Multinutrient-fortified juices improve vitamin D and vitamin E status in children: a randomized controlled trial. Effect of an improved local ingredient-based complementary food fortified or not with iron and selected multiple micronutrients on Hb concentration. Effect of a nutrient-enriched drink on dietary intake and nutritional status in institutionalised elderly Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania. The effect of a biscuit with red palm oil as a source of β-carotene on the vitamin A status of primary school children: a comparison with β-carotene from a synthetic source in a randomised 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 multinutrient-fortified beverage enhances the nutritional status of children in Botswana. Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. A multiple-micronutrient-fortified beverage affects hemoglobin, iron, and vitamin A status and growth in adolescent girls in rural Bangladesh. Fortification of sugar with iron sodium ethylenediaminotetraacetate (FeNaEDTA) improves iron status in semirural Guatemalan populations. Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Efficacy of a vitamin A-fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren. Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y. Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants. Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. An efficacy study on alleviating micronutrient deficiencies through a multiple micronutrient fortified salt in children in South India. Impact of a multiple-micronutrient fortified salt on the nutritional status and memory of schoolchildren. Effect of consumption of micronutrient fortified candies on the iron and vitamin A status of children aged 3-6 years in rural Haryana. Effect of micronutrient fortified beverage on nutritional anaemia during pregnancy. Long-term evaluation of a micronutrient-fortified biscuit used for addressing micronutrient deficiencies in primary school children. Efficacy of a multi micronutrient-fortified drink in improving iron and micronutrient status among schoolchildren with low iron stores in India: a randomised, double-masked placebo-controlled trial The impact of home fortification with multiple micronutrient powder on vitamin A status in young children: A multicenter pragmatic controlled trial in Brazil. Effects of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on preschool children in a suburb of Chongqing, China. Impact of fortified versus unfortified lipid-based supplements on morbidity and nutritional status: A randomised double-blind placebo-controlled trial in ill Gambian children Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention. 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. Double Fortified Salt Intervention Improved Iron Intake But Not Energy and Other Nutrient Intakes in Female Tea Plantation Workers From West Bengal, India The effect of daily consumption of the small fish Amblypharyngodon mola or added vitamin A on iron status: a randomised controlled trial among Bangladeshi children with marginal vitamin A status. Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women. School snacks decrease morbidity in Kenyan schoolchildren: a cluster randomized, controlled feeding intervention trial. Effects of fortified milk on morbidity in young children in north India: community based, randomised, double masked placebo controlled trial Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children. Micronutrient-Fortified Milk and Academic Performance among Chinese Middle School Students: A Cluster-Randomized Controlled Trial Impact of micronutrient fortification of yoghurt on micronutrient status markers and growth – a randomized double blind controlled trial among school children in Bangladesh Avocado Consumption Enhances Human Postprandial Provitamin A Absorption and Conversion from a Novel High–β-Carotene Tomato Sauce and from Carrots12 Micronutrient Fortified Milk Improves Iron Status, Anemia and Growth among Children 1–4 Years: A Double Masked, Randomized, Controlled Trial Short-Term Evaluation of the Impact of a Fortified Food Aid Program on the Micronutrient Nutritional Status of Argentinian Pregnant Women The effect of dietary supplementation with vitamins A, C and E on cell-mediated immune function in elderly long-stay patients: a randomized controlled trial. Evaluation of the effect of vitamin A-fortified margarine on the vitamin A status of preschool Filipino children. A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children Daily consumption of milk enriched with fish oil, oleic acid, minerals and vitamins reduces cell adhesion molecules in healthy children. Effect of micronutrient supplementation on health and nutritional status of schoolchildren: growth and morbidity. 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. Multiple micronutrient fortification of salt Vitamin A-fortified cooking oil reduces vitamin A deficiency in infants, young children and women: results from a programme evaluation in Indonesia. Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children. Vitamin A intake and the risk of hip fracture in postmenopausal women: the Iowa Women’s Health Study Retail Sugar From One Zambian Community Does Not Meet Statutory Requirements for Vitamin A Fortification Effect of vitamin-enriched bread on the vitamin status of an isolated rural community--a controlled clinical trial. Impact of Sorghum Supplementation on Growth and Micronutrient Status of School Going Children in Southern India — A Randomized Trial Vitamin A-fortified milk increases total body vitamin A stores in Mexican preschoolers. [Influence of caloric restriction diet on clinical and biochemical parameters in patients with type 2 diabetes mellitus]. Multi-micronutrient-fortified biscuits decreased prevalence of anemia and improved micronutrient status and effectiveness of deworming in rural Vietnamese school children. Vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns. Effectiveness of Fortified Flour for Enhancement of Vitamin and Mineral Intakes and Nutrition Status in Northwest Chinese Villages Fortification of maize meal improved the nutritional status of 1-3-year-old African children. Efficacy of Pandesal Baked from Wheat Flour Fortified with Iron and Vitamin A in Improving the Iron and Anthropometric Status of Anemic Schoolchildren in the Philippines Double-blind cluster randomised controlled trial of wheat flour chapatti fortified with micronutrients on the status of vitamin A and iron in school-aged children in rural Bangladesh. Effect of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on infectious morbidity of preschool children. Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India.
BACKGROUND Provision of fortified juices may provide a convenient method to maintain and increase blood fat-soluble vitamins . OBJECTIVE To determine whether children consuming orange juice fortified with calcium and combinations of vitamins D , E , and A  could increase serum 25-hydroxyvitamin D [ 25(OH)D ] , α-tocopherol , and retinol levels . DESIGN A 12-week r and omized , double-blind , controlled trial . PARTICIPANTS / SETTING One hundred eighty participants ( aged 8.04±1.42 years ) were recruited at Tufts ( n=70 ) and Boston University ( n=110 ) during 2005 - 2006 . Of those recruited , 176 children were r and omized into three groups : CaD ( 700 mg calcium+200 IU vitamin D ) , CaDEA ( 700 mg calcium+200 IU vitamin D+12 IU vitamin E+2,000 IU vitamin A as beta carotene ) , or Ca ( 700 mg calcium ) . Children consumed two 240-mL glasses of CaD , CaDEA , or Ca fortified orange juice daily for 12 weeks . MAIN OUTCOME MEASURES Serum 25(OH)D , α-tocopherol , and retinol concentrations . STATISTICAL ANALYSES Changes in 25(OH)D , α-tocopherol , retinol , and parathyroid hormone concentrations were examined . Covariates included sex , age , race/ethnicity , body mass index , and baseline 25(OH)D , α-tocopherol , retinol , or