dL was significantly reduced in the iron group ( from 65 % to 29 % ) compared with the control group ( 68 % to 55 % ) . CONCLUSIONS . Our findings suggest providing iron in a fortified food to lead-exposed children may reduce chronic lead intoxication . Iron fortification may be an effective and sustainable strategy to accompany environmental lead abatement BACKGROUND Sodium iron edetic acid ( NaFeEDTA ) might be a more bioavailable source of iron than electrolytic iron , when added to maize flour . We aim ed to assess the effect , on children 's iron status , of consumption of whole maize flour fortified with iron as NaFeEDTA or electrolytic iron . METHODS 516 children , aged 3 - 8 years , from four schools in Marafa , Kenya , were r and omly assigned to four groups . All were given the same amount of porridge five times a week . The porridge for one group was made from unfortified whole maize flour ; for the other three groups it was fortified with either high-dose NaFeEDTA ( 56 mg/kg ) , low-dose NaFeEDTA ( 28 mg/kg ) , or electrolytic iron ( 56 mg/kg ) . Concentrations of haemoglobin , plasma ferritin , and transferrin receptor were analysed in sample s taken at baseline and at the end of the 5-month intervention . The primary outcome was iron-deficiency anaemia . We analysed data on an intention-to-treat basis . This trial is registered with Clinical Trials.gov , number NCT00386074 . FINDINGS The prevalence of iron-deficiency anaemia in children given unfortified flour was 10 % . Compared with placebo , the prevalence of iron-deficiency anaemia in children given flour fortified with high-dose NaFeEDTA , low-dose NaFeEDTA , and electrolytic iron changed by -89 % ( 95 % CI -97 % to -49 % ) , -48 % ( -77 % to 20 % ) , and 59 % ( -18 % to 209 % ) , respectively . Consumption of high-dose NaFeEDTA improved all measured iron-status indicators . Low-dose NaFeEDTA decreased the prevalence of iron deficiency but did not noticeably change the prevalence of anaemia . Electrolytic iron did not improve any of these iron-status indicators .  Children who were iron-deficient at baseline benefited more from high-dose and low-dose NaFeEDTA than those with sufficient iron at baseline . INTERPRETATION Consumption of whole maize flour fortified with NaFeEDTA caused modest , dose-dependent improvements in children 's iron status . Fortification with electrolytic iron did not improve their iron status . Therefore , in high-phytate flours , NaFeEDTA is more suitable than electrolytic iron for supplementation of iron in the diet BACKGROUND Iron status de grade s in female soldiers during military training . Inflammation-mediated up-regulation of hepcidin , a key mediator of iron homeostasis , may be a contributing factor . OBJECTIVE We measured the efficacy of an iron-fortified food product for maintaining iron status in female soldiers during basic combat training ( BCT ) and examined relations between iron status , serum hepcidin concentrations , and inflammation . DESIGN A r and omized , double-blind , placebo-controlled trial was conducted . Volunteers received an iron-fortified food product ( total dose = 56 mg Fe/d ) or a placebo twice daily during the 9-wk BCT course . Iron-status indicators , serum hepcidin concentrations , and markers of inflammation were measured pre- and post-BCT . RESULTS BCT affected iron status ; serum ferritin concentrations decreased ( P < or = 0.05 ) , and concentrations of soluble transferrin receptor ( sTfR ) and hemoglobin and the red cell distribution width increased ( P < or = 0.05 ) . Consumption of the iron-fortified food product attenuated declines in iron status in iron-deficient anemic soldiers ; a group-by-time interaction was observed for hemoglobin and sTfR concentrations ( P < or = 0.05 ) . Serum hepcidin concentrations were not affected by BCT ; however , hepcidin concentrations were lower in iron-deficient anemic soldiers than in those with normal iron status ( P < or = 0.05 ) and were positively associated with serum ferritin ( P < or = 0.05 ) and C-reactive protein ( P < or = 0.05 ) concentrations pre- and post-BCT . CONCLUSIONS Twice-daily consumption of an iron-fortified food product improved iron status in iron-deficient anemic soldiers but not in iron-normal or iron-deficient nonanemic soldiers . Serum hepcidin concentrations were not affected by training but were associated with iron status and inflammation pre- and post-BCT . This trial was registered at clinical trials.gov as NCT01100905 Preschool children in developing countries are likely to have multiple , concurrent micronutrient deficiencies . This study was design ed to evaluate the effectiveness of different combinations of nutritional fortified diet to improve the blood levels of iron , vitamin A and other essential micronutrients in the preschool population of Banan District of Chongqing , China . From December 2005 to June 2006 , a total of 226 2 - 6 y old preschool children were recruited from three nurseries in the area , and they were r and omly assigned to three different fortified diet groups for 6 mo . Group I was fortified with vitamin A ; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron , thiamine , riboflavin , folic acid , niacinamide , zinc and calcium , respectively . Subjects ' weight and height were measured for assessing the children 's growth and development . Blood sample s were taken at the beginning and the end of the 6-mo study period for measuring serum levels of micronutrients . Group III with the multiple micronutrient fortified diet was the most effective to improve the serum level of retinol from [ media ( P25 , P75 ) : 1.06 ( 0.89 , 1.32 ) ] micromol/L to 1.29 ( 1.04 , 1.39 ) micromol/L ( p<0.05 ) and retinol binding protein from 17.0 ( 12.6 , 25.6 ) mg/L to 31.6 ( 24.4 , 44.0 ) mg/L ( p<0.05 ) and to mobilize the stored iron in the liver ( p<0.05 ) . In addition , the three groups ' hemoglobin levels were elevated from 117.0 ( 109.0 , 124.1 ) g/L , 114.0 ( 109.2 , 119.7 ) g/L and 115.0 ( 109.5 , 122.7 ) g/L to 125.7 ( 119.2 , 133.1 ) g/L , 126.5 ( 122.2 , 135.9 ) g/L and 125.1 ( 119.8 , 131.6 ) g/L over the 6 mo of intervention period , but there were no difference among the three groups ( p>0.05 ) . Nevertheless , unexpected results were obtained when comparing the effects on growth status among the different supplement groups . Our study has demonstrated that a multiple micronutrient fortified diet for 6 mo is more effective to improve the levels of hemoglobin , serum retinol , and RBP as well as to facilitate the mobilization of iron storage in preschool children CONTEXT Iodine fortification ( IF ) of salt was introduced in Denmark in 1998 . Little is known about the effect of a minor increase in iodine intake on the incidence of hypothyroidism . We prospect ively identified all new cases of overt hypothyroidism in two areas of Denmark before and for the first 7 yr after IF had been introduced . METHODS A computer-based register was used to identify continuously all new cases of overt hypothyroidism in two subcohorts with previous moderate and mild iodine deficiency ( ID ) , respectively ( Aalborg , n = 310,124 , urinary iodine = 45 microg/liter ; and Copenhagen , n = 225,707 , urinary iodine = 61 microg/liter ) . Data were obtained 1 ) before IF ( 1997 - 1998 ) , 2 ) during voluntary IF ( 1999 - 2000 ) , 3 ) during early ( 2001 - 2002 ) and 4 ) during late ( 2003 - 2005 ) period with m and atory IF . RESULTS The overall incidence rate of hypothyroidism increased during the study period : baseline , 38.3/100,000.yr ; voluntary IF , 43.7 ( not significant vs. baseline ) ; early m and atory IF , 48.7 [ vs. baseline , rate ratio ( RR ) = 1.27 ; 95 % confidence interval ( CI ) = 1.10 - 1.47 ] ; and late m and atory IF , 47.2 ( vs. baseline , RR = 1.23 ; 95 % CI = 1.07 - 1.42 ) . There was a geographic difference because hypothyroidism increased only in the area with previous moderate ID : Aalborg , late m and atory IF vs. baseline , 40.3/29.7 ( RR = 1.11 ; 95 % CI = 1.11 - 1.66 ) ; Copenhagen , 56.7/51.6 ( RR = 1.10 ; 95 % CI = 0.90 - 1.34 ) . The increase occurred in young and middle-aged adults . CONCLUSION Even a cautious iodization of salt was accompanied by a moderate increase in the incidence rate of overt hypothyroidism . This occurred primarily in young and middle-aged subjects with previous moderate ID OBJECTIVE To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification . DESIGN Pre- and post-intervention study using a longitudinal cohort . SETTING Nangweshi refugee camp , Zambia . SUBJECTS Two hundred and twelve adolescents ( 10 - 19 years ) , 157 children ( 6 - 59 months ) and 118 women ( 20 - 49 years ) were selected at r and om by household survey in July 2003 and followed up after 12 months . RESULTS Maize grain was milled and fortified in two custom- design ed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration . During the intervention period mean Hb increased in children ( 0.87 g/dl ; P < 0.001 ) and adolescents ( 0.24 g/dl ; P = 0.043 ) but did not increase in women . Anaemia decreased in children by 23.4 % ( P < 0.001 ) but there was no significant change in adolescents or women . Serum transferrin receptor ( log10-transformed ) decreased by -0.082 microg/ml ( P = 0.036 ) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency ( -8.5 % ; P = 0.079 ) . In adolescents , serum retinol increased by 0.16 micromol/l ( P < 0.001 ) and vitamin A deficiency decreased by 26.1 % ( P < 0.001 ) . CONCLUSIONS The introduction of fortified maize meal led to a decrease in  anaemia in children and a decrease in vitamin A deficiency in adolescents . Central ised , camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations Background : Very low birth weight infants ( < 1500 g ) have high nutritional needs . Deficiencies of minerals , trace elements ( especially zinc ) may develop as a result of rapid growth , low body stores and low content of these substances in human milk We hypothesized that fortification of human milk might prevent deficiencies . Methods : Prospect i ve , r and omized trial to evaluate mineral , trace element , thyroid status and growth of infants fed human milk fortified with different amounts of calcium , phosphorus and protein , with ( BMF ) or without ( FM 85 ) trace elements . Sixty-two infants , 1000 to 1499 g birth weight , were r and omized .  Minerals and trace elements in serum , red blood cells and human milk and alkaline phosphatase activity , TSH , T4 and FT4 in serum were measured once until the fifth day and at 3 and 6 weeks of life . Clinical course and anthropometric measurements were recorded . Results : Intake of zinc , copper , manganese , calcium , phosphorus and magnesium was higher in the BMF group ( P < 0.001 ) . Serum zinc concentrations < 0.49 mg/L occurred in 12 % of the FM 85 group and 7 % of the BMF group at 6 weeks ( not significant ) . Median alkaline phosphatase activity was 436/379 IU/L in the FM 85/BMF group at 6 weeks ( P < 0.01 ) . The FM 85 group showed a higher weight gain ( P < 0.05 ) , possibly because of higher caloric ( P < 0.01 ) and protein intake ( P < 0.05 ) at 3 weeks . Conclusions : Zinc deficiency was rare . Elevated intake of calcium , phosphorus and zinc was associated with lower serum alkaline phosphatase activity but did not influence serum zinc concentration 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 The objective of this research was to study the effectiveness of NaFeEDTA-fortified soy sauce for controlling iron deficiency in a high-risk population . This was an 18-month , r and omized , placebo-controlled intervention trial in 14,000 residents aged three years or older in Bijie City , Guizhou Province , China , using sodium-iron ethylene diamine tetraacetate (NaFeEDTA)-fortified soy sauce ( 29.6 mg Fe/100 ml ) . The study data included measurements of food consumption , hemoglobin , serum ferritin , and serum retinol . The results showed that the diet consisted primarily of cereals , fruits , and vegetables , with very little meat . Food consumption remained unchanged during the study period and was similar in the fortified and control groups . The average daily  soy sauce  consumption of the group consuming the fortified product was 16.4 ml per person , which provided 4.9 mg of iron from NaFeEDTA . At the end of the trial , all age and sex subgroups receiving NaFeEDTA had significantly higher hemoglobin levels , a lower prevalence of anemia , and higher plasma ferritin levels than the controls . The effects became statistically significant after six months of intervention and were maintained throughout the study period . We conclude that NaFeEDTA-fortified soy sauce was highly effective in controlling iron deficiency and reducing the prevalence of iron-deficiency anemia in men , women , and children . NaFeEDTA-fortified soy sauce is affordable and was well accepted by the study population OBJECTIVE To determine if repletion of hemoglobin was achievable in young children presenting both severe ( < or = 9.4 g hemoglobin/dL blood ) and less severe iron deficiency anemia ( 9.5 to 11.0 g hemoglobin/dL blood ) through fortification of liquid 3.3 % butterfat milk with a bioavailable ferrous iron amino acid chelate ( Ferrochel ) at 3 mg iron/liter/day . METHODS A group of 185 children were selected from Tupã , Brazil who presented the above two stages of iron deficiency anemia plus normalcy . Initially , 54 % had severe iron deficiency anemia , 33 % were less severely anemic and 13 % had normal hemoglobin concentrations . They received iron-fortified milk for a mean of 222+/-2 days . Hemoglobin concentrations were measured initially , at 133+/-13 days , and at 222+/-2 days . RESULTS By mean 222 days , 57 % of the childrens ' hemoglobins were normal . Highest rates of repletion were in the initially severe anemic group . Repeated measures ANOVAs demonstrated that hemoglobins at 0 , 133 and 222 days for the total group , as well as for the severe and less severe iron deficiency anemic groups , represented statistically different population s at alpha=0.0005 . Children with initially normal hemoglobin concentrations showed no change at 0 , 133 and 222 days ( alpha=0.10 ) , suggesting the possibility of absorptive regulation of this form of iron . CONCLUSIONS Low hemoglobin concentrations in young children can be increased through daily consumption of fluid milk fortified with 3 mg ferrous amino acid chelate ( Ferrochel ) OBJECTIVE To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration , as primary outcomes . DESIGN Non-blinded , r and omised controlled study . SETTING Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago , Chile . SUBJECT Pregnant women were assigned to receive regular powdered milk ( n = 477 ) or a milk product fortified with multiple micronutrients and omega-3 fatty acids  ( n = 495 ) . RESULTS Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls ( 65.4 g difference , 95 % confidence interval ( CI ) 5 - 126 g ; P = 0.03 ) and the incidence of very preterm birth ( 0.80 just for mean birth weight and birth length in the on-treatment analysis ; birth length in that analysis had a difference of 0.57 cm ( 95 % CI 0.19 - 0.96 cm ; P = 0.003 ) . CONCLUSIONS The new intervention result ed in increased mean birth weight . Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation It is uncertain whether multiple micronutrients benefit the mental and psychomotor development of young children in developing countries . We conducted a r and omised double-blind controlled trial to evaluate the effect of a richly micronutrient-fortified v. a basal fortified porridge on mental and psychomotor development  in Zambian infants . Infants ( n 743 ) were r and omised at age 6 months to receive either the richly fortified or the basal fortified infant food and were followed up until 18 months of age . All the infants were evaluated monthly for achievement of a series of developmental milestones . The Bayley scales of infant development II were administered to a sub sample of 502 infants at 6 , 12 and 18 months . Rich micronutrient fortification had no significant benefit on the following : ( a ) number of developmental milestones achieved ( rate ratio at 12 months = 1·00 ; 95 % CI 0·96 , 1·05 ; P = 0·81 , adjusted for sex , socio-economic status and maternal education , with similar results at 15 and 18 months ) ; ( b ) ages of walking unsupported ( hazard ratio ( HR ) 1·04 ; 95 % CI 0·88 , 1·24 ; P = 0·63 , adjusted for the above covariates ) and of speaking three or four clear words ( HR 1·01 ; 95 % CI 0·84 , 1·20 ; P = 0·94 , adjusted for the above covariates ) ; ( c ) mental development index ( MDI ) and psychomotor development index ( PDI ) of the Bayley scales ( scores difference adjusted for baseline scores , age at the assessment , sex , socio-economic status , maternal education , language , age and HIV status : MDI 0·3 ( 95 % CI - 0·5 , 1·1 ) , P = 0·43 ; PDI - 0·1 ( 95 % CI - 0·9 , 0·7 ) , P = 0·78 ) . In conclusion , the results do not support the hypothesis that rich micronutrient fortification improves Zambian infants '  mental and motor development 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 Multiple micronutrient deficiencies are highly prevalent among preschool children and often lead to anemia and growth faltering . Given the limited success of supplementation and health education programs , fortification of foods could be a viable and sustainable option . We report results from a community based double-masked , r and omized trial among children 1–4 years evaluating the effects of micronutrients ( especially of zinc and iron ) delivered through fortified milk on growth , anemia and iron status markers as part of a four group study design , running two studies simultaneously . Methods and Findings Enrolled children ( n = 633 ) were r and omly allocated to receive either micronutrients fortified milk ( MN = 316 ) or control milk ( Co = 317 ) . Intervention of MN milk provided additional 7.8 mg zinc , 9.6 mg iron , 4.2 µg selenium , 0.27 mg copper , 156 µg vitamin A , 40.2 mg vitamin C , and 7.5 mg vitamin E per day ( three serves ) for one year . Anthropometry was recorded at baseline , mid- and end- study . Hematological parameters were estimated at baseline and end- study . Both groups were comparable at baseline . Compliance was over 85 % and did not vary between groups . Compared to children consuming Co milk , children consuming MN milk showed significant improvement in weight gain ( difference of mean : 0.21 kg/year ; 95 % confidence interval [ CI ] 0.12 to 0.31 , p<0.001 ) and height gain ( difference of mean : 0.51 cm/year ; 95 % CI 0.27 to 0.75 , p<0.001 ) . Mean hemoglobin ( Hb ) ( difference of 13.6 g/L ; 95 % CI 11.1 to 16.0 , p<0.001 ) and serum ferritin levels ( difference of 7.9 µg/L ; 95 % CI 5.4 to 10.5 , p<0.001 ) also improved . Children in MN group had 88 % ( odds ratio = 0.12 , 95 % CI 0.08 to 0.20 , p<0.001 ) lower risk of iron deficiency anemia . Conclusions / Significance Milk provides an acceptable and effective vehicle for delivery of specific micronutrients , especially zinc and iron . Micronutrient bundle improved growth and iron status and reduced anemia in children 1–4 years old . Trial Registration Clinical Trials.gov OBJECTIVE Studies of hypothyroidism are often based on referred patients , and limited information is available on the incidence rates of subtypes of hypothyroidism in the general population . We therefore studied incidences of subtypes of primary , overt hypothyroidism in a Danish population cohort and compared incidences in two subcohorts with different levels of iodine intake . DESIGN A prospect i ve population -based study , monitoring a well-defined cohort representative of the Danish population . METHODS The Danish Investigation of Iodine Intake and Thyroid Diseases registry of hyper- and hypothyroidism was established as part of the monitoring of the iodine fortification of salt in Denmark . A computer-based system linked to laboratory data bases identified all patients diagnosed with new , biochemically overt hypothyroidism in population s living in Aalborg ( moderate iodine deficiency , n = 311,102 ) and Copenhagen ( mild iodine deficiency , n = 227,632 ) . We subsequently evaluated all identified patients to verify incident thyroid disease , and subclassified hypothyroidism into nosological types . RESULTS During a 4-year period ( 2,027,208 person-years ) 685 new cases of overt hypothyroidism  were diagnosed in the cohort ; the incidence rate was 32.8 per 100,000 person-years ( st and ardised to the Danish population ) . Nosological types of hypothyroidism were : spontaneous ( presumably autoimmune ) 84.4 % , post-partum 4.7 % , amiodarone-associated 4.0 % , subacute thyroiditis 1.8 % , previous radiation or surgery 1.8 % , congenital 1.6 % and lithium-associated 1.6 % . Crude incidence rates were 29.0 around Aalborg and 40.6 in an area of Copenhagen . The higher incidence rate of hypothyroidism in the area with higher iodine intake was caused solely by more cases of spontaneous ( presumably autoimmune ) hypothyroidism , whereas the incidence of non-spontaneous hypothyroidism ( all types combined ) was significantly lower in the area with higher iodine intake . CONCLUSION In a population -based study we observed a higher incidence of hypothyroidism with higher iodine intake . This was due solely to the entity of spontaneous hypothyroidism . The occurrence of overt hypothyroidism was relatively low in Denmark Much existing data on the effects of calcium or milk products on bone mineral accretion are based on bone mineral content ( BMC ) or areal bone mineral density ( aBMD ) , neither of which accounts for changing bone size during the growing period . The aim of this study was to investigate the effects of 2-year milk supplementation on total body size-corrected BMD in Chinese girls with low habitual dietary calcium intake . Chinese girls aged 10 years were r and omised , according to their school , to receive calcium fortified milk ( Ca milk ) , or calcium and vitamin D fortified milk ( CaD milk ) for two years or act as unsupplemented controls . Dual-energy X-ray absorptiometry  total body bone measures were obtained from 345 girls at baseline and 2 years . Size-corrected total body and regional BMD was calculated as : BMDsc = BMC /BApc , where pc was the regression coefficient of the natural logarithm transformed total body BMC and bone area . After 2 years , both supplemented groups had significantly greater gain in BMDsc of total body ( 3.5 - 5.8 % , p < 0.05 ) and legs ( 3.0 - 5.9 % , p < 0.05 ) than did the control group . Milk supplementation showed positive effects on bone mineral accretion when accounting for the changing skeletal size during growth . The effects were mainly on the lower limbs 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 Fe-deficiency anaemia is a worldwide health problem . We studied the influence of consuming an Fe-fortified fruit juice on Fe status in menstruating women . A r and omised , double-blind , placebo-controlled study of 16 weeks of duration was performed . Subjects were r and omised into two groups : the P group ( n 58 ) or the F group ( n 64 ) , and consumed , as a supplement to their usual diet , 500 ml/d of a placebo fruit juice or an Fe-fortified fruit juice , respectively . The Fe-fortified fruit juice , containing microencapsulated iron pyrophosphate , provided 18 mg Fe/d ( 100 % of the RDA ) . At baseline and monthly , dietary intake , body weight and Fe parameters were determined : total erythrocytes , haematocrit , mean corpuscular volume ( MCV ) , red blood cell distribution width ( RDW ) , Hb , serum Fe , serum ferritin , serum transferrin , transferrin saturation , soluble transferrin receptor ( sTfR ) and zinc protoporphyrin ( ZnPP ) . The fruit juice consumption involved increased intake of carbohydrates and vitamin C , and increased BMI within normal limits . Ferritin was higher in the F group after week 4 ( P < 0·05 ) and became 80 % higher than in the P group after week 16 ( P < 0·001 ) , and transferrin decreased in the F group compared with the P group after week 4 ( P < 0·001 ) . RDW was higher at weeks 4 and 8 in the F group compared with the P group ( P < 0·05 ) . Transferrin saturation increased after week 8 , and haematocrit , MCV and Hb increased after week 12 , in the F group compared with the P group . Serum Fe did not change . sTfR and ZnPP decreased in the F group at week 16 ( P < 0·05 ) . Iron pyrophosphate-fortified fruit juice improves Fe status and may be used to prevent Fe-deficiency anaemia Evidence suggests that New Zeal and ( NZ ) children are mildly zinc deficient and may respond to dietary change . A 20-wk r and omized intervention trial was therefore conducted to determine whether an increased intake of red meat or consumption of a fortified manufactured toddler milk drink ( FTMD , fortified with zinc and other micronutrients ) would increase dietary zinc intakes and improve the biochemical zinc status of 12- to 20-mo-old NZ toddlers . Toddlers were r and omized to a red meat intervention ( n = 90 ) , FTMD intervention ( n = 45 ) , or nonfortified milk placebo ( n = 90 ) . Study foods were provided . Adherence was assessed via monthly 7-d meat or milk recording diaries . Hair and serum zinc concentrations , and length and weight were measured at baseline and postintervention . Nutrient intakes were assessed via 3-d weighed food records at baseline , wk 4 , and wk 18 . At baseline , 38 % of participants had low serum zinc concentrations despite seemingly adequate dietary zinc intakes ( < 4 % below the Estimated Average Requirement ) . Dietary zinc intakes significantly increased by 0.8 mg/d ( 95 % CI : 0.5 , 1.1 ) in the meat group and 0.7 mg/d ( 95 % CI : 0.2 , 1.1 ) in the FTMD group compared with a decrease of -0.5 ( 95 % CI : -0.8 , -0.2 ) mg/d in the placebo group . No corresponding increases in serum or hair zinc concentrations were observed . Dietary zinc intakes achievable via interventions based on red meat or a FTMD are unlikely to improve biochemical zinc status in NZ toddlers . These results also question cutoffs used to define zinc deficiency in toddlers High calcium intake during childhood has been suggested to increase bone mass accrual , potentially result ing in a greater peak bone mass . Whether the effects of calcium supplementation on bone mass accrual vary from one skeletal region to another , and to what extent the level of spontaneous calcium intake may affect the magnitude of the response has , however , not yet been clearly established . In a double-blind , placebo-controlled study , 149 healthy prepubertal girls aged 7.9+/-0.1 yr ( mean+/-SEM ) were either allocated two food products containing 850 mg of calcium ( Ca-suppl . ) or not ( placebo ) on a daily basis for 1 yr . Areal bone mineral density ( BMD ) , bone mineral content ( BMC ) , and bone size were determined at six sites by dual-energy x-ray absorptiometry . The difference in BMD gain between calcium-supplemented ( Ca-suppl . ) and placebo was greater at radial ( metaphysis and diaphysis ) and femoral ( neck , trochanter , and diaphyses ) sites ( 7 - 12 mg/cm2 per yr ) than in the lumbar spine ( 2 mg/cm2 per yr ) . The difference in BMD gains between Ca-suppl . and placebo was greatest in girls with a spontaneous calcium intake below the median of 880 mg/d . The increase in mean BMD of the 6 sites in the low-calcium consumers was accompanied by increased gains in mean BMC , bone size , and statural height . These results suggest a possible positive effect of calcium supplementation on skeletal growth at that age . In conclusion , calcium-enriched foods significantly