parathyroid hormone levels . Multivariate models and repeated measures analysis of variance tested for group differences with pre-post measures ( n=141 ) . RESULTS Baseline 25(OH)D was 68.4±27.7 nmol/L ( 27.4±11.10 ng/mL ) ) , with 21.7 % of participants having inadequate 25(OH)D ( < 50 nmol/L [ 20.03 ng/mL ] ) . The CaD group 's 25(OH)D increase was greater than that of the Ca group ( 12.7 nmol/L [ 5.09 ng/mL ] , 95 % CI 1.3 to 24.1 ; P=0.029 ) . The CaDEA group 's increase in α-tocopherol concentration was greater than that in the Ca or CaD groups ( 3.79 μmol/L [ 0.16 μg/mL ] , 95 % CI 2.5 to 5.1 and 3.09 μmol/L [ 0.13 μg/mL ] , 95 % CI -1.8 to 4.3 ) , respectively ( P<0.0001 ) . Retinol levels did not change , and body weight remained as expected for growth . CONCLUSIONS Daily consumption of orange juice providing 200 IU vitamin D and 12 IU vitamin E increased 25(OH)D and α-tocopherol concentrations in young children within 12 weeks 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 : ( 1 ) To determine whether nutritional supplementation ( energy and micronutrients ) in institutionalised elderly has a positive effect on dietary intake and nutritional status . ( 2 ) To investigate whether individuals tend to compensate for the energy content of the intervention product by decreasing their habitual food consumption . Methods : A 24-week , r and omised , double-blind , placebo-controlled , intervention trial in homes for the elderly ( n=3 ) , in nursing homes ( n=3 ) and ‘ mixed ’ homes ( n=3 ) in The Netherl and s. Institutionalised elderly people ( n=176 ) older than 60 years of age , with a body mass index ⩽30 kg/m2 and a Mini-Mental State Examination score of 10 points or higher , r and omly received a nutrient-enriched drink or a placebo drink twice a day during 24 weeks in addition to their usual diet . Allocation to treatment took into account of sex , the Mini-Mental State Examination score and the plasma homocysteine level . Body weight and several nutrition-related analyses in fasting blood sample s were measured in all participants . Data on dietary intake were collected in a sub sample ( n=66 ) . Results : A significantly favourable effect ( P<0.001 ) of the intervention drink was observed on vitamin intake , mineral intake and vitamin status in blood ( for example , homocysteine decreased from 14.7 to 9.5 μmol/l in the intervention group as compared with that in the placebo group ( 17.2–15.9 ) ) . The difference in change in total energy intake between the two treatment groups was 0.8 MJ/day ( P=0.166 ) . Energy intake from food decreased in both groups to the same extent ( −0.5 MJ/day ) . Therefore , this decrease can not be considered as compensation for the energy content of the product . Conclusions : This group of institutionalised elderly people does not compensate for the energy content of a concentrated nutritional supplement . Therefore , this supplement is effective for counteracting the development of malnutrition in this population Objective To investigate the effects of delayed umbilical cord clamping , compared with early clamping , on infant iron status at 4 months of age in a European setting . Design R and omised controlled trial . Setting Swedish county hospital . Participants 400 full term infants born after a low risk pregnancy . Intervention Infants were r and omised to  delayed umbilical cord clamping ( ≥180 seconds after delivery )  or early clamping ( ≤10 seconds after delivery ) . Main outcome measures Haemoglobin and iron status at 4 months of age with the power estimate based on serum ferritin levels . Secondary outcomes included neonatal anaemia , early respiratory symptoms , polycythaemia , and need for phototherapy . Results At 4 months of age , infants showed no significant differences in haemoglobin concentration between the groups , but infants subjected to delayed cord clamping had 45 % ( 95 % confidence interval 23 % to 71 % ) higher mean ferritin concentration ( 117 μg/L v 81 μg/L , P<0.001 ) and a lower prevalence of iron deficiency ( 1 ( 0.6 % ) v 10 ( 5.7 % ) , P=0.01 , relative risk reduction 0.90 ; number needed to treat=20 ( 17 to 67 ) ) . As for secondary outcomes , the delayed cord clamping group had lower prevalence of neonatal anaemia at 2 days of age ( 2 ( 1.2 % ) v 10 ( 6.3 % ) , P=0.02 , relative risk reduction 0.80 , number needed to treat 20 ( 15 to 111 ) ) . There were no significant differences between groups in postnatal respiratory symptoms , polycythaemia , or hyperbilirubinaemia requiring phototherapy . Conclusions Delayed cord clamping , compared with early clamping , result ed in improved iron status and reduced prevalence of iron deficiency at 4 months of age , and reduced prevalence of neonatal anaemia , without demonstrable adverse effects . As iron deficiency in infants even without anaemia has been associated with impaired development , delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia . Trial registration Clinical Trials NCT01245296 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 Objective : To determine the effect of a biscuit with red palm oil as a source of β-carotene on the vitamin A status of primary school children and to compare this with the effect of a biscuit with β-carotene from a synthetic source . Design : R and omised controlled trial . Setting : A rural community in KwaZulu-Natal , South Africa . Subjects : A total of 437 primary school children , aged 5–11 y ; 400 completed the study .Intervention : Subjects were r and omly assigned to one of three groups , receiving , respectively : ( i ) a placebo biscuit ; ( ii ) a biscuit with synthetic β-carotene as a vitamin A fortificant ( SB ) ; ( iii ) a biscuit with red palm oil as a source of β-carotene ( PB ) ; SB and PB supplied 30 % of the RDA for vitamin A per serving of three biscuits . Biscuits were distributed daily during the school week ; vitamin A status was assessed at baseline and after 3 months . Results : There was a significant improvement in serum retinol compared to the control group in both the SB and PB groups ( P<0.005 ) ; the treatment effect for the two groups was equivalent ( difference in treatment effect 0.62 µg/dl , with a 90 % CI−0.33–1.57 ) . Conclusions : A biscuit with red palm oil as a source of β-carotene is as effective as a biscuit with synthetic β-carotene in improving the vitamin A status of primary school children . The additional qualities of red palm oil ( ie no trans fatty acids ; rich source of antioxidants ) make it an excellent alternative fortificant for addressing vitamin A deficiency . Sponsorship : Financial support from Palm Oil Research Institute of Malaysia (PORIM).European Journal of Clinical Nutrition ( 2001 ) 55 , 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 Due to their widespread acceptability , multinutrient-fortified foods and beverages may be useful in reducing micronutrient deficiencies , especially in developing countries . We studied the efficacy of a new fortified beverage in improving the nutritional status of children in Botswana . We screened 311 lower income urban school children , ages 6 - 11 y , in two primary schools near Gaborone . Children were given seven 240-mL servings weekly of either an experimental beverage ( EXP ) fortified with 12 micronutrients or an isoenergetic placebo drink ( CON ) for 8 wk . Weight , mid-upper arm circumference , hemoglobin , retinol , ferritin , vitamin B-12 , folate and riboflavin status were measured at baseline and at the end of the study . Plasma zinc and serum transferrin receptors also were measured at study end . A total of 145 children in the EXP group and 118 in the CON group completed the trial . Using multivariate analysis , the changes in mid-upper arm circumference , weight for age and total weight were significantly better in the EXP group than in the CON group ( P < 0.01 ) . Ferritin , riboflavin and folate status were significantly better in the EXP group than in the CON group at study end ( P < 0.01 ) , but serum vitamin B-12 was not . Zinc was significantly higher and transferrin receptors were significantly lower at the conclusion of the study in the EXP group than in the CON group ( P < 0.001 ) . Mean plasma retinol concentrations , which were low ( < 0.7 micro mol/L ) in both groups , did not change . We conclude that a micronutrient-fortified beverage may be beneficial as part of a comprehensive nutritional supplementation program in population s at risk for micronutrient deficiencies BACKGROUND Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children . OBJECTIVE We assessed the effect of micronutrients , long-chain n-3 fatty acids , or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children . DESIGN Two 2-by-2 factorial r and omized controlled double-blind trials were performed home-based in Adelaide , South Australia , and at 6 primary schools in Jakarta , Indonesia . A total of 396 children ( aged 6 - 10 y ) in Australia and 384 children in Indonesia were r and omly allocated to receive a drink with a micronutrient mix ( iron , zinc , folate , and vitamins A , B-6 , B-12 , and C ) , with docosahexanoic acid ( DHA , 88 mg/d ) and eicosapentaenoic acid ( EPA , 22 mg/d ) , or with both or placebo 6 d/wk for 12 mo .  Biochemical indicators were determined at baseline and 12 mo . Cognitive performance was measured at baseline , 6 mo , and 12 mo . RESULTS The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children . DHA+EPA treatment increased plasma DHA and total plasma n-3 fatty acids in both countries . The micronutrient treatment result ed in significant increases in scores on tests representing verbal learning and memory in Australia ( estimated effect size : 0.23 ; 95 % CI : 0.01 , 0.46 ) . A similar effect was observed among Indonesian girls ( estimated effect size : 0.32 ; 95 % CI : -0.01 , 0.64 ) . No effects were found on tests measuring general intelligence or attention . No effects of DHA+EPA on the factors of cognitive tests were observed . CONCLUSION In well-nourished school-aged children , fortification with multiple micronutrients can result in improvements in verbal learning and memory Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries , despite longst and ing efforts to fortify foods or to distribute medicinal supplements to pregnant women . The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients ( iron , iodine , zinc , vitamin A , vitamin C , niacin , riboflavin , folate , vitamin B-12 , vitamin B-6 and vitamin E ) on the hemoglobin , iron and vitamin A status of pregnant women in Tanzania . A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a r and omized double-blind controlled trial in which study women received 8 wk of supplementation .  Hemoglobin , ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period . The supplement result ed in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56 % , respectively . The risk of iron deficiency was reduced by 70 % among those who had iron deficiency at baseline and by 92 % among those who had adequate stores . The micronutrient-fortified beverage may be a useful and convenient preventative measure , one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies Adolescent girls have high nutrient needs and are susceptible to micronutrient deficiencies . The objective of this study was to test the effect of a multiple-micronutrient-fortified beverage on  hemoglobin ( Hb ) concentrations , micronutrient status , and growth among adolescent girls in rural Bangladesh . A total of 1125 girls ( Hb > or = 70 g/L ) enrolled in a r and omized , double-blind , placebo-controlled trial and were allocated to either a fortified or nonfortified beverage of similar taste and appearance . The beverage was provided at schools 6 d/wk for 12 mo . Concentrations of Hb and serum ferritin ( sFt ) , retinol , zinc , and C-reactive protein were measured in venous blood sample s at baseline , 6 mo , and 12 mo . In addition , weight , height , and mid-upper arm circumference ( MUAC ) measurements were taken . The fortified beverage increased the Hb and sFt and retinol concentrations at 6 mo ( P < 0.01 ) . Adolescent girls in the nonfortified beverage group were more likely to suffer from anemia ( Hb < 120 g/L ) , iron deficiency ( sFt < 12 microg/L ) , and low serum retinol concentrations ( serum retinol < 0.70 micromol/L ) ( OR = 2.04 , 5.38 , and 5.47 , respectively ; P < 0.01 ) . The fortified beverage group had greater increases in weight , MUAC , and BMI over 6 mo ( P < 0.01 ) . Consuming the beverage for an additional 6 mo did not further improve the Hb concentration , but the sFt level continued to increase ( P = 0.01 ) . The use of multiple-micronutrient-fortified beverage can contribute to the reduction of anemia and improvement of micronutrient status and growth in adolescent girls in rural Bangladesh A 32-mo-long , double-blind field study involving one highl and control community receiving only vitamin A-fortified sugar and three vitamin A- and FeNaEDTA-sugar-fortified communities , two in the lowl and s and one in the highl and s of Guatemala , was undertaken to test the effectiveness of this approach in controlling iron deficiency .  The communities ' population ranged between 1200 and 17000 .  Sugar fortified with 1 g FeNaEDTA and 15 mg retinol as retinyl palmitate/kg was stable , did not segregate , and was well accepted by the communities . The impact of fortification on iron nutrition was estimated at 8 , 20 , and 32 mo of intervention . All pregnant women and subjects with severe anemia received supplements or treatment and were excluded from the analysis . Iron stores in the fortified communities increased significantly except for women 18 - 48 y of age in one lowl and community and > 49 y in the highl and community . Iron stores in the control community remained unchanged except for a rise among adult males 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 ] 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 BACKGROUND Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded linear growth and reducing anemia in stunted children . DESIGN Saharawi refugee children ( n = 374 ) aged 3 - 6 y with initial height-for-age z scores < -2 were assigned to 1 of 5 groups : fortified spread ( FS ) , fortified spread plus metronidazole ( FS+M ) , unfortified spread ( US ) , unfortified spread plus metronidazole ( US+M ) , or control . Supervised supplementation was given daily for 6 mo . Weight , height , knee-heel length , hematologic indexes , parasitic infections , and morbidity were assessed at 0 , 3 , and 6 mo . RESULTS Linear growth of children fed FS was 30 % faster at 3 mo than in US and control groups , after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups . No additional benefits from metronidazole were observed . Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups ( 37 + /- 40 , 19 + /- 15 , and 16 + /- 17 g/L , respectively ; P < 0.0001 ) , and anemia was reduced by nearly 90 % . CONCLUSIONS FS , and not US , induces catch-up growth in stunted children whose diets are poor in micronutrients . Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 BACKGROUND Maize-meal porridge is used for infant feeding in many African countries , including South Africa . A low-cost , finely milled , maize-meal porridge was fortified with beta-carotene , iron , and zinc ( 100 % of recommended dietary allowance ) , as well as ascorbic acid , copper , selenium , riboflavin , vitamin B-6 , vitamin B-12 , and vitamin E. OBJECTIVE We assessed whether the fortified porridge could reduce anemia and improve the micronutrient status and motor development of infants .  