increased bone mass accrual in prepubertal girls , with a preferential effect in the appendicular skeleton , and greater benefit at lower spontaneous calcium intake Objective : We investigated the effects of mineral water fortified with folic acid , vitamins B6 , B12 , D and calcium on folate concentrations in serum and erythrocytes , serum vitamin B12 and plasma homocysteine concentrations in free-living subjects . In addition , we investigated the bioavailability of calcium added to mineral water by measuring urinary calcium excretion and serum alkaline phosphatase activity . Design : R and omized , controlled , double-blinded , parallel design . Setting : Outpatient dietary intervention with free-living subjects in Eastern Finl and .Subjects : Altogether , 66 subjects were recruited for the study . In all , 60 subjects completed the study . Interventions : The study began with a 2-week run-in period followed by an 8-week intervention period . During the intervention study , subjects consumed mineral water fortified with folic acid ( 563 μg/day ) , vitamins B6 ( 1 mg/day ) , B12 ( 7.5 μg/day ) , cholecalciferol ( 0.6 μg/day ) and calcium ( 563 mg/day ) or placebo mineral water . Results : The fortified mineral water increased serum and erythrocyte folate concentrations by 16.1±5.6 nmol/l ( P<0.001 ) and 199±76 nmol/l ( P<0.001 ) , respectively , and decreased plasma homocysteine concentration by 1.6 μmol/l ( P<0.001 ) . Urinary calcium excretion and serum alkaline phosphatase activity for 24 h increased significantly ( P<0.001 and P=0.01 respectively ) in the intervention group . Conclusions : Mineral water fortified with folic acid , vitamins B6 , B12 and D and calcium enhanced folate status and reduced plasma homocysteine concentration in normohomocysteinemic subjects without folate deficiency . Indirect measures of calcium and bone metabolism indicated that the calcium used in the fortification of the mineral water was bioavailable . Sponsorship : Olvi PLC , Iisalmi , Finl and Acceleration of bone remodelling increases the risk of fragility fractures . The objective of the present study was to explore in elderly women whether a vitamin D and Ca-fortified dairy product providing about 17 - 25 % of the recommended intakes in vitamin D , Ca and proteins would reduce secondary hyperparathyroidism and bone remodelling in a way that may attenuate age-related bone loss in the long term . Thirty-seven institutionalised women , aged 84.8 ( sd 8.1 ) years , with low serum 25-hydroxyvitamin D ( 5.5 ( sd 1.7 ) ng/ml ) were enrolled into a multicentre open trial to consume during 1 month two servings of soft plain cheese made of semi-skimmed milk providing daily 686 kJ ( 164 kcal ) , 2.5 microg vitamin D , 302 mg Ca and 14.2 g proteins . The primary endpoint was the change in serum carboxy terminal cross-linked telopeptide of type I collagen ( CTX ) , selected as a marker of bone resorption . Thirty-five subjects remained compliant . Mean serum changes were : 25-hydroyvitamin D , + 14.5 % ( P = 0.0051 ) ; parathyroid hormone ( PTH ) , - 12.3 % ( P = 0.0011 ) ; CTX , - 7.5 % ( P = 0.01 ) ; tartrate-resistant acid phosphatase isoform 5b ( TRAP 5b ) , - 9.9 % ( P < 0.0001 ) ; albumin , + 6.2 % ( P < 0.0001 ) ; insulin-like growth factor-I (IGF-I),+16.9 % ( P < 0.0001 ) ; osteocalcin , + 8.3 % ( P = 0.0166 ) ; amino-terminal propeptide of type 1 procollagen (P1NP),+19.3 % ( P = 0.0031 ) . The present open trial suggests that fortified soft plain cheese consumed by elderly women with vitamin D insufficiency can reduce bone resorption markers by positively influencing Ca and protein economy , as expressed by decreased PTH and increased IGF-I , respectively . The rise in the bone formation marker P1NP could be explained by a protein-mediated increase in IGF-I. Thus , such a dietary intervention might uncouple , at least transiently , bone resorption from bone formation and thereby attenuate age-related bone loss BACKGROUND The optimal public health strategy for maintaining 25-hydroxyvitamin D [ 25(OH)D ] concentrations in schoolchildren in Mongolia is unknown . OBJECTIVE The objective was to compare the effectiveness of different supplement and fortified milk regimens to increase 25(OH)D concentrations in Mongolian schoolchildren . DESIGN Twenty-one classrooms of 579 children aged 9 - 11 y were r and omized to interventions with an equivalent content of vitamin D(3 ) : 1 ) a one-time seasonal supplement of 13,700 IU , 2 ) 300 IU/d from supplements , 3 ) 300 IU/d from fortified ultra-high-temperature pasteurized milk from the United States , 4 ) 300 IU/d from fortified pasteurized Mongolian milk , or 5 ) unfortified pasteurized Mongolian milk ( control ) . RESULTS In January , the mean ( ±SD ) serum 25(OH)D concentration was 8 ± 4 ng/mL ( 20 ± 10 nmol/L ) , and 98 % of the children had a concentration < 20 ng/mL ( 50 nmol/L ) . In March , concentrations were 8 ± 4 ng/mL after unfortified milk , 20 ± 6 ng/mL after fortified Mongolian milk , 29 ± 10 ng/mL after fortified US milk , 21 ± 6 ng/mL after daily supplements , and 12 ± 4 ng/mL after seasonal supplements ( each greater than unfortified milk , P < 0.01 ) . Seasonal supplementation was less effective than was daily supplementation ( P < 0.0001 ) . Despite consuming daily supplements or fortified milk , 41 % of the children still had concentrations < 20 ng/mL ( 50 nmol/L ) . Children with lower baseline 25(OH)D concentrations experienced slightly larger 25(OH)D responses to intervention than did children with higher concentrations ( P = 0.002 ) . CONCLUSIONS In this population with extremely low vitamin D concentrations , delivery of 300 IU vitamin D/d via supplements or in fortified milk improved 25(OH)D concentrations but failed to raise concentrations uniformly to > 20 ng/mL ( 50 nmol/L ) . The daily low-dose intervention was superior to the seasonal larger-dose intervention . Higher doses may be needed to prevent deficiency in schoolchildren in Mongolia and at other northern latitudes . This trial is registered at clinical trials.gov as NCT00886379 Summary Single interventions for helminthic infections and micronutrient deficiencies are effective , but it is not clear whether combined interventions will provide equal , additive or synergistic effects to improve children 's health . The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children . A double-blind , r and omized , placebo-controlled trial in 11 rural South African primary schools r and omly allocated 579 children aged between 8 and 10 years into six study groups , half of whom received antihelminthic treatment at baseline . The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits , either unfortified or fortified with vitamin A and iron or with vitamin A only , given daily for 16 weeks . The outcome measures were anthropometric , micronutrient and parasite status , and scholastic and cognitive test scores . There was a significant treatment effect of vitamin A on serum retinol ( p < 0.01 ) , and the suggestion of an additive effect between vitamin A fortification and de-worming . Fortified biscuits improved micronutrient status in rural primary school children ; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection . The burden of micronutrient deficiency ( anaemia , iron and vitamin A ) and stunting in this study population was low and , coupled with the restricted duration of the intervention ( 16 weeks ) , might have limited the impact of the interventions Inadequate zinc intake may lead to poor growth and developmental outcome in very-low-birth-weight ( VLBW ; < 1,500 g ) infants . Fifty-two infants ( mean birth weight , 1,117 + /- 287 g ; mean gestational age , 29 + /- 2.9 weeks ) were r and omly allocated to two groups . SUPP infants received a regular term formula plus zinc supplements ( 4.4 mg/L ; final content , 11 mg/L ) ; PLAC infants received the same formula plus placebo ( final content , 6.7 mg/L ) . Infants started their formula at 1,853 + /- 109 g and consumed the formula for 6 months . All subjects were evaluated at 3 , 6 , 9 , and 12 + /- 0.75 months corrected-for-gestational-age . At each evaluation , weight , length , and head circumference were measured , a Griffiths developmental assessment was performed , and a blood sample was taken . Higher plasma zinc levels ( p < 0.05 ) were found in the SUPP group at 1 and 3 months , and improved linear growth velocity was found in the SUPP group over the study period for the whole group as well as for girls alone . Maximum motor development scores were higher ( p = 0.018 ) in the SUPP ( 98 + /- 10 ) than the PLAC ( 90 + /- 8) group , indicating that increased zinc intake in early infancy may be beneficial to VLBW infants Cowpeas , like other legumes , contain high amounts of native iron but are rich in phytic acid ( PA ) and polyphenols ( PP ) that inhibit iron absorption . NaFeEDTA may overcome the combined inhibitory effect of PA and PP . Our objective was to test the efficacy of NaFeEDTA-fortified cowpea meal in improving iron status of school children in a malaria endemic area . We conducted a double-blind , controlled trial with 5- to 12-y-old school children from 2 rural communities in northern Ghana ( n = 241 ) . Eligible children were r and omly assigned to 2 treatment groups to receive either cowpea meal fortified with 10 mg Fe/meal as NaFeEDTA , or an identical but nonfortified cowpea meal . Meals were provided 3 d/wk for a period of ~7 mo under strict supervision . Mass deworming and malaria antigenemia screening and treatment were carried out at baseline and 3.5 mo into the trial . Consumption of cowpea flour fortified with NaFeEDTA result ed in improvement of hemoglobin ( P < 0.05 ) , serum ferritin ( P < 0.001 ) , and body iron stores ( P < 0.001 ) and reduction of transferrin receptor ( P < 0.001 ) compared with nonfortified flour . Fortification result ed in a 30 and 47 % reduction in the prevalence of iron deficiency ( ID ) and iron deficiency anemia ( IDA ) ( P < 0.05 ) , respectively . The results indicate that fortification of cowpea flour with NaFeEDTA overcomes the combined inhibitory effect of PA and PP and , when used for targeted school-based fortification of cowpea flour , is effective in reducing the prevalence of ID and IDA among school children in malaria endemic rural northern Ghana BACKGROUND Iron is essential for the growth and virulence of many pathogenic enterobacteria , whereas beneficial barrier bacteria , such as lactobacilli , do not require iron . Thus , increasing colonic iron could select gut microbiota for humans that are unfavorable to the host . OBJECTIVE The objective was to determine the effect of iron fortification on  gut microbiota and gut inflammation in African children . DESIGN In a 6-mo , r and omized , double-blind , controlled trial , 6 - 14-y-old Ivorian children ( n = 139 ) received iron-fortified biscuits , which contained 20 mg Fe/d , 4 times/wk as electrolytic iron or nonfortifoed biscuits . We measured changes in hemoglobin concentrations , inflammation , iron status , helminths , diarrhea , fecal calprotectin concentrations , and microbiota diversity and composition ( n = 60 ) and the prevalence of selected enteropathogens . RESULTS At baseline , there were greater numbers of fecal enterobacteria than of lactobacilli and bifidobacteria ( P < 0.02 ) . Iron fortification was ineffective ; there were no differences in iron status , anemia , or hookworm prevalence at 6 mo . The fecal microbiota was modified by iron fortification as shown by a significant increase in profile dissimilarity ( P < 0.0001 ) in the iron group as compared with the control group . There was a significant increase in the number of enterobacteria ( P < 0.005 ) and a decrease in lactobacilli ( P < 0.0001 ) in the iron group after 6 mo . In the iron group , there was an increase in the mean fecal calprotectin concentration ( P < 0.01 ) , which is a marker of gut inflammation , that correlated with the increase in fecal enterobacteria ( P < 0.05 ) . CONCLUSIONS Anemic African children carry an unfavorable ratio of fecal enterobacteria to bifidobacteria and lactobacilli , which is increased by iron fortification . Thus , iron fortification in this population produces a potentially more pathogenic gut microbiota profile , and this profile is associated with increased gut inflammation . This trial was registered at controlled-trials.com as IS RCT N21782274 OBJECTIVE To evaluate the impact of the fortification of rolls with microencapsulated iron sulfate with sodium alginate on the hemoglobin levels in preschoolers as compared to controls . METHODS Double-blind r and omized controlled trial comprised of children aged 2 to 6 years with initial hemoglobin exceeding 9 g/dL from four not-for-profit daycares r and omly selected in the city of São Paulo - Brazil . Children of 2 daycares ( n = 88 ) received rolls with fortified wheat flour as the exposed group ( EC ) and children of 2 daycares ( n = 85 ) received rolls without fortification as the control group ( CG ) over a 24-week period . Rolls with 4 mg iron each were offered once a day , five days a week . Hemoglobin concentrations were determined in capillary blood by HemoCue ® at three moments of trial : baseline ( Ml ) , after 12 and 24 weeks of intervention ( M2 , M3 ) . RESULTS Hemoglobin concentration presented significant increase up to M3 in EG ( 11.7 - 12.5 - 12.6 g/dL ) and in CG ( 11.1 - 12.4 - 12.3 g/dL ) with higher elevations in children initially with anemia . There was significant reduction in the occurrence of anemia from 22 % to 9 % in EG and from 47 % to 8.2 % in CG at M3 . CONCLUSION Rolls fortified with microencapsulated iron sulfate were well tolerated , increased hemoglobin levels and reduced the occurrence of anemia , but with no difference compared to the control group CONTEXT Mild to moderate iodine deficiency during pregnancy can cause transient maternal hypothyroidism and impaired mental development of the progeny . These unfavorable effects are preventable by iodine supplementation . In Europe , however , less than 50 % pregnant women receive iodine-containing supplements , thus representing dietary iodized salt the only carrier of iodine for most women in this life stage . OBJECTIVE / DESIGN This longitudinal study is aim ed to investigate the effects of long-term iodized salt consumption on maternal thyroid function during gestation . PARTICIPANTS / OUTCOME MEASURES : We prospect ively evaluated thyroid function in 100 consecutive thyroperoxidase antibody-negative pregnant women from a mildly iodine-deficient area . Sixty-two women who had regularly used iodized salt for at least 2 yr prior to becoming pregnant and 38 who commenced iodized salt consumption upon becoming pregnant were classified as long-term ( LT ) and short-term ( ST ) iodine supplemented , respectively . RESULTS Long-term iodized salt consumption result ed in a very low prevalence of maternal thyroid failure ( MTF ) in LT women . Conversely , short-term iodine prophylaxis does not seem to protect against the risk of MTF , the prevalence of which was almost 6-fold higher in ST than LT women ( 36.8 % vs. 6.4 % ; chi(2 ) 14.7 , P < 0.0005 ; relative risk 5.7 , 95 % confidence interval 2.03 - 16.08 , P < 0.001 ) . The relative risk reduction amounted to 82.5 % , this measure indicating the extent to which long-term iodine prophylaxis using iodized salt would reduce the risk of MTF in ST women . CONCLUSIONS Prolonged iodized salt significantly improves maternal thyroid economy and reduces the risk of maternal thyroid insufficiency during gestation , probably because of a nearly restoring intrathyroidal iodine stores BACKGROUND Anemia during infancy impairs neurodevelopment . Little information has been published about the effectiveness of large-scale programs on anemia and iron-deficiency prevention . OBJECTIVE The objective was to assess the effectiveness of a large-scale program that distributes subsidized iron-fortified milk in Mexico on  anemia and iron deficiency in children aged 12 - 30 mo . DESIGN A double-blinded , group-r and omized effectiveness trial was conducted in 12 milk distribution clusters assigned to consume iron-fortified ( FM ; n = 7 ) or nonfortified ( NFM ; n = 5 ) milk . A daily portion of FM contained 5.28 mg Fe ( ferrous gluconate ) and 48 mg sodium ascorbate . RESULTS Overall treatment effects were documented at 6 and 12 mo for anemia and for iron deficiency assessed by both serum ferritin ( SF ) and serum soluble transferrin receptor ( sTfR ) ( interaction : P < 0.10 ) . Differential effects at 6 mo ( P = 0.004 ) and 12 mo ( P = 0.664 ) were documented only for sTfR. Estimated prevalences ( EPs ) of anemia ( hemoglobin < 110 g/L ) from baseline to 6 and 12 mo decreased from 42.6 % to 19.7 % and 9.4 % , respectively , in the NFM group ( n = 210 ) and from 44.5 % to 12.7 % and 4.0 % , respectively , in the FM group ( n = 357 ) . EPs of SF < 12 mug/L from baseline to 6 and 12 mo changed from 36.0 % to 41.8 % and 17.1 % , respectively , in the NFM group ( n = 43 ) and from 29.8 % to 18.6 % and 5.7 % , respectively , in the FM group ( n = 144 ) . EPs of sTfR > 3.3 mg/L from baseline to 6 and 12 mo decreased from 16.2 % to 8.3 % and 2.0 % , respectively , in the NFM group ( n = 114 ) and from 15.5 % to 0.7 % and 1.1 % , respectively , in the FM group . CONCLUSION A large-scale iron-fortified subsidized-milk program was effective at reducing the rates of anemia and iron deficiency in Mexican children during 12 mo of implementation . This trial was registered at clinical trials.gov as NCT00508131 OBJECTIVE To investigate the efficacy of biscuits fortified with different doses of vitamin A on improving vitamin A deficiency ( VAD ) , anaemia and physical growth of pre-school children .  DESIGN A r and omised double-masked population -based field interventional trial with a positive control group . SETTING Banan district of Chongqing , China . SUBJECTS A total of 580 pre-school children aged 3 - 6 years were r and omly recruited into four groups . Children in groups I and II were given biscuits fortified with vitamin A at 30 % of the recommended daily intake ( RDA ) and 100 % of the RDA once a day for 9 and 3 months , respectively . Children in group III received biscuits containing 20,000 IU of vitamin A once a week for 3 months . Initially , the children in group IV received a 200,000 IU vitamin A capsule just once . At the beginning and end of the study , blood sample s were collected to measure Hb , serum retinol , retinol-binding protein and prealbumin , and weight and height were measured . RESULTS All the fortification types significantly decreased the prevalence of VAD and anaemia in each group ( P < 0.05 ) . The effect of 9-month intervention on group I was the most efficient ( P < 0.0045 ) . After intervention , the Z-scores of height-for-age , weight-for-age and weight-for-height in all groups increased markedly compared with baseline ( P < 0.05 ) , but no significant difference was observed among the groups . CONCLUSIONS Data indicated that consuming vitamin A-fortified biscuits with daily 100 % RDA for 3 months has the same effect on the improvement of VAD , anaemia and physical growth as did the weekly 20,000 IU and single 200,000 IU administration in pre-school children Dietary studies often report low calcium intake amongst post-menopausal Malaysian women and calcium deficiency has been implicated as part of the etiology of age-related bone loss leading to osteoporosis . Therefore , the objective of this study was to examine the effectiveness of high calcium skimmed milk ( Anlene Gold ™ , New Zeal and Milk , Wellington , New Zeal and ) to reduce bone loss in Chinese postmenopausal women . Two hundred subjects aged 55–65 years and who were more than 5 years postmenopausal were r and omized to a milk group and control group . The milk group consumed 50 g of high calcium skimmed milk powder daily , which contained 1200 mg calcium ( taken as two glasses of milk a day ) . The control group continued with their usual diet . Using repeated measures ANCOVA , the milk supplement was found to significantly reduce the percentage of bone loss at the total body compared to the control group at 24 months ( control −1.04 % , milk −0.13 % ; P<0.001 ) . At the lumbar spine , the percentage of bone loss in the control group was significantly higher ( −0.90 % ) when compared to the milk ( −0.13 % ) supplemented group at 24 months ( P<0.05 ) . Similarly , milk supplementation reduced the percentage of bone loss at the femoral neck ( control −1.21 % , milk 0.51 % ) ( P<0.01 ) and total hip ( control −2.17 % , milk −0.50 % ) ( P<0.01 ) . The supplemented group did not experience any significant weight gain over the 24 months . The serum 25-hydroxy vitamin D level improved significantly ( P<0.01 ) from 69.1±16.1 nmol/l at baseline to 86.4±22.0 nmol/l at 24 months in the milk group . In conclusion , ingestion of high calcium skimmed milk was effective in reducing the rate of bone loss at clinical ly important lumbar spine and hip sites in postmenopausal Chinese women in Malaysia . Supplementing with milk had additional benefits of improving the serum 25-hydroxy vitamin D status of the subjects Micronutrient-fortified , cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries , but their nutritional quality is not always optimal . In a double-blind r and omized trial , we compared the efficacy of a locally produced porridge based on maize , beans , bambaranuts , and groundnuts fortified with 19 ( rich ) or 9 ( basal ) micronutrients .  Infants aged 6 mo from Lusaka , Zambia were r and omized to receive the richly fortified ( n = 373 ) or basal ( n = 370 ) porridge daily for 12 mo along with routine vitamin A supplements .  Baseline and final micronutrient status and inflammation ( based on α-1-glycoprotein ) were assessed using nonfasting blood sample s. Baseline prevalence of anemia ( 39 % ) and zinc deficiency ( 51 % ) were a public health concern . There were overall treatment effects on hemoglobin ( Hb ) ( P = 0.001 ) , serum transferrin receptor ( P < 0.001 ) , serum ferritin ( P < 0.001 ) , and serum selenium ( P = 0.009 ) ; biomarker responses for iron and zinc were modified by baseline concentrations , and for Hb and iron by socioeconomic status . At 18 mo , the adjusted odds of anemia , iron deficiency anemia ( Hb < 105 g/L and transferrin receptor > 11.0 mg/L ) , and iron deficiency were 0.37 ( 95 % CI = 0.25 , 0.55 ) , 0.18 ( 0.09 , 0.35 ) , and 0.30 ( 0.18 , 0.50 ) times those in the basal group , respectively . The rich level of fortification had no overall treatment effect on serum zinc ( 1.09 ; 0.66 , 1.80 ) but improved serum zinc in children with lower Hb concentrations at baseline ( P = 0.024 ) . A locally produced cereal- and legume-based infant food richly fortified with micronutrients  reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian infants Background Universal fortification of staple foods with iron has been widely promoted as a cost-effective strategy to reduce iron deficiency in developing-country population s. Nonetheless , relatively few efficacy trials have been reported to date to demonstrate impact on iron status . The Ultra Rice technology provides a means of delivering fortificant iron via rice . Objective The objective of this study was to test the efficacy of rice fortified with microencapsulated , micronized iron pyrophosphate to improve the iron status of women in Mexico in a r and omized , controlled intervention trial . Methods Nonpregnant , nonlactating women 18 to 49 years of age were recruited from six factories . The women received a daily portion of cooked rice 5 days per week for a period of 6 months , before and after which iron status indicators were determined in venous blood sample s. Results The average intake of iron from the fortificant was 13 mg/day . Mean plasma ferritin concentration and estimated body iron stores were significantly higher , and transferrin receptors were lower , in the iron-fortified rice group following the intervention . Mean hemoglobin concentration also increased in the treatment group , but the increase was significant only when the analysis was restricted to those with baseline hemoglobin < 12.8 g/dL. The absolute reduction in anemia and iron deficiency was 10.3 and 15.1 percentage points , respectively . Total iron intake from fortificant was a significant covariate of change in body iron stores . The overall prevalence of anemia was reduced by 80 % . Conclusions Fortification of rice with iron using this technology is an efficacious strategy for preventing iron deficiency BACKGROUND Zinc deficiency has been seen in developing countries in which grain-based vegetable protein is consumed more often than animal protein . This study was done to emphasize the importance of zinc-fortified foods and to investigate bioavailability of zinc in zinc-fortified bread . METHODS Serum zinc concentrations in healthy 7- to 11-year-old school children were determined . In 24 of 101 children serum zinc concentrations were below 65 micrograms/ul . These 24 children with asymptomatic zinc deficiency were divided into two equal groups . The 12 children with low serum zinc concentrations received the zinc-fortified bread providing 2 mg/kg/day elemental zinc acetate for 90 days ( zinc-supplemented group ) , whereas the other 12 children received the same quality bread with no zinc fortification ( control group ) . RESULTS By the end of the period , the zinc-supplemented group had significantly higher serum and leukocyte zinc concentrations ( p < 0.01 ) and the weight , serum albumin levels , and alkaline phosphatase increased ( p < 0.01 ) . Immune functions improved , evidence d by conversion of delayed hypersensitivity skin reactions . Zinc-fortified bread ( 2 mg/kg/day ) caused no side effects or manifestations of zinc toxicity . CONCLUSIONS The results indicate that the bioavailability of zinc in the bread is satisfactory . The use of zinc-fortified bread was found to be an economical and readily accessible method to eliminate zinc deficiency and to prevent further occurrence Summary Premenopausal women with low calcium intakes consumed calcium-fortified ice cream daily for 28 days . Bone markers , NTX , CTX and PTH decreased significantly by 7 days , with some evidence of a calcium dose-dependent effect . Bone marker responses were observed within 1 h of consuming ice cream . Body weight remained constant over 28 days . Introduction Dietary calcium is important for lifelong bone health . Milk is a good source of bioavailable calcium , but consumption has declined among young adults . The aims were to determine whether calcium-fortified ice cream , a palatable source of calcium , produces significant , sustainable changes in bone turnover markers and parathyroid hormone ( PTH ) in premenopausal women with calcium intake below recommended UK levels . Methods Eighty women , ages 20–39 years ( calcium intake < 750 mg/day ) were r and omised to consume lower saturated fat/sugar ice cream containing 96 , 244 , 459 or 676 mg calcium daily for 28 days . Urinary NTX/Cr , serum CTX , PINP , 1,25D and PTH were measured ( baseline , days 1 , 7 and 28 ) . Acute changes in CTX and PTH were measured over 5 h ( n = 29 women ) . Results There were significant mean decreases by 7 days in NTX/Cr , CTX , PTH and 1,25D and increases in PINP ( one sample t tests ) , with a significant dose-dependent effect on CTX analysis of covariance . Only CTX remained suppressed at 28 days . Serum CTX and PTH decreased within 1 h. Body weight did not change significantly between baseline and 28 days . Conclusions Daily consumption of calcium-fortified ice