DESIGN Infants aged 6 - 12 mo ( n = 361 ) were r and omly assigned to receive either the fortified or unfortified porridge for 6 mo . Primary outcomes were hemoglobin and serum retinol , zinc , and ferritin concentrations and motor development . Growth was assessed as a secondary outcome . Primary and secondary outcomes were assessed at baseline and 6 mo . RESULTS Two hundred ninety-two infants completed the study . The fortified-porridge group had an intervention effect of 9.4 microg/L ( 95 % CI : 3.6 , 15.1 microg/L ) for serum ferritin and 9 g/L ( 95 % CI : 6 , 12 g/L ) for hemoglobin concentrations . The proportion of infants with anemia decreased from 45 % to 17 % in the fortified-porridge group , whereas it remained > 40 % in the control group . The fortified-porridge group achieved on average 15.5 of the 25 motor development score items , whereas the control group achieved 14.4 items ( P = 0.007 ) . Serum retinol concentration showed an inconsistent effect , and no intervention effect was observed for serum zinc concentrations . CONCLUSIONS This low-cost fortified porridge can potentially have a significant effect in reducing anemia and improving iron status and motor development of infants in poor setting s. The formulation needs some adjustment in terms of zinc fortification BACKGROUND Vitamin A deficiency is a risk factor for blindness and for mortality from measles and diarrhoea in children aged 6 - 59 months . We aim ed to estimate trends in the prevalence of vitamin A deficiency between 1991 and 2013 and its mortality burden in low-income and middle-income countries . METHODS We collated 134 population -representative data sources from 83 countries with measured serum retinol concentration data . We used a Bayesian hierarchical model to estimate the prevalence of vitamin A deficiency , defined as a serum retinol concentration lower than 0·70 μmol/L. We estimated the relative risks ( RRs ) for the effects of vitamin A deficiency on mortality from measles and diarrhoea by pooling effect sizes from r and omised trials of vitamin A supplementation . We used information about prevalences of deficiency , RRs , and number of cause-specific child deaths to estimate deaths attributable to vitamin A deficiency . All analyses included a systematic quantification of uncertainty . FINDINGS In 1991 , 39 % ( 95 % credible interval 27 - 52 ) of children aged 6 - 59 months in low-income and middle-income countries were vitamin A deficient . In 2013 , the prevalence of deficiency was 29 % ( 17 - 42 ; posterior probability [ PP ] of being a true decline=0·81 ) . Vitamin A deficiency significantly declined in east and southeast Asia and Oceania from 42 % ( 19 - 70 ) to 6 % ( 1 - 16 ; PP>0·99 ) ; a decline in Latin America and the Caribbean from 21 % ( 11 - 33 ) to 11 % ( 4 - 23 ; PP=0·89 ) also occurred . In 2013 , the prevalence of deficiency was highest in sub-Saharan Africa ( 48 % ; 25 - 75 ) and south Asia ( 44 % ; 13 - 79 ) . 94 500 ( 54 200 - 146 800 ) deaths from diarrhoea and 11 200 ( 4300 - 20 500 ) deaths from measles were attributable to vitamin A deficiency in 2013 , which accounted for 1·7 % ( 1·0 - 2·6 ) of all deaths in children younger than 5 years in low-income and middle-income countries . More than 95 % of these deaths occurred in sub-Saharan Africa and south Asia . INTERPRETATION Vitamin A deficiency remains prevalent in south Asia and sub-Saharan Africa . Deaths attributable to this deficiency have decreased over time worldwide , and have been almost eliminated in regions other than south Asia and sub-Saharan Africa . This new evidence for both prevalence and absolute burden of vitamin A deficiency should be used to reconsider , and possibly revise , the list of priority countries for high-dose vitamin A supplementation such that a country 's priority status takes into account both the prevalence of deficiency and the expected mortality benefits of supplementation . FUNDIN Bill & Melinda Gates Foundation , Gr and Challenges Canada , UK Medical Research Council BACKGROUND Multiple micronutrient deficiencies are prevalent in India . OBJECTIVE The study aims to establish the efficacy of multi-micronutrient fortified salt in addressing multiple micronutrient deficiencies among children compared to nutrition education and no intervention in Tamilnadu . METHODS The study employed a community based r and omized controlled trial design ed to study the impact of multiple micronutrient salt ( micronutrient group ) in comparison with nutrition education ( education group ) and no intervention ( control group ) on haemoglobin , serum ferritin , soluble transferrin receptor , body iron stores , serum retinol and urinary iodine outcomes over a period of 8 months . The fortified salt contained iron , iodine , vitamin A , vitamin B12 and folic acid . All the children were dewormed at baseline and at the end of the study just before the biochemical measurements . RESULTS There was a significant improvement in most biochemical parameters studied in the micronutrient group when compared with the control group whereas this was not seen between the education and control . Over 8 months , in the micronutrient group , hemoglobin increased by 0.52 g/dL , retinol by 8.56 μg/dL , ferritin by 10.8 μg/L , body iron stores by 1.27 mg and the decrease in the prevalence of retinol deficiency was from 51.6 % to 28.1 % , anaemia from 46.0 % to 32.6 % , iron deficiency from 66.9 % to 51.3 % and iron deficiency anaemia from 35.2 % to 31.0 % , while the prevalence of all these deficiencies increased or the changes were not significant in the other two groups . CONCLUSIONS Multiple micronutrient fortified salt was able to improve iron and vitamin A status , whereas this was not seen in the nutrition education group OBJECTIVE This study was conducted to test the efficacy of a multiple micronutrient-fortified cooking salt . METHODS A r and omized controlled trial with a pre- and post-test design was used to study children 5 to 18 years of age , with an experimental ( n=213 ) and control group ( n=189 ) . The children were sample d from 3 residential schools and were studied for 9 months . The experimental group received a multiple micronutrient-fortified salt containing vitamins A , B(1 ) , B(2 ) , B(6 ) , B(12 ) , as well as folic acid , niacin , iron , iodine , and zinc . The control group received iodized salt . Biochemical measurements [ hemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( sTfR ) , C-reactive protein ( CRP ) , alpha-1 acid glycoprotein ( AGP ) , serum retinol , serum vitamin B(12 ) , serum folic acid , serum zinc , and urinary iodine ( UI ) ] were measured at baseline and post-intervention . Hemoglobin was measured in all the children three times during the study period , while the remaining biochemical measurements were performed in a sub sample of children . Children between 11 and 18 years of age were given cognitive tests to assess memory and attention . RESULTS There was a significant improvement ( p<0.05 ) in all the biochemical measurements and memory tests in the experimental group when compared with the control group . Post-intervention in the experimental group , the increase in hemoglobin was 0.67 g/dL ( p<0.05 ) . Iron status and body iron stores increased significantly ( p<0.05 ) in the experimental group compared to the control group , while serum zinc increased by 50 mug/dL ( p<0.05 ) , and the prevalence of retinol deficiency decreased from 57.1 % at baseline to 16 % post-intervention ( p<0.05 ) . CONCLUSION The multiple micronutrients from the multiple micronutrient-fortified cooking salt were absorbed in the children and helped in combating micronutrient deficiencies OBJECTIVE To assess the efficacy of micronutrient fortified sugar c and ies in improving the iron and vitamin A status in children aged 3 to 6 years . DESIGN Triple blind r and omized controlled trial . SETTING S Anganwadis and preparatory schools in rural Haryana . METHODS 410 children were r and omized in four groups . One group received full dose c and y ( vitamin A 1000 IU and 14 mg elemental iron ) daily , the second group received full dose c and y for 3 days a week , the third group received half dose c and y ( vitamin A 500 IU and 7 mg elemental