cream by premenopausal women may significantly reduce levels of the bone resorption marker serum CTX , without stimulating weight gain . The ice cream could be incorporated into the diet to replace low-calcium snacks and thus help individuals with habitually low calcium intakes to meet recommended intakes . The 244 mg calcium preparation would provide more than a quarter of the UK daily recommended nutrient intake for premenopausal women Adverse sensory changes prevent the addition of highly bioavailable ferrous sulfate ( FeSO4 ) to most wheat flours . Poorly absorbable reduced Fe powders are commonly used . Encapsulation of FeSO4 can overcome these sensory changes , but the particle size of commercial compounds is too large to be used by flour mills . The first objective of the study was to measure the efficacy in wheat flour of two newly developed Fe compounds , an H-reduced Fe powder ( NutraFine RS ; North America Höganäs High Alloys LLC , Johnstown , PA , USA ) and small particle-sized ( 40 microm ) encapsulated FeSO4 . As a second objective , the microcapsules were evaluated as a vehicle for iodine fortification . A r and omised , double-blind controlled intervention trial was conducted in Kuwaiti women ( n 279 ; aged 18 - 35 years ) with low body Fe stores ( serum ferritin ( SF ) < 25 microg/l ) r and omly assigned to one of three groups ( 20 mg Fe as NutraFine RS , 10 mg Fe as encapsulated FeSO4 and 150 microg iodine , or no fortification Fe ) who consumed wheat-based biscuits 5 d per week . At baseline and 22 weeks , Hb , SF , transferrin receptor , urinary iodine and body Fe stores were measured . Relative to control , mean SF in the encapsulated FeSO4 group increased by 88 % ( P < 0.001 ) and body Fe stores increased from - 0.96 to 2.24 mg/kg body weight ( P < 0.001 ) , while NutraFine RS did not significantly increase SF or body Fe stores . The median urinary iodine concentration increased from 140 to 213 microg/l ( P < 0.01 ) . NutraFine RS added at double the amount of Fe as FeSO4 was not efficacious in improving Fe status . The newly developed microcapsules were highly efficacious in improving both Fe stores and iodine status BACKGROUND In many developing countries , children are at high risk for both goiter and anemia . In areas of subsistence farming in rural Africa , salt is one of the few regularly purchased food items and could be a good fortification vehicle for iodine and iron , provided that a stable yet bioavailable iron fortificant is used . OBJECTIVE We tested the efficacy of salt dual-fortified with iodine and micronized ferric pyrophosphate for reducing the prevalence of iodine and iron deficiencies in children . DESIGN In rural northern Morocco , we fortified local salt with 25 microg I ( as potassium io date ) /g salt and 2 mg Fe ( as micronized ferric pyrophosphate ; mean particle size = 2.5 microm)/g salt . After storage and acceptability trials , we compared the efficacy of the dual-fortified salt ( DFS ) with that of iodized salt in a 10-mo , r and omized , double-blind trial in iodine-deficient 6 - 15-y-old children ( n = 158 ) with a high prevalence of anemia . RESULTS After storage for 6 mo , there were no significant differences in iodine content or color lightness between the DFS and iodized salt . During the efficacy trial , the DFS provided approximately 18 mg Fe/d ; iron absorption was estimated to be approximately 2 % . After 10 mo of treatment in the DFS group , mean hemoglobin increased by 16 g/L ( P < 0.01 ) , iron status and body iron stores increased significantly ( P < 0.01 ) , and the prevalence of iron deficiency anemia decreased from 30 % at baseline to 5 % ( P < 0.001 ) . In both groups , urinary iodine ( P < 0.001 ) and thyroid volume ( P < 0.01 ) improved significantly from baseline . CONCLUSION A DFS containing iodine and micronized ferric pyrophosphate can be an effective fortification strategy in rural Africa 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 The aim of the current study was to examine whether calcium supplementation could prevent bone loss in postmenopausal women or more favourable outcomes could be obtained via the consumption of dairy products fortified with calcium and vitamin D3 . For this purpose changes in bone mineral density ( BMD ) at different skeletal sites , assessed by dual-energy X-ray absorptiometry , as well as in quantitative ultrasound ( QUS ) parameters of the calcaneus over 12 months were estimated . A population of 101 postmenopausal women ( 55 - 65 years old ) was r and omized into a dairy group ( DG : n 39 ) , receiving approximately 1200 mg calcium/d and 7.5 microg vitamin D3/d through fortified dairy products ; a calcium-supplemented group ( CaG : n 26 ) provided with a calcium supplement of 600 mg/d ; and a control group ( CG : n 36 ) . Over the intervention period the DG was found to have more favourable changes in pelvis ( P=0.040 ) , total spine ( P<0.001 ) and total body BMD ( P<0.001 ) than the other groups . A significant increase was also observed for DG in lumbar spine BMD ( 2.0 % ; 95 % CI 0.5 , 3.5 ) although it did not differentiate significantly compared to the other groups . No significant differences were observed with respect to the changes in QUS parameters . The current study revealed that recommended intakes of vitamin D3 and calcium via fortified dairy products for 12 months can induce favourable changes in pelvis , total spine and total body BMD in postmenopausal women but not in QUS parameters . No such favourable changes were observed via supplementation of calcium alone Elderly women are at increased risk for bone loss and fractures . In previous cross-sectional and longitudinal studies of women residing in northern latitudes , bone loss was most pronounced during winter months and in those consuming less than 1 g calcium per day . In this study we sought to test the hypothesis that calcium supplementation by either calcium carbonate or dietary means would prevent seasonal bone loss and preserve bone mass . Sixty older postmenopausal women without osteoporosis were r and omized to one of three treatment arms : Dietary milk supplementation ( D-4 glasses of milk/day ) , Calcium carbonate ( CaCO3 - 1000 mg/day in two divided doses ) , or placebo ( P ) . After 2 yr , placebo-treated women consumed a mean of 683 mg/day of calcium and lost 3.0 % of their greater trochanteric ( GT ) bone mineral density ( BMD ) ( P < 0.03 vs. baseline ) ; Dietary supplemented women averaged a calcium intake of 1028 mg/day and sustained minimal loss from the GT ( -1.5 % ; P = 0.30 ) , whereas CaCO3-treated women ( total Ca intake , 1633 mg/day ) suffered no bone loss from the GT and showed a significant increase in spinal and femoral neck BMD ( P < 0.05 ) . Femoral bone loss occurred exclusively during the two winters of the study ( i.e. total loss , -3.2 % ; P < 0.02 in placebo-treated women ) with virtually no change in GT BMD during summer . Serum 25-OH vitamin D declined by more than 20 % ( P < 0.001 ) in all groups during the winter months but returned to baseline in summer ; PTH levels rose approximately 20 % ( P < 0.001 ) during winter but did not return to baseline during the summers . Urine N-telopeptide and osteocalcin levels increased significantly but only in the P-treated women and only during winter . Serum insulin growth factor binding protein 4 , an inhibitory insulin growth factor binding protein , rose 15 % ( P < 0.03 ) from summer to winter , but this increase was significant only in those women consuming < 1000 mg/day of calcium . By multivariate analysis , total calcium intake was the strongest predictor of bone loss from the hip . Urinary N-telopeptide also closely correlated with GT BMD but only during winter ( P = 0.003 ) . We conclude that calcium supplementation prevents bone loss  in elderly women by suppressing bone turnover during the winter when serum 25-OH vitamin D declines and serum PTH increases . The precise amount of calcium necessary to preserve BMD in elderly women requires further studies , although in this study , at least 1000 mg/day of supplemental calcium was adequate prophylaxis against femoral bone loss To investigate whether an intervention including micronutrient-fortified complementary foods can improve iron status , we conducted a r and omized controlled trial in 5-mo-old Vietnamese infants ( n = 246 ) . Villages ( n = 29 ) were r and omly divided into those receiving instant flour ( FF ) or a food complement ( FC ) both fortified with micronutrients or nothing [ control ( C ) ] . FF and FC infants received daily for 6 mo at least 2 meals of fortified complementary foods . Micronutrient status was assessed by measurement of hemoglobin ( Hb ) and plasma ferritin ( PF ) , transferrin receptor , zinc , and retinol . Final Hb ( mean ± SD ) was higher in the FF ( 112.5 ± 8.0 g/L ) and FC ( 114.0 ± 7.0 g/L ) groups compared with C ( 109.0 ± 8.0 g/L ; P = 0.006 ) . PF ( geometric mean [ 95 % CI ] ) was also higher in FF ( 19.8 μg/L [ 17.5 - 22.3 ] ) and FC ( 20.8 μg/L [ 18.3 - 23.6 ] ) compared with C ( 11.1 μg/L [ 9.8 - 12.5 ] ; P < 0.0001 ) . Anemia prevalence decreased more in the FC group ( -43.6 % ) compared with C ( -10.3 % ; P = 0.006 ) . The change in prevalence of PF < 12 μg/L was different in the FF ( -16.4 % ) and FC ( -6.7 % ) groups compared with C ( + 30.4 % ; P < 0.01 ) . Endpoint prevalence of iron deficiency ( ID ) and ID anemia ( IDA ) were lower in the FF ( 13.4 and 6.7 % , respectively ) and FC ( 15.2 and 3.8 % ) groups compared with C ( 57.5 and 37.5 % ) ( P < 0.0001 ) . Retinol and zinc concentrations did not differ among groups , but endpoint prevalence of zinc deficiency was lower in FF infants ( 36.1 % ) than in C infants ( 52.9 % ; P = 0.04  ) . Micronutrient-fortified complementary foods  significantly improved iron status and decreased the prevalence of anemia , ID , and IDA  in Vietnamese infants and can be an important tool to reduce ID in infancy in developing countries BACKGROUND Inhabitants of agrarian villages of rural Cambodia suffer from high prevalences of iron deficiency and anemia in the context of a monotonous diet . OBJECTIVE To compare the efficacy and safety of placebo Khmer fish sauce to that of 10 mL of fish sauce containing 10 mg of iron , added to daily school meals either as NaFe-EDTA or as FeSO4 + citrate . METHODS 140 students aged 6 - 21 years were enrolled in a double-blinded , placebo-controlled intervention trial . They were r and omly allocated to one of three treatment groups , and followed for 21 weeks during which 114 school meals seasoned with 10 mL of fish sauce were consumed by each participant . Changes in the concentrations of hemoglobin ( hb ) , serum ferritin ( SF ) , and C-reactive protein ( CRP ) and in body weight and st and ing height were determined . Prevalences of vomiting , diarrhea , and acute respiratory infections were monitored weekly . RESULTS Both iron-fortified fish sauces increased hb and SF concentrations significantly as compared to placebo . No significant differences were observed between FeSO4+citrate and NaFe-EDTA fortification , regarding mitigation of iron-deficiency anemia ( IDA ) or regarding CRP , growth , infections , or side-effects . CONCLUSIONS Iron-fortified Khmer fish sauce added to Khmer food is a suitable vehicle for iron fortification in children and adolescents . FeSO4+citrate and NaFe-EDTA show equivalent efficacy and safety Low vitamin D status in women of childbearing age may have implication s for health . Vitamin D status of New Zeal and ers ( NZ ) , based on low serum 25-hydroxyvitamin D ( 25OHD ) is suboptimal . Vitamin D status may be improved with supplements and /or fortified foods . Recently an Adequate Intake ( AI ) for Australia and NZ was set at 5 microg/d vitamin D. We aim ed to determine the effect of daily consumption of milk powder fortified with 5 microg vitamin D3 on serum 25OHD concentration over 12 wks . 73 non-pregnant women ( 18 - 47 y ) living in Dunedin , NZ ( 46 degrees S ) were r and omised to receive either unfortified ( control ) or fortified ( 5 microg vitamin D3 ) milk for 12 wks from January to April . Mean 25OHD was similar between groups at week 0 ( control 74 vs 76 nmol/L ) and fell significantly in both groups over the 12 weeks ( control 53 nmol/L , fortified 65 nmol/L ; p < 0.001 ) . After 12 wks the fortified milk group had a serum 25OHD 19 % ( 95 % CI ; 7 , 32 % ) higher ( 10 nmol/L ) than the control group after adjusting for baseline levels ( p < 0.001 ) . Daily consumption of fortified milk providing the current AI of 5 microg day vitamin D3 for 12 weeks result ed in higher 25OHD concentrations than control milk . This dose was not sufficient to prevent the seasonal decline in 25OHD . This study suggests an AI of 5 microg may be inadequate for New Zeal and ers to allow for seasonal changes in sunlight exposure , and is unlikely sufficient for other population s with low sunlight exposure Objectives : To evaluate the effects of fortified drinking water , with different concentrations of iron added , on hemoglobin and hematocrit values in preschoolers . Methods : Double-blind , r and omized cluster clinical trial , with children aged 2 to 5 years of age , from 4 state-run schools , forming 1 group for each school . For fortification , ferrous sulphate in concentrations of 5 mg of elemental iron per liter of water ( group A ) , 7.5 mg ( group B ) , and 10 mg ( group C ) , was used during a period of 4 months . In group D , the control , a placebo ( Bixa orellana ) was added . Hemoglobin and hematocrit values were checked before and after intervention . Results : Before fortification , hemoglobin and hematocrit averages were below the reference values adopted in all groups . After fortification , the prevalence of anemia showed a reduction in the 4 groups , which was more pronounced in group B , at 48.3 % . The hemoglobin values in groups B ( 11.5 ) and C ( 11.4 ) were statistically similar . However , the average consumption of water/day/student was lower in group C. Comparison of hemoglobin values between groups A ( 11.2 ) and D ( 11.0 ) did not show a significant difference , suggesting insignificant efficacy with 5 mg Fe/L fortification . Conclusions : The consumption of drinking water fortified with 7.5 mg of elemental iron/L water result ed in greater adhesion and an increase in hemoglobin values , with a reduction in the prevalence of anemia 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 effectiveness of bread fortified with iron bis-glycinate chelate for the control of iron deficiency and iron deficiency anemia was evaluated in 89 preschool children from families of low socioeconomic level attending 2 day nurseries of the Sao Paulo City Council . During the intervention 's time of 6 months the children received besides their usual center 's diet , a daily supplement of two sweet rolls fortified with 2 mg each of iron from the chelate for a total daily iron intake of 4 mg . After six months of intervention there was a significant decrease in the prevalence of iron deficiency anemia from 62 to 22 % . There was a mean hemoglobin improvement of 1.1 g/dL , and in children with initial hemoglobin levels < 11 g/dL the mean increase in hemoglobin was 1.42 g/dL. The total mean plasma ferritin values increased from 11.34 to 20.2 micrograms/L , and in those children originally iron depleted the ferritin values normalized . A significant increase in the " z " score for weight/height was also observed . We concluded that the use of sweet rolls fortified with 2 mg of iron from the bis-glycinate chelate is highly effective for the control of iron deficiency and iron deficiency anemia in young children A 2-year milk intervention trial was carried out with 757 girls , aged 10 years , from nine primary schools in Beijing ( April 1999 - March 2001 ) . Schools were r and omised into three groups : group 1 , 238 girls consumed a carton of 330 ml milk fortified with Ca on school days over the study period ; group 2 , 260 girls received the same quantity of milk additionally fortified with 5 or 8 microg cholecalciferol ;  group 3 , 259 control girls .  Anthropometric and bone mineralisation measurements , as well as dietary , health and physical-activity data , were collected at baseline and after 12 and 24 months of the trial . Over the 2-year period the consumption of this milk , with or without added cholecalciferol , led to significant increases in the changes in height ( > or = 0.6 % ) , sitting height ( > or = 0.8 % ) , body weight ( > or 2.9 % ) , and ( size-adjusted ) total-body bone mineral content ( > or = 1.2 % ) and bone mineral density ( > or = 3.2 % ) . Those subjects receiving additional cholecalciferol compared with those receiving the milk without added 25-hydoxycholecalciferol had significantly greater increases in the change in ( size-adjusted ) total-body bone mineral content ( 2.4 v. 1.2 % ) and bone mineral density ( 5.5 v. 3.2 % ) . The milk fortified with cholecalciferol significantly improved vitamin D status at the end of the trial compared with the milk alone or control groups . It is concluded that an increase in milk consumption , e.g. by means of school milk programmes , would improve bone growth during adolescence , particularly when Ca intake and vitamin D status are low Abstract Objective : To compare the effect of unmodified cows ‘ milk and iron supplemented formula milk on  psychomotor development in infants from inner city areas when used as the main milk source . Design : Double blind , r and omised intervention trial . Setting : Birmingham health centre . Subjects : 100 infants , mean age 7.8 months ( range 5.7 to 8.6 months ) , whose mothers had already elected to use unmodified cows ‘ milk as their infant 's milk source . Intervention : Changing to an iron supplemented formula milk from enrolment to 18 months of age , or continuing with unmodified cows ‘ milk . Main outcome measures : Developmental assessment s using Griffiths scales at enrolment and at 18 and 24 months . Results : 85 participants completed the trial . There were no significant differences in haemoglobin concentration between the two groups at enrolment , but by 18 months of age 33 % of the unmodified cows ‘ milk group , but only 2 % of the iron supplemented group , were anaemic ( P<0.001 ) . The experimental groups had Griffiths general quotient scores that were not significantly different at enrolment , but the scores in both groups declined during the study . By 24 months the decrease in the mean scores in the unmodified cows ‘ milk group was 14.7 whereas the decrease in the mean scores in the iron supplemented group was 9.3 ( P<0.02 , 95 % confidence interval 0.4 to 10.4 ) . Mean subquotient scores were considerably lower in the unmodified cows ‘ milk group at 24 months ; significantly so for personal and social scores ( P<0.02 , –5.4 to 17.2 ) . Conclusion : Replacing unmodified cows ‘ milk with an iron supplemented formula milk up to 18 months of age in infants from inner city areas prevents iron deficiency anaemia and reduces the decline in psychomotor development seen in such infants from the second half of the first year 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 OBJECTIVE The aim of our study was to evaluate the effect of zinc supplementation on linear growth , body composition , and growth factors in premature infants . DESIGN Thirty-six preterm infants ( gestational age : 32.0 + /- 2.1 weeks , birth weight : 1704 + /- 364 g ) participated in a longitudinal double-blind , r and omized clinical trial . They were r and omly allocated either to the supplemental ( S ) group fed with a st and ard term formula supplemented with zinc ( final content 10 mg/L ) and a small quantity of copper ( final content 0.6 mg/L ) , or to the placebo group fed with the same formula without supplementation ( final content of zinc : 5 mg/L and copper : 0.4 mg/L ) , from 36 weeks postconceptional age until 6 months corrected postnatal age  . At each evaluation , anthropometric variables and bioelectrical impedance were measured , a 3-day dietary record was collected , and a blood sample was taken . We analyzed serum levels of total alkaline phosphatase , skeletal alkaline phosphatase ( sALP ) , insulin growth factor (IGF)-I , IGF binding protein-3 , IGF binding protein-1 , zinc and copper , and the concentrations of zinc in erythrocytes . RESULTS The S group had significantly higher zinc levels in serum and erythrocytes and lower serum copper levels with respect to the placebo group . We found that the S group had a greater linear growth ( from baseline to 3 months corrected age : Delta score deviation st and ard length : 1.32 + /-.8 vs.38 + /-.8 ) . The increase in total body water and in serum levels of sALP was also significantly higher in the S group ( total body water : 3 months ; corrected age : 3.8 + /-.5 vs 3.5 + /-.4 kg , 6 months ; corrected age : 4.5 + /-.5 vs 4.2 + /-.4 kg ; sALP : 3 months ; corrected age : 140.2 + /- 28.7 vs 118.7 + /- 18.8 micro g/L ) . CONCLUSIONS Zinc supplementation has a positive effect on linear growth in premature infants 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 The therapeutic effects of NaFeEDTA-fortified soy sauce on anaemic students were investigated . Three hundred and four iron-deficient anaemic school children ( 11 - 17 years ) were r and omly assigned to three treatment groups : control group ( consuming non-fortified soy sauce ) , low-NaFeEDTA group ( consuming fortified soy sauce , providing 5 mg Fe/day ) and high-NaFeEDTA group ( consuming fortified soy sauce , providing 20 mg Fe/day ) . Blood haemoglobin ( Hb ) levels were determined before and after 1 month , 2 months and 3 months of intervention . In addition , serum iron ( SI ) , serum ferritin ( SF ) , free erythrocytic porphyrin ( FEP ) , total iron binding capability ( TIBC ) and transferritin ( TF ) were measured before and after consumption of soy sauce for 3 months . The results obtained herein show that the parameters measured were not changed remarkably within the 3-month intervention in the control group ( P < 0.05 ) . However , increased Hb , SI , SF and TF levels and decreased TIBC and FEP levels were observed in both the high-NaFeEDTA group ( P < 0.01 ) and the low-NaFeEDTA group ( P < 0.05 ) . The effectiveness of iron intervention in the low-NaFeEDTA group and high-NaFeEDTA group had no statistical significance after 3 months . It was concluded that nutritional intervention for anaemic students using NaFeEDTA-fortified soy sauce could play a positive role in the improvement of iron status and control of anaemia BACKGROUND The low micronutrient content of complementary foods is associated with growth faltering in many population s. A potential low-cost solution is the home fortification of complementary foods with Sprinkles ( SP ) powder , crushable Nutritabs ( NT ) tablets , or energy-dense ( 108 kcal/d ) , fat-based Nutributter ( NB ) . OBJECTIVE The objective was to test the hypothesis that multiple micronutrients added to home-prepared complementary foods would increase growth and that the effect would be greatest in the presence of added energy from fat . DESIGN We r and omly assigned 313 Ghanaian infants to receive SP , NT , or NB containing 6 , 16 , and 19 vitamins and minerals , respectively , daily from 6 to 12 mo of age . We assessed anthropometric status at 6 , 9 , and 12 mo ; micronutrient status at 6 and 12 mo ; motor development at 12 mo ; and morbidity weekly . Infants ( n = 96 ) not r and omly selected for the intervention ( nonintervention ; NI ) were assessed at 12 mo . RESULTS The groups did not differ significantly at baseline , except that the NB group had a higher proportion of boys and weighed slightly more . The dropout rate ( 15/313 ) was low . At 12 mo , after control for initial size , the NB group had a significantly greater weight-for-age z score ( WAZ ) ( -0.49 + /- 0.54 ) and length-for-age z score ( LAZ ) ( -0.20 + /- 0.54 ) than did the NT group ( WAZ : -0.67 + /- 0.54 ; LAZ : -0.39 + /- 0.54 ) and the NT and SP groups combined ( WAZ : -0.65 + /- 0.54 ; LAZ : -0.38 + /- 0.54 ) ; the difference with the NI group ( WAZ : -0.74 + /- 1.1 ; LAZ : -0.40 + /- 1.0 ) was not significant . A lower percentage of the NI infants ( 25 % ) than of the intervention groups ( SP : 39 % ; NT : 36 % ; NB : 49 % ) could walk independently by 12 mo . CONCLUSION All 3 supplements had positive effects on motor milestone acquisition by 12 mo compared with no intervention , but only NB affected growth OBJECTIVE Mild to severe iodine deficiency has been documented in Lesotho since 1960 . To eliminate the persisting iodine deficiency , legislation on universal salt iodization was introduced in 2000 as a long-term public health intervention strategy . We assessed the urinary iodine status of school children and women of child-bearing age in Lesotho 2 y after the introduction of legislation on universal salt iodization . METHODS A 31-cluster national survey was conducted in 2002 by using the proportion to population size method . In each cluster , 30 women ages 15 to 30 y and 30 primary school children ages 8 to 12 y were r and omly selected to provide urine sample s for urinary iodine analysis . Data were interpreted according to criteria of the World Health Organization , United Nations Children 's Fund , and International Council for Control of Iodine Deficiency Disorders ( 2001 ) . Statistical analysis was performed using SAS . RESULTS We analyzed 912 urine sample s from children and 924 from women . The median urinary iodine concentrations were 214.7 microg/L for children and 280.1 microg/L for women , indicating more than adequate iodine intake . Median iodine concentration was higher in the lowl and s ( 256.0 microg/L in children and 329.9 microg/L in women ) than in the mountains ( 99.30 microg/L in children and 182.6 microg/L in women ) . Analysis of the distribution of the data showed values below 50 microg/L in 10.1 % of children and in 9.8 % of women . In addition , 21.5 % of children and 17.9 % of women had urinary iodine excretion values below 100 microg/L. In contrast , 36 % of children and 47.2 % of women had urinary iodine concentrations in excess of 300 microg/L. CONCLUSION Results of urinary iodine excretion measurements indicated that iodine deficiency has been eliminated as a public health problem in Lesotho . However , the high median urinary iodine concentration of women in the lowl and s indicated the possibility of a risk of iodine-induced hyperthyroidism in vulnerable people The Chinese diet is low in calcium ( less than 500 mg/day on average ) , and previous observational studies have suggested an association between a low calcium intake and risk of hip and vertebral fracture . In this study , we r and omly assigned 200 postmenopausal Chinese women ( age range , 55 - 59 years ) to receive 50 g of milk powder containing 800 mg of calcium per day or to a control group . The following are the mean percentage changes ( and SEs ) in height and bone mineral density ( BMD ) over 24 months : for height , -0.1 + /- 0.2 cm in the milk supplementation group and -0.2 + /- 0.1 cm in the control group ; for BMD at the total hip , -0.06 + /- 0.22 % in the milk supplementation group and -0.88 + /- 0.26 % in the control group ; for BMD at the spine ( L1-L4 ) , -0.56 + /- 0.29 % in the milk supplementation group and -1.5 + /- 0.29 % in the control group ; for total body BMD , -0.32 + /- 0.16 % in the milk supplementation group and -1.2 + /- 0.19 % in the control group ( p < 0.05 by analysis of covariance [ ANCOVA ] for repeated measures for height and BMD at all sites ) . The milk supplementation group had less loss in terms of both