iron ) daily and the fourth received placebo . The c and ies were provided to children under supervision of field workers . Hemoglobin , S. ferritin , S. retinol and S. retinol binding protein levels were estimated at baseline and after 13 weeks of intervention . RESULTS The increase in hemoglobin was least in the placebo group ( 0.3 g/dL ) as compared to the two full dose groups ( 1.15 - 1.18 g/dL , P < 0.001 ) . Among anemic children , the increase in hemoglobin was about 2 g/dL in the full dose group and 0.7 g/dL in the placebo group ( P < 0.001 ) . S. ferritin levels increased significantly only in the full dose daily group ( p < 0.05 ) . The prevalence of anemia decreased from around 50 % at baseline to 9.6 % in the full dose daily group ( p < 0.01 ) . Based on the S. retinol levels , the study area was not vitamin A deficient and the intervention did not result in a significant improvement in the vitamin A status of the children . CONCLUSION Micronutrient fortified c and ies were effective in improving the hemoglobin level and decreasing anemia prevalence . It could serve as a suitable vehicle for micronutrient supplementation in children and other target groups OBJECTIVE To evaluate the efficacy of a multiple micronutrient fortified beverage containing eleven nutrients at physiological levels in prevention of anaemia and improving iron and vitamin A status  during pregnancy . DESIGN A r and omised double blind placebo controlled study . SETTING Mpwapwa and Kongwa Districts in Dodoma Region of Tanzania . SUBJECTS Five hundred and seventy nine pregnant women were screened for entry into the study and 439 women who met the study criteria were enrolled . INTERVENTIONS Study participants received either a fortified ( F ) or non-fortified ( NF ) orange flavoured drinks identical in appearance , provided in two self administered servings per day for an eight week period . MAIN OUTCOME MEASURES Comparison of haemoglobin ( Hb ) , serum ferritin ( SF ) and serum retinol ( SR ) at baseline and follow up . RESULTS After eight weeks of supplementation , the F group ( n=129 ) had a significantly higher Hb increase of 0.86 g/dL compared to 0.45 g/dL in the NF group ( n=130 ) p<0.0001 . Gestational age at entry into the study , moderated the effect on Hb of the fortified drink . Women at earlier gestational age upon entry , had a higher rise in Hb than women of late gestational age ( 0.8 g/dL versus 0.04 g/dL rise respectively , p=0.038 , n=188 ) . The risk of being anaemic at the end of the study for those in the F group was reduced by 51 % ( RR=0.49 , CI=0.28 to 0.85 ) . Iron stores ( by serum ferritin levels ) increased by 3 microg/L in the F group ( p=0.012 ) and a decrease of 2 microg/L in the NF group ( p=0.115 ) . The follow up ferritin concentration depended on initial ferritin level . Regardless of treatment group , serum retinol concentrations were significantly higher in mothers who had delivered . Mothers who had adequate levels at entry benefited more from the supplement than those with low levels ( 0.26 micromol/L versus no significant difference ) . CONCLUSIONS The multiple micronutrient-fortified beverage given for eight weeks to pregnant women improved their haemoglobin , serum ferritin and retinol status . The risk for anaemia was also significantly reduced . The important predictors of Hb increase at follow up were the fortified beverage , baseline Hb , serum retinol , baseline ferritin and gestational age at entry into study . Anthropological research showed that the beverage was highly acceptable and well liked OBJECTIVE To evaluate the long-term effect on micronutrient status of a beta-carotene- , iron- and iodine-fortified biscuit given to primary school children as school feeding . DESIGN Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years ( n = 108 ) ; in addition , cross-sectional data from three subsequent surveys conducted in the same school are reported . SETTING A rural community in KwaZulu-Natal , South Africa . SUBJECTS Children aged 6 - 11 years attending the primary school where the biscuit was distributed . RESULTS There was a significant improvement in serum retinol , serum ferritin , haemoglobin , transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention . However , when the school reopened after the summer holidays , all variables , except urinary iodine , returned to pre-intervention levels . Serum retinol increased again during the next 9 months , but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays ; this pattern was repeated in two further cross-sectional surveys . Haemoglobin gradually deteriorated at each subsequent assessment , as did serum ferritin ( apart from a slight increase at the 42-month assessment at the end of the school year ) . CONCLUSIONS This study has shown that fortification of a biscuit with beta-carotene at a level of 50 % of the Recommended Dietary Allowance ( RDA ) was enough to maintain serum retinol concentrations from day to day , but not enough to sustain levels during the long school holiday break . Other long-term solutions , such as local food production programmes combined with nutrition education , should also be examined . The choice of the iron compound used as fortificant in the biscuit needs further investigation Background / Objectives : A multiple micronutrient-fortified drink could be an effective strategy to combating micronutrient deficiencies in school going children . To assess the efficacy of a multiple micronutrient-fortified drink in reducing iron deficiency ( ID ) , ID anemia ( IDA ) , anemia and improving micronutrient status among schoolchildren with low iron stores . The study employed a school-based , r and omized , double-blind , placebo-controlled design .Subjects/ Methods : Schoolchildren with low serum ferritin ( SF < 20 μg/l ) ( n=246 ) , aged 6–12 years were r and omly assigned to receive either a multi-micronutrient fortified or an unfortified identical control drink . The drinks were provided 6 days/week for 8 weeks . Anthropometric and biochemical assessment s were taken at baseline and endline . Results : Study groups at baseline were comparable , and compliance to the intervention was similar . The overall prevalence of ID , IDA and anemia was 64 % , 19 % and 24 % , respectively . The prevalence of ID , IDA , vitamin C and vitamin B12 deficiencies significantly reduced by 42 % , 18 % , 21 % and 5 % , respectively , in the intervention arm ( P<0.01 ) as compared with the control arm at the end of the study . Similarly , the concentration of hemoglobin , SF , vitamin A , vitamin B12 , vitamin C and body iron stores were significantly higher in the intervention arm in comparison to the control arm ( P<0.001 ) . Red cell folate levels also improved significantly in the intervention arm ( P=0.04 ) , however , serum zinc status did not change in either of the study arms . Children who had received the fortified drink had significantly lower odds of being ID ( 0.15 ; 95 % confidence interval ( CI ) : 0.09–0.27 ) , IDA ( 0.14 ; 95 % CI : 0.04–0.52 ) , vitamin B12 deficient ( 0.36 ; 95 % CI : 0.18–0.73 ) and vitamin C deficient ( 0.24 ; 95 % CI : 0.13–0.46 ) , after adjusting for baseline age , gender and weight . Conclusions : The multi micronutrient-fortified drink was efficacious in reducing the prevalence of ID , IDA , vitamin C and vitamin B12 deficiency and improved micronutrient status in schoolchildren Home fortification with multiple micronutrient powder ( MNP ) is effective in the prevention of anemia  in young children . However , the impact on their vitamin A status remains controversial . This study aim ed to evaluate the effect of MNP on vitamin A status in young Brazilian children . A multicenter pragmatic , controlled trial was carried out in primary health centers in four Brazilian cities . In the beginning of the study , the control group ( CG ) consisted of children 11 - 14 months old ( n = 395 ) attending in routine pediatric health