height and BMD than the control group ( p < 0.05 by ANCOVA for repeated measures ) . Serum parathyroid hormone ( PTH ) concentration was lower and serum 25-hyroxyvitamin D [ 25(OH)D ] level was higher in the milk supplementation group than the control group at 12 months ( p < 0.05 by paired t-test ) . We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss Food fortification is advocated to tackle iron deficiency in anemic population s. Our objective was to evaluate the impact of iron-fortified rice ( Ultrarice ( ® ) ) weekly on hemoglobin and anemia levels compared with st and ard rice ( control ) . This cluster-r and omized study deals with infants ( 10 - 23 months ) from two public child day care centers in Brazil , n = 216 , in an 18 week intervention . The intervention group received individual portions of fortified rice ( 50 g ) provided 56.4 mg elemental/Fe . For intervention center : baseline mean hemoglobin was 11.44 ± 1.07 g/dl , and after intervention 11.67 ± 0.96 g/dl , p < 0.029 ; for control : baseline mean hemoglobin value was 11.35 ± 4.01 g/dl , and after intervention 11.36 ± 2.10 g/dl , p = 0.986 . Anemia prevalence for intervention center was 31.25 % at baseline , and 18.75 % at end of study , p = 0.045 ; for control 43.50 % were anemic at baseline , and 37.1 % at the end of study , p = 0.22 . Number Needed to Treat was 7 . Iron-fortified rice was effective in increasing hemoglobin levels and reducing anemia in infants Objective : Fortified spreads ( FSs ) have proven effective in the rehabilitation of severely malnourished children . We examined acceptability , growth and change in blood haemoglobin ( Hb ) concentration among moderately underweight ambulatory infants given FS . Methods : This was a r and omised , controlled , parallel-group , investigator-blind clinical trial in rural Malawi . Six- to 17-month-old underweight infants ( weight for age < −2 ) , whose weight was greater than 5.5 kg and weight-for-height z score greater than −3 received for 12 weeks at home 1 of 8 food supplementation schemes : nothing , 5 , 25 , 50 , or 75 g/day milk-based FS or 25 , 50 , or 75 g/day soy-based FS . Outcome measures included change in weight , length and blood Hb concentration . Results : A total of 126 infants started and 125 completed the intervention . All infants accepted the spread well , and no intolerance was recorded . Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS . Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS . All average gains were largest among infants receiving 50 g of FS daily : mean difference ( 95 % confidence interval ) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g ( range , −130 to 700 g ) , 0.9 cm ( range , −0.3 to 2.2 cm ) , and 17 g/L ( range , 0 to 34 g/L ) for weight , length and blood Hb concentration , respectively . In soy- vs milk-based FS groups , average outcomes were comparable . Conclusions : Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants . Further trials should test this hypothesis OBJECTIVE To evaluate the prevalence of chronic autoimmune thyroiditis ( CAT ) and iodine-induced hypothyroidism , hyperthyroidism  ( overt and sub clinical ) , and goiter in a population exposed to excessive iodine intake for 5 years ( table salt iodine concentrations : 40 - 100 mg/kg salt ) . Design This was a population -based , cross-sectional study with 1085 participants r and omly selected from a metropolitan area in São Paulo , Brazil , and conducted during the first semester of 2004 . METHODS  Thyroid ultrasound examination  was performed in all participants and sample s of urine and blood were collected from each subject . Serum levels of thyroid-stimulating hormone , free thyroxine , and anti-thyroid peroxidase ( TPO ) antibodies , urinary iodine concentration , thyroid volume , and thyroid echogenicity were evaluated . We also analyzed table salt iodine concentrations . RESULTS At the time the study was conducted , table salt iodine concentrations were within the new official limits ( 20 - 60 mg/kg salt ) . Nevertheless , in 45.6 % of the participants , urinary iodine excretion was excessive ( above 300 microg/l ) and , in 14.1 % , it was higher than 400 microg/l . The prevalence of CAT ( including atrophic thyroiditis ) was 16.9 % ( 183/1085 ) , women were more affected than men ( 21.5 vs 9.1 % respectively , P=0.02 ) . Hypothyroidism was detected in 8.0 % ( 87/1085 ) of the population with CAT . Hyperthyroidism was diagnosed in 3.3 % of the individuals ( 36/1085 ) and goiter was identified in 3.1 % ( 34/1085 ) . CONCLUSIONS Five years of excessive iodine intake by the Brazilian population may have increased the prevalence of CAT and hypothyroidism in subjects genetically predisposed to thyroid autoimmune diseases . Appropriate screening for early detection of thyroid dysfunction may be considered during excessive nutritional iodine intake UNLABELLED Recent research has not only question ed the necessity of iron supplementation in human milk substitutes prior to weaning , but also suggested some potential adverse effects . This study investigated the hypothesis that infant formula need not contain added iron in the first 3 mo . Healthy term infants were recruited into a double-blind controlled trial and r and omized to receive either a new no added iron formula ( New ; < 0.1 mg Fe 100 ml(-1 ) ) or a st and ard formula ( St and ard ; 0.5 mg Fe 100 ml(-1 ) ) for the first 3 mo of life . A breastfed reference group was also studied . Iron status was assessed at 3 and 12 mo from heel-prick capillary blood sample s evaluated by full blood-count analysis , including reticulocytes and serum ferritin . In total , 149 infants were entered ( 51 New , 49 St and ard , 49 breastfed ) with no differences between the groups in gender distribution , birthweight , gestation or numbers completing the study . There were no significant differences between the principal outcome measures : mean values for haemoglobin , mean cell volume and ferritin , between the two formula-fed groups , and the proportion with a haemoglobin level < 11 g dl(-1 ) or ferritin < 10 microg l(-1 ) did not differ . CONCLUSION The use of a " no added iron " infant formula in place of an iron-fortified formula during the first 3 mo of life did not clinical ly affect iron status at 3 and 12 mo of age . The universal supplementation of formulae with iron during this initial period needs further consideration Concurrent micronutrient deficiencies are prevalent among Vietnamese school children . A school-based program providing food fortified with multiple micronutrients could be a cost-effective and sustainable strategy to improve health and cognitive function of  school children . However , the efficacy of such an intervention may be compromised by the high prevalence of parasitic infestation . To evaluate the efficacy of school-based intervention using multi-micronutrient-fortified biscuits with or without deworming on anemia and micronutrient status in Vietnamese schoolchildren , a r and omized , double-blind , placebo-controlled trial was conducted among 510 primary schoolchildren , aged 6 - 8 y , in rural Vietnam .  Albendazole ( Alb ) ( 400 mg ) or placebo was given at baseline . Nonfortified or multi-micronutrient-fortified biscuits including iron ( 6 mg ) , zinc ( 5.6 mg ) , iodine ( 35 microg ) , and vitamin A ( 300 microg retinol equivalents ) were given 5 d/wk for 4 mo . Multi-micronutrient fortification significantly improved the concentrations of hemoglobin ( + 1.87 g/L ; 95 % CI : 0.78 , 2.96 ) , plasma ferritin ( + 7.5 microg/L ; 95 % CI : 2.8 , 12.6 ) , body iron ( + 0.56 mg/kg body weight ; 95 % CI : 0.29 , 0.84 ) , plasma zinc ( + 0.61 micromol/L ; 95 % CI : 0.26 , 0.95 ) , plasma retinol ( + 0.041 micromol/L ; 95 % CI : 0.001 , 0.08 ) , and urinary iodine ( + 22.49 micromol/L ; 95 % CI : 7.68 , 37.31 ) . Fortification reduced the risk of anemia and deficiencies of zinc and iodine by > 40 % . Parasitic infestation did not affect fortification efficacy , whereas fortification significantly enhanced deworming efficacy , with the lowest reinfection rates in children receiving both micronutrients and Alb . Multi-micronutrient fortification of biscuits is an effective strategy to improve the micronutrient status of Vietnamese schoolchildren and enhances effectiveness of deworming Anemia is still the major nutritional problem among pregnant women in Southeast Asia . The objective of this study was to measure hemoglobin status and reduction of underweight in a group of pregnant women who received iron-fortified or nonfortified milk  , and another group who received iron supplements ( tablets ) or placebo . The 44 women in the iron-fortified milk group received 15 mg of iron per day per 400 ml of milk , and 41 women received placebo . The 40 women in the iron supplement group received 60 mg of iron per day , and 43 women received nonfortified milk . During this intervention trial , all women were supervised from the 14th to the 18th week of gestation until delivery . Blood was sample d at 0 , 5 , 10 , and 16 weeks of intervention . After the 16th week of intervention , the changes in hemoglobin ( ΔHb ) concentrations in both treatment groups ( the iron-fortified milk and the iron tablet groups ) were not significantly different ( ΔHb : −0.5 ± 0.9 and −0.3 ± 0.9 g/L , respectively ) , but the changes were significantly greater in the nonfortified milk and placebo groups ( ΔHb : −1.2 ± 0.9 and −1.1 ± 0.8 g/L , respectively ; p < .01 ) . The change in transferrin saturation ( ΔTS ) in the iron-fortified milk group ( ΔTS : 3.4 ± 12.9 % ) was greater than that in the placebo and nonfortified milk groups ( ΔTS : −10.1 ± 9.8 % and −11.6 ± 10.7 % , respectively ) ( p < .01 ) . The weight gain of the subjects during intervention did not differ significantly in the fortified and nonfortified milk groups ( Δweight : 5.0 ± 2.0 and 5.8 ± 2.1 kg , respectively ) , but was higher than in the iron tablet group ( Δweight : 4.6 ± 3.1 kg p < .05 ) and the placebo group ( Δweight : 3.8 ± 2.5 kg ; p < .001 ) . Iron supplementation and fortification were seen to be effective in promoting weight gain in pregnant Vietnamese women . For women who are underweight , the administration of iron-fortified milk has additional benefits to those of supplementation , most likely due to additional energy and nutrient inputs OBJECTIVE To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1 - 3-year-old malnourished African children . DESIGN A r and omised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A , thiamine , riboflavin and pyridoxine , while 23 control children and their families received unfortified maize meal . The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households . METHODS Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics ' criteria and aged 1 - 3 years were r and omly assigned to an experimental or control group . Baseline measurements included demographic , socio-economic and dietary data , as well as height , weight , haemoglobin , haematocrit , serum retinol and retinol-binding protein ( RBP ) . Anthropometric , blood and serum variables were measured again after 12 months of intervention . Complete baseline measurements were available for 44 children and end data for only 36 . Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests , t-tests and analysis of variances using the SPSS program , controlling for expected weight gain in this age group over 12 months . Relationships between changes in variables were examined by calculating correlation coefficients . RESULTS The children in the experimental group had a significantly ( P < or = 0.05 ) higher increase in body weight than control children ( 4.6 kg vs. 2.0 kg ) and both groups had significant ( P < or = 0.05 ) but similar increases in height . The children in the experimental group showed non-significant increases in haemoglobin and serum retinol , while the control children had a significant ( P = 0.007 ) decrease in RBP . The change in serum retinol showed a significant correlation with baseline retinol ( P = 0.014 ) , RBP ( P = 0.007 ) and weight ( P = 0.029 ) , as well as with changes in haemoglobin ( P = 0.029 ) . CONCLUSION Despite a small sample size , this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1 - 3-year-old African children . The study confirmed the relationship between vitamin A and iron status . The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa Wheat is the primary staple food for nearly one-third of the world 's population . NaFeEDTA is the only iron ( Fe ) compound suitable for fortifying high extraction flours . We tested the hypothesis that NaFeEDTA-fortified , whole wheat flour reduces Fe deficiency ( ID ) and improves body Fe stores ( BIS ) and cognitive performance in Indian children . In a r and omized , double-blind , controlled , school feeding trial , 6- to 15-y-old , Fe-depleted children ( n = 401 ) were r and omly assigned to either a daily wheat-based lunch meal fortified with 6 mg of Fe as NaFeEDTA or an otherwise identical unfortified control meal .  