care . In parallel , the intervention group ( IG ) was composed of children 6 - 8 months old ( n = 399 ) , in the same health centers , who followed the intervention with MNP for 2 - 3 months . The analysis of the effect of  MNP  on vitamin A status was performed by comparing the IG with the CG after a 4- to 6-month follow-up when IG children had reached the age of the controls . The prevalence of vitamin A deficiency ( VAD ; serum retinol < 0.70 μmol/L ) in the CG was 16.2 % , while in the IG was 7.5%-a 55 % reduction in the VAD [ prevalence ratio ( 95 % confidence interval ) = 0.45 ( 0.28 ; 0.72 ) ] . This reduction was also significant when stratifying the study centers by coverage of the Brazilian Vitamin A Supplementation Program . The adjusted mean of vitamin A serum concentrations improved in the IG compared with CG children , with a shift to the right in the vitamin A distribution . Home fortification with MNP was effective in reducing VAD among young Brazilian children 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 Background Multiple micronutrients ( MMN ) are commonly prescribed in pediatric primary healthcare in sub-Saharan Africa to improve nutritional status and appetite without evidence for their effectiveness or international clinical guidelines . Community-wide MMN supplementation has shown limited and heterogeneous impact on growth and morbidity . Short-term ready-to-use therapeutic foods in acutely sick children in a hospital setting also had limited efficacy regarding subsequent growth . The effectiveness of MMN in improving morbidity or growth in  sick children presenting for primary care has not been assessed . Methods and findings We undertook a double-blind r and omised controlled trial of small-quantity lipid-based nutrient supplements ( SQ-LNS ) fortified with 23 micronutrients in children aged 6 months ( mo ) to 5 years ( y ) presenting with an illness at a rural primary healthcare centre in The Gambia . Primary outcomes were repeat clinic presentations and growth over 24 wk . Participants were r and omly assigned to receive 1 of 3 interventions : ( 1 ) supplementation with micronutrient-fortified SQ-LNS for 12 wk ( MMN-12 ) , ( 2 ) supplementation with micronutrient-fortified SQ-LNS for 6 wk followed by unfortified SQ-LNS for 6 wk ( MMN-6 ) , or ( 3 ) supplementation with unfortified SQ-LNS for 12 wk ( MMN-0 ) to be consumed in daily portions . Treatment masking used 16 letters per 6-wk block in the r and omisation process . Blinded intention-to-treat analysis based on a prespecified statistical analysis plan included all participants eligible and correctly enrolled . Between December 2009 and June 2011 , 1,101 children ( age 6–60 mo , mean 25.5 mo ) were enrolled , and 1,085 were assessed  ( MMN-0 = 361 , MMN-6 = 362 , MMN-12 = 362 ) . MMN supplementation was associated with a small increase in height-for-age z-scores 24 wk after recruitment ( effect size for MMN groups combined : 0.084 SD/24 wk , 95 % CI : 0.005 , 0.168 ; p = 0.037 ; equivalent to 2–5 mm depending on age ) . No significant difference in frequency of morbidity measured by the number of visits to the clinic within 24 wk follow-up was detected with 0.09 presentations per wk for all groups ( MMN-0 versus MMN-6 : adjusted incidence rate ratio [ IRR ] 1.03 , 95 % CI : 0.92 , 1.16 ; MMN-0 versus MMN-12 : 1.05 , 95 % CI : 0.93 , 1.18 ) . In post hoc analysis , clinic visits significantly increased by 43 % over the first 3 wk of fortified versus unfortified SQ-LNS ( adjusted IRR 1.43 ; 95 % CI : 1.07 , 1.92 ; p = 0.016 ) , with respiratory presentations increasing by 52 % with fortified SQ-LNS ( adjusted IRR 1.52 ; 95 % CI : 1.01 , 2.30 ; p = 0.046 ) . The number of severe adverse events during supplementation were similar between groups ( MMN-0 = 20 [ 1 death ] ; MMN-6 = 21 [ 1 death ] ; MMN-12 = 20 [ 0 death ] ) . No participant withdrew due to adverse effects . Study limitations included the lack of supervision of daily supplementation . Conclusion Prescribing micronutrient-fortified SQ-LNS to ill children presenting for primary care in rural Gambia had a very small effect on linear growth and did not reduce morbidity compared to unfortified SQ-LNS . An early increase in repeat visits indicates a need for the establishment of evidence -based guidelines and caution with systematic prescribing of MMN . Future research should be directed at underst and ing the mechanisms behind the lack of effect of MMN supplementation on morbidity measures and limited effect on growth . Trial registration IS RCT N 73571031 Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition . In the present study , we investigated the effects of micronutrients and sugar , alone and in combination , in a beverage on growth and cognition in schoolchildren . In a 2 × 2 factorial design , children ( n 414 , 6 - 11 years ) were r and omly allocated to consume beverages containing ( 1 ) micronutrients with sugar , ( 2 ) micronutrients with a non-nutritive sweetener , ( 3 ) no micronutrients with sugar or ( 4 ) no micronutrients with a non-nutritive sweetener for 8.5 months . Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II ( KABC-II ) subtests and the Hopkins Verbal Learning Test ( HVLT ) . Micronutrients decreased the OR for Fe deficiency at the endpoint ( OR 0.19 ; 95 % CI 0.07 , 0.53 ) . Micronutrients  increased KABC Atlantis ( intervention effect : 0.76 ; 95 % CI 0.10 , 1.42 ) and HVLT Discrimination Index ( 1.00 ; 95 % CI 0.01 , 2.00 ) scores . Sugar  increased KABC Atlantis ( 0.71 ; 95 % CI 0.05 , 1.37 ) and Rover ( 0.72 ; 95 % CI 0.08 , 1.35 ) scores and HVLT Recall 3 ( 0.94 ; 95 % CI 0.15 , 1.72 ) . Significant micronutrient × sugar interaction effects on the Atlantis , Number recall , Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone . Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls ( micronutrients - 0.08 ; 95 % CI - 0.15 , - 0.01 ; sugar - 0.07 ; 95 % CI - 0.14 , - 0.002 ) , but in combination , this effect was attenuated . The beverages with micronutrients or added sugar alone had a beneficial effect on cognition , which was attenuated when provided in combination OBJECTIVE 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 : Iron deficiency is a global public health concern and has implication s on the health status of women in reproductive age . Objective : We hypothesized that improving iron intake with double fortified salt would improve food intake , result ing in higher energy , nutrient intakes , and weight indicators of female tea plantation workers . Methods : In this r and omized double-masked study , the participants ( n = 245 ) were assigned to receive salt double fortified with iron and iodine ( DFS ; treatment ) or salt fortified with iodine ( control ) and followed for 7.5 to 9 months . Dietary intakes were measured at three time points , baseline , midpoint , and end line using ( 1 ) food frequency question naire , ( 2 ) 24-hour recall , and ( 3 ) weighed lunch intake . Anthropometric measures of height ( cm ) , weight ( kg ) , and mid-upper arm circumference ( cm ) were also recorded at three time points . Mixed-model repeated- measures approach was used to detect group differences across time . Results : Double fortified salt improved dietary iron intake in the treatment group compared to the control group ( P < .001 ) . No other dietary or anthropometric differences could be attributed to treatment . Significant effect of time was observed in the intake frequency of major food groups and calcium , vitamin A and C ( P < .001 for all ) , suggesting an equal effect of seasonality in both the groups . Conclusion : Addition of DFS in the diet improved dietary iron intake but did not affect the intake of energy , other nutrients , or nutritional status indicators . The improvement observed in the dietary iron intake demonstrates that fortification is an effective strategy to address iron deficiency in at-risk population BACKGROUND AND OBJECTIVES Mola ( Amblypharyngodon mola ) is a nutrient-rich , small fish found in ponds and rice fields in Bangladesh . The aim of the present intervention was to assess the effect of mola consumption on iron status in children with marginal vitamin A status . METHODS AND STUDY DESIGN Bangladeshi children ( n=196 ) , aged 3 - 7 years , with marginal vitamin A status were r and omly allocated to one of three intervention groups served different fish curries : mola curry ( experimental group ) ; rui ( Labeo rohita ) curry with added retinyl palmitate ( positive control group ) ; or rui curry ( negative control group ) . The intervention meals were served 6 days/week for 9 weeks . The experimental and positive control meals were design ed to contain similar amounts of retinol activity equivalents per portion . The mola curry contained four times more iron compared to the rui curries due to different iron content in the two fish species . Haemoglobin , ferritin , serum transferrin receptor and Creactive protein were measured at screening and endpoint . RESULTS In the experimental group receiving mola , serum transferrin receptor concentration declined 0.73 mg/L ( 95 % CI 0.17 , 1.28 , p=0.01 ) compared to the positive control group , while there were no differences between groups in ferritin or haemoglobin . CONCLUSIONS Consumption of mola instead of rui has potentially an effect on iron status in children with marginal vitamin A status , seen as a decrease in serum transferrin receptor concentration OBJECTIVE To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration , as primary outcomes . DESIGN Non-blinded , r and omised controlled study . SETTING Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago , Chile . SUBJECT Pregnant women were assigned to receive regular powdered milk ( n = 477 ) or a milk product fortified with multiple micronutrients and omega-3 fatty acids  ( n = 495 ) . RESULTS Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls ( 65.4 g difference , 95 % confidence interval ( CI ) 5 - 126 g ; P = 0.03 ) and the incidence of very preterm birth ( 0.80 just for mean birth weight and birth length in the on-treatment analysis ; birth length in that analysis had a difference of 0.57 cm ( 95 % CI 0.19 - 0.96 cm ; P = 0.003 ) . CONCLUSIONS The new intervention result ed in increased mean birth weight . Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation OBJECTIVE To examine the effects of three different school snacks on morbidity outcomes . DESIGN Twelve schools were r and omized to either one of three feeding groups or a Control group . There were three schools per group in this cluster r and omized trial . Children in feeding group schools received school snacks of a local plant-based dish , githeri , with meat , milk or extra oil added . The oil used was later found to be fortified with retinol .  Physical status , food intake and morbidity outcomes were assessed longitudinally over two years . SETTING Rural Embu District , Kenya , an area with high prevalence of vitamin A deficiency . SUBJECTS St and ard 1 schoolchildren ( n 902 ; analytic sample ) enrolled in two cohorts from the same schools one year apart . RESULTS The Meat and Plain Githeri ( i.e. githeri+oil ) groups showed the greatest declines in the probability of a morbidity outcome ( PMO ) for total and severe illnesses , malaria , poor appetite , reduced activity , fever and chills . The Meat group showed significantly greater declines in PMO for gastroenteritis ( mainly diarrhoea ) and typhoid compared with the Control group , for jaundice compared with the Plain Githeri group , and for skin infection compared with the Milk group . The Milk group showed the greatest decline in PMO for upper respiratory infection . For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time . CONCLUSIONS The intervention study showed beneficial effects of both animal source foods and of vitamin A-fortified oil on morbidity status Objective To evaluate the efficacy of milk fortified with specific multiple micronutrients on morbidity in children compared with the same milk without fortification . Design Community based , double masked , individually r and omised trial . Setting Peri-urban settlement in north India . Participants Children ( n=633 ) aged 1 - 3 r and omly allocated to receive fortified milk ( n=316 ) or control milk ( n=317 ) . Intervention One year of fortified milk providing additional 7.8 mg zinc , 9.6 mg iron , 4.2 � g selenium , 0.27 mg copper , 156 � g vitamin A , 40.2 mg vitamin C , 7.5 mg vitamin E per day ( three feeds ) . Main outcome measures Days with severe illnesses , incidence and prevalence of diarrhoea , and acute lower respiratory illness . Results Study groups were comparable at baseline ; compliance in the groups was similar . Mean number of episodes of diarrhoea per child was 4.46 ( SD 3.8 ) in the intervention ( fortified milk ) group and 5.36 ( SD 4.1 ) in the control group . Mean number of episodes of acute lower respiratory illness was 0.62 ( SD 1.1 ) and 0.83 ( SD 1.4 ) , respectively . The fortified milk reduced the odds for days with severe illnesses by 15 % ( 95 % confidence interval 5 % to 24 % ) , the incidence of diarrhoea by 18 % ( 7 % to 27 % ) , and the incidence of acute lower respiratory illness by 26 % ( 3 % to 43 % ) . Consistently greater beneficial effects were observed in children aged ≤24 months than in older children . Conclusion Milk is well accepted as a means of delivery of micronutrients . Consumption of milk fortified with specific micronutrients can significantly reduce the burden of common morbidities among preschool children , especially in the first two years of life . Trial registration NCT00255385 OBJECTIVE To evaluate the efficacy of a community-based dietary intervention to reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian diets . DESIGN Quasi-experimental post-test design with a non-equivalent control group . SETTING Four villages in Mangochi District , Southern Malawi . PARTICIPANTS Households with children aged 3 - 7 years in two intervention ( n = 200 ) and two control ( n = 81 ) villages participated in a 6-month intervention employing dietary diversification , changes in food selection patterns , and modifications to food processing to reduce the phytate content of maize-based diets . Baseline comparability between the groups was confirmed via assessment of sociodemographic characteristics , anthropometry , knowledge and practice s , morbidity , haemoglobin and hair zinc . After 12 months , knowledge and practice s and dietary intakes were assessed by interactive 24-hour recalls , one during the food plenty and a second during the food shortage season . Nutrient adequacy for the two groups was compared via dietary quality indicators and predicted prevalence of inadequate intakes using the probability approach . RESULTS Intervention children had diets that were significantly more diverse and of a higher quality than those of controls . Median daily intakes of protein , calcium , zinc ( total and available ) , haem iron , vitamin B12 and animal foods ( grams ; % of total energy ) were higher ( P < 0.05 ) whereas phytate intakes , phytate/zinc and phytate/iron molar ratios were lower ( P < 0.01 ) in the intervention group ; some spread of knowledge and practice s to controls occurred . CONCLUSIONS Our community-based dietary strategies reduced the predicted prevalence of inadequate intakes of protein , calcium , zinc and vitamin B12 , but not iron , in children from Malawian households with very limited re sources Many children suffer from nutritional deficiencies that may negatively affect their academic performance  . This cluster-r and omized controlled trial aim ed to test the effects of micronutrient-fortified milk in Chinese students . Participants received either micronutrient-fortified ( n = 177 ) or unfortified ( n = 183 ) milk for six months . Academic performance , motivation , and learning strategies were estimated by end-of-term tests and the Motivated Strategies for Learning Question naire . Blood sample s were analyzed for micronutrients . In total , 296 students ( 82.2 % ) completed this study . Compared with the control group , students in the intervention group reported higher scores in several academic subjects ( p < 0.05 ) , including language s , mathematics , ethics , and physical performance at the end of follow-up . Students in the intervention group showed greater self-efficacy and use of cognitive strategies in learning , and reported less test anxiety ( p < 0.001 ) . Moreover , vitamin B2 deficiency ( odds ratio ( OR ) = 0.18 , 95 % confidence interval ( CI ) : 0.11~0.30 ) and iron deficiency ( OR = 0.34 , 95 % CI : 0.14~0.81 ) were less likely in the students of the intervention group , whereas vitamin D , vitamin B12 , and selenium deficiencies were not significantly different . “ Cognitive strategy ” had a partial mediating effect on the test scores of English ( 95 % CI : 1.26~3.79 ) and Chinese ( 95 % CI : 0.53~2.21 ) . Our findings suggest that micronutrient-fortified milk may improve students ’ academic performance , motivation , and learning strategies Background Interventions providing foods fortified with multiple micronutrients can be a cost-effective and sustainable strategy to improve micronutrient status and physical growth of school children . We evaluated the effect of micronutrient-fortified yoghurt on the biochemical status of important micronutrients ( iron , zinc , iodine , vitamin A ) as well as growth indicators among school children in Bogra district of Bangladesh . Methods In a double-masked r and omized controlled trial ( RCT ) conducted in 4 primary schools , 1010 children from classes 1–4 ( age 6–9 years ) were r and omly allocated to receive either micronutrient fortified yoghurt ( FY , n = 501 ) or non-fortified yoghurt ( NFY , n = 509 ) . For one year , children were fed with 60 g yoghurt everyday providing 30 % RDA for iron , zinc , iodine and vitamin A.  Anthropometric measurements and blood/urine sample s were collected at base- , mid- and end-line . All children ( FY , n = 278 , NFY , n = 293 ) consenting for the end-line blood sample were included in the present analyses . Results Both groups were comparable at baseline for socio-economic status variables , micronutrient status markers and anthropometry measures . Compliance was similar in both the groups . At baseline 53.4 % of the population was anemic ; 2.1 % was iron deficient ( ferritin < 15.0 μg/L and TfR > 8.3 mg/L ) . Children in the FY group showed improvement in Hb ( mean difference : 1.5 ; 95 % CI : 0.4 - 2.5 ; p = 0.006 ) as compared to NFY group . Retinol binding protein ( mean diff : 0.05 ; 95 % CI : 0.002 - 0.09 ; p = 0.04 ) and iodine levels ( mean difference : 39.87 ; 95 % CI : 20.39 - 59.35 ; p < 0.001 ) decreased between base and end-line but the decrease was significantly less in the FY group . Compared to NFY , the FY group had better height gain velocity ( mean diff : 0.32 ; 95 % CI : 0.05 - 0.60 ; p = 0.02 ) and height-for-age z-scores ( mean diff : 0.18 ; 95 % CI : 0.02 - 0.33 ; p = 0.03 ) . There was no difference in weight gain velocity , weight-for-age z-scores or Body Mass Index z-scores . Conclusion In the absence of iron deficiency at baseline the impact on iron status would not be expected to be observed and hence can not be evaluated . Improved Hb concentrations in the absence of a change in iron status suggest improved utilization of iron possibly due to vitamin A and zinc availability . Fortification improved height gain without affecting weight gain . Trial registration Clinical Trial.gov : Dietary lipids have been shown to increase bioavailability of provitamin A carotenoids  from a single meal , but the effects of dietary lipids on conversion to vitamin A during absorption are essentially unknown . Based on previous animal studies , we hypothesized that the consumption of provitamin A carotenoids with dietary lipid would enhance conversion to vitamin A during absorption compared with the consumption of provitamin A carotenoids alone . Two separate sets of 12 healthy men and women were recruited for 2 r and omized , 2-way crossover studies . One meal was served with fresh avocado ( Persea americana Mill ) , cultivated variety Hass ( delivering 23 g of lipid ) , and a second meal was served without avocado . In study 1 , the source of provitamin A carotenoids was a tomato sauce made from a novel , high – β-carotene variety of tomatoes ( delivering 33.7 mg of β-carotene ) . In study 2 , the source of provitamin A carotenoids was raw carrots ( delivering 27.3 mg of β-carotene and 18.7 mg of α-carotene ) . Postpr and ial blood sample s were taken over 12 h , and provitamin A carotenoids and vitamin A were quantified in triglyceride-rich lipoprotein fractions to determine baseline-corrected area under the concentration-vs.-time curve . Consumption of lipid-rich avocado enhanced the absorption of β-carotene from study 1 by 2.4-fold ( P < 0.0001 ) . In study 2 , the absorption of β-carotene and α-carotene increased by 6.6- and 4.8-fold , respectively ( P < 0.0001 for both ) . Most notably , consumption of avocado enhanced the efficiency of conversion to vitamin A ( as measured by retinyl esters ) by 4.6-fold in study 1 ( P < 0.0001 ) and 12.6-fold in study 2 ( P = 0.0013 ) . These observations highlight the importance of provitamin A carotenoid consumption with a lipid-rich food such as avocado for maximum absorption and conversion to vitamin A , especially in population s in which vitamin A deficiency is prevalent . This trial was registered at clinical trials.gov as NCT01432210 Background Multiple micronutrient deficiencies are highly prevalent among preschool children and often lead to anemia and growth faltering . Given the limited success of supplementation and health education programs , fortification of foods could be a viable and sustainable option . We report results from a community based double-masked , r and omized trial among children 1–4 years evaluating the effects of micronutrients ( especially of zinc and iron ) delivered through fortified milk on growth , anemia and iron status markers as part of a four group study design , running two studies simultaneously . Methods and Findings Enrolled children ( n = 633 ) were r and omly allocated to receive either micronutrients fortified milk ( MN = 316 ) or control milk ( Co = 317 ) . Intervention of MN milk provided additional 7.8 mg zinc , 9.6 mg iron , 4.2 µg selenium , 0.27 mg copper , 156 µg vitamin A , 40.2 mg vitamin C , and 7.5 mg vitamin E per day ( three serves ) for one year . Anthropometry was recorded at baseline , mid- and end- study . Hematological parameters were estimated at baseline and end- study . Both groups were comparable at baseline . Compliance was over 85 % and did not vary between groups . Compared to children consuming Co milk , children consuming MN milk showed significant improvement in weight gain ( difference of mean : 0.21 kg/year ; 95 % confidence interval [ CI ] 0.12 to 0.31 , p<0.001 ) and height gain ( difference of mean : 0.51 cm/year ; 95 % CI 0.27 to 0.75 , p<0.001 ) . Mean hemoglobin ( Hb ) ( difference of 13.6 g/L ; 95 % CI 11.1 to 16.0 , p<0.001 ) and serum ferritin levels ( difference of 7.9 µg/L ; 95 % CI 5.4 to 10.5 , p<0.001 ) also improved . Children in MN group had 88 % ( odds ratio = 0.12 , 95 % CI 0.08 to 0.20 , p<0.001 ) lower risk of iron deficiency anemia . Conclusions / Significance Milk provides an acceptable and effective vehicle for delivery of specific micronutrients , especially zinc and iron . Micronutrient bundle improved growth and iron status and reduced anemia in children 1–4 years old . Trial Registration Clinical Trials.gov We studied the impact of a food supplementation program ( Plan Más Vida ( PMV ) ) on the micronutrient nutritional condition of pregnant women from low-income families 1 year