Hemoglobin ( Hb ) and Fe status were measured at baseline , 3.5 mo , and 7 mo . Cognitive performance was evaluated at baseline and 7 mo in children ( n = 170 ) at one of the study sites . After 7 mo , the prevalence of ID and ID anemia in the treatment group significantly decreased from 62 to 21 % and 18 to 9 % , respectively . There was a time x treatment interaction for Hb , serum ferritin , transferrin receptor , zinc protoporphyrin , and BIS ( all P < 0.0001 ) . Changes in BIS differed between the groups ; it increased in the treatment group ( 0.04 ± 0.04 mmol/kg body weight ) and decreased in the control group ( -0.02 ± 0.04 mmol/kg body weight ) ( P < 0.0001 ) . In sensory tests , NaFeEDTA-fortified flour could not be differentiated from unfortified flour . There were no significant differences in cognitive performance tests between the groups . NaFeEDTA-fortified wheat flour markedly improved BIS and reduced ID  in Fe-depleted children . It may be recommended for wider use in national school feeding programs CONTEXT Iodine deficiency in utero impairs fetal growth , but the relationship between iodine deficiency and postnatal growth is less clear . OBJECTIVE The objective of the study was to determine whether iodine repletion improves somatic growth in iodine-deficient children and investigate the role of IGF-I and IGF binding protein (IGFBP)-3 in this effect . DESIGN , PARTICIPANTS , AND INTERVENTIONS Three prospect i ve , double-blind intervention studies were done : 1 ) in a 10-month study , severely iodine-deficient , 7- to 10-yr-old Moroccan children ( n = 71 ) were provided iodized salt and compared with children not using iodized salt ; 2 ) in a 6-month study , moderately iodine-deficient , 10- to 12-yr-old Albanian children ( n = 310 ) were given 400 mg iodine as oral iodized oil or placebo ; 3 ) in a 6-month study , mildly iodine-deficient 5- to 14-yr-old South African children ( n = 188 ) were given two doses of 200 mg iodine as oral iodized oil or placebo . At baseline and follow-up , height , weight , urinary iodine ( UI ) , total T4 ( TT4 ) , TSH , and IGF-I were measured ; in Albania and South Africa , IGFBP-3 was also measured . RESULTS In all three studies , iodine treatment increased median UI to more than 100 microg/liter , whereas median UI in the controls remained unchanged . In South Africa , iodine repletion modestly increased IGF-I but did not have a significant effect on IGFBP-3 , TT4 , or growth . In Albania and Morocco , iodine repletion significantly increased TT4 , IGF-I , IGFBP-3 , weight-for-age z scores , and height-for-age z scores . CONCLUSION This is the first controlled study to clearly demonstrate that iodine repletion in school-age children increases IGF-I and IGFBP-3 concentrations and improves somatic growth 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 This study evaluates the impact of a milk-based cornstarch porridge fortified with iron , in 4-year olds , compared with control on hemoglobin levels and anemia prevalence . This trial was a cluster-r and omized , double-blind one , and used milk-based cornstarch porridge fortified with 10 mg elemental iron ( FeSO(4 ) ) , daily , during 14 weeks , compared with control . The study population comprised 4-year-old preschoolers ( n = 131 ) . Mean hemoglobin values at baseline were found to be 10.6 ± 0.61 g dl(-1 ) for intervention group , and after intervention 11.5 ± 0.80 g/dl , p < 0.0001 . For control , mean hemoglobin values at baseline were 10.9 ± 0.53 g/dl , and after intervention 11.2 ± 0.73 , p < 0.0001 . The increase in mean hemoglobin was much greater in the intervention than in the control group , 0.86 - 0.26 g dl(-1 ) , respectively ( p < 0.0001 ) . Anemia prevalence reduced from 75 % to 20 % , p < 0.0001 , in the intervention group , with no reduction in the control group . Number needed for treatment was four . This study showed that milk-based cornstarch porridge fortified with ferrous sulfate  increased hemoglobin levels and reduced anemia prevalence in 4-year-old preschoolers Background Iron and vitamin D deficiencies are two of the most widespread nutritional disorders in the world . Our aim was to know whether the consumption of an iron-fortified fruit juice modifies bone remodelling and the possible influence of baseline vitamin D status on the recovery of iron status in a group of iron-deficient women . Methods  Iron biomarkers , 25-hydroxyvitamin D levels and dietary intake  were measured in 123 iron-deficient menstruating women . A subgroup ( n = 41 ) participated in a r and omised double-blind placebo-controlled study of 16-weeks during winter . They consumed a placebo fruit juice ( P ) or iron-fortified fruit juice ( F ) . Dietary intake , 25-hydroxyvitamin D , parathormone ( PTH ) , bone alkaline phosphatase ( ALP ) , aminoterminal telopeptide of collagen I ( NTX ) and iron biomarkers were determined . Results Ninety-two per cent of the iron-deficient women were vitamin D deficient or insufficient . Transferrin saturation and 25-hydroxyvitamin D were positively correlated . Iron status improved in F , 25-hydroxyvitamin D decreased in F and P , and PTH , ALP and NTX levels were within the normal range and did not vary . Women with 25-hydroxyvitamin D ≥ 50 nmol/L compared with 25-hydroxyvitamin D < 50 nmol/L showed a higher increase in transferrin saturation ( a marker of iron supply to tissues ) during iron recovery . Conclusion The prevalence of vitamin D deficiency or insufficiency is very high in iron-deficient women . The recovery of iron status by consuming an iron-fortified food does not affect 25-hydroxyvitamin D levels ; however , the increase in iron supply to tissues is lower if the women also present vitamin D deficiency . Although bone health does not seem to be affected in this group of women , correction of iron and vitamin D deficiencies should be promoted in young women to improve present and future health OBJECTIVE To evaluate levels of vitamin D3 and HDL-cholesterol ( HDL-C ) , and the ratio of HDL-C to LDL-cholesterol ( LDL-C ) , in schoolchildren receiving vitamin-D-fortified , fat-depleted , high-Ca milk in schools . DESIGN Cross-sectional study of previously r and omised schools receiving supplemental milk  , compared with a matched control group . SETTING Low-decile Year 1 - 6 schools in the Waikato region of New Zeal and . SUBJECTS Year 3 children from either milk schools or control schools , consenting to blood sampling . RESULTS For eighty-nine children receiving supplementary daily milk  ,  vitamin D3  levels were significantly higher than in eighty-three control children matched for age , sex , body composition and ethnicity ( mean ( sd ) : 49.6 ( 15.8 ) v. 43.8 ( 14.7 ) nmol/l , P = 0.011 ) , as were HDL-C levels ( mean ( sd ) : 1.47 ( 0.35 ) v. 1.35 ( 0.29 ) mmol/l , P = 0.024 ) and HDL-C : LDL-C ( median : 0.79 v. 0.71 , P = 0.026 ) . LDL-C levels were similar in both groups ( mean ( sd ) : 2.07 ( 0.55 ) v. 2.16 ( 0.60 ) mmol/l , P = 0.31 ) . Of control children , 32/83 ( 20.2 % ) of the milk group ( Pearson 's chi2 = 7.00 , P = 0.008 ) . Mean 25-hydroxyvitamin D ( vitamin D3 ) levels in the milk group were still below the lower end of the recommended normal range ( 60 nmol/l ) . CONCLUSIONS Vitamin D3 levels are low in low-decile Year 3 children in midwinter . Levels are improved with vitamin-D-fortified milk but still below the recommended range . HDL-C and HDL-C : LDL-C levels are improved in the milk-supplemented group . This supports the supply of vitamin-D-fortified , fat-reduced milk to schools OBJECTIVE Improvement of hemoglobin and serum retinol and facilitation of the mobilization of iron storage were achieved with a multiple-micronutrient-fortified diet in preschoolers for 6 mo in a suburb of Chongqing , China . We investigated whether fortification with multiple micronutrients in a diet for preschool children results in changes in children 's infectious morbidity compared with diets fortified solely with vitamin A and with vitamin A plus iron . METHODS From December 2005 to June 2006 , 226 2- to 6-y-old preschool children were recruited from three nurseries r and omly assigned to three different fortified-diet groups for 6 mo . Group I was fortified with vitamin A ; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron , thiamine , riboflavin , folic acid , niacinamide , zinc , and calcium , respectively . The secondary functional outcomes , morbidity of diarrhea and respiratory infection , were collected during supplementation . RESULTS The groups were comparable concerning compliance and loss to follow-up . There was evidence of a lower incidence rate of respiratory-related illnesses , diarrhea-related illness , fewer symptoms of runny nose , cough , and fever , and shorter duration of respiratory-related illnesses and cough for children in group III compared with children in groups I and II . However , there was no significantly or clinical ly important difference between children in groups I and II . CONCLUSION The beneficial effects on infectious morbidity over 6 mo , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a diet for preschool children Anemia and micronutrient deficiencies are common among Indian schoolchildren . We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India . In this placebo-controlled , cluster-r and omized study , 499 schoolchildren ( 6 - 10 y ) received either multiple micronutrients ( treatment group ) or placebo ( control group ) as part of school meals ( 6 d/wk ) for 8 mo . Both groups were dewormed at the beginning of the study . The micronutrient premix provided 10 mg iron , 375 microg vitamin A , 4.2 mg zinc , 225 microg folic acid , and 1.35 microg vitamin B-12 for each child per day ( approximately 75 % recommended dietary allowance ) . Blood sample s drawn before and after the intervention were analyzed for hemoglobin , ferritin , retinol , zinc , folate , and vitamin B-12 . Baseline prevalence of anemia ( 37 % ) , iron deficiency anemia ( 10 % ) , low serum ferritin ( 24 % ) , retinol ( 56 % ) , zinc ( 74 % ) , folate ( 68 % ) , and vitamin B-12 ( 17 % ) did not differ between groups . Postintervention , fewer in the treatment group had lower serum retinol [ odds ratio ( OR ) ( 95 % CI ) : 0.57 ( 0.33 - 0.97 ) ] and folate [ OR ( 95 % CI ) : 0.47 ( 0.26 - 0.84 ) ] than the control group . The serum vitamin B-12 concentration decreased in both groups , but the magnitude of change was less in the treatment than in the control group ( P < 0.05 ) . Total body iron ( TBI ) increased in both groups ; however , the change was greater in the treatment than in the control group ( P < 0.05 ) . Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A , folate , and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status BACKGROUND R and om serial sampling is widely used in population pharmacokinetic studies and may have advantages compared with conventional fixed time-point evaluation of iron fortification . OBJECTIVE Our objective was to vali date r and om serial sampling to judge the efficacy of iron fortification of a low-fat margarine . DESIGN We conducted a 32-wk placebo-controlled , double-blind , iron-intervention trial in 18 - 40-y-old Swiss women ( n = 142 ) with serum ferritin ( SF ) concentrations < 25 μg/L. Women were r and omly assigned to 3 groups to receive 20 g margarine , with 14 mg added iron as either micronized ground ferric pyrophosphate ( MGFePP ) or sodium iron edetate ( NaFeEDTA ) , or placebo daily . We measured hemoglobin and iron status of subjects at 2 fixed time points ( at baseline and the endpoint ) plus 3 r and omly assigned time points between 4 and 28 wk . With the use of bootstrapping , the number of observations per individual was reduced to 3 and then compared with the 5-time-point data . Mixed-effects models were used to estimate iron repletion over time for r and om sampling , and analysis of covariance was used for fixed time-point sampling . RESULTS Body iron stores increased in women who received MGFePP or NaFeEDTA compared with women who received placebo ( P < 0.05 ) . The increase in body iron stores  with NaFeEDTA fortification was 2 - 3 times the increase with MGFePP fortification ( P < 0.05 ) ; the difference was more marked in women with baseline SF concentrations < 15 μg/L ( P < 0.05 ) . R and om serial sampling reduced the required sample size per group to one-tenth of that for 2 fixed time points . Compared with the 5-time-point analysis , the 3-time-point sparse sampling generated comparable estimates of efficacy . CONCLUSIONS When used to evaluate the efficacy of iron fortificants , r and om serial sampling can reduce the sample size , invasiveness , and costs while increasing sensitivity . R and om serial sampling more clearly describes the pattern of iron repletion and may prove useful in evaluating other micronutrient interventions Anemia is common among children in sub-Saharan Africa and its etiology is multifactorial . Likely causes of anemia are low bioavailability of dietary iron , malaria , and helminth infection . In this study , we aim ed to assess the effect of iron fortification , intermittent preventive treatment ( IPT ) of malaria , and anthelmintic treatment on hemoglobin concentration and anemia prevalence among school children . The study was a 6-mo , r and omized , double-blind , controlled trial enrolling 591 6- to 14-y-old school children in Côte d'Ivoire using the following : 1 ) iron-fortified biscuits providing an additional 20 mg iron/d as electrolytic iron 4 times/wk ; 2 ) IPT of malaria with sulfadoxine-pyrimethamine at 0 and 3 mo ; and 3 ) anthelmintic treatment at 0 and 3 mo as the interventions . Prevalence of anemia , iron deficiency , malaria parasitemia , and helminth infection was 70.4 , 9.3 , 57.7 , and 54.8 % , respectively . Iron fortification did not improve iron status , IPT of malaria did not affect malaria burden , and neither had an impact on anemia prevalence . Anthelmintics significantly reduced the burden of helminth infections and decreased anemia prevalence ( odds ratio : 0.4 , 95 % CI : 0.3 , 0.7 ) . The low prevalence of iron deficiency and an extended dry season that decreased malaria transmission likely reduced the potential impact of iron fortification and IPT . In this setting , anthelmintic treatment was the only intervention that modestly decreased rates of anemia
Background Vitamins and minerals are essential for growth and metabolism .
The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals .
Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children , given their increased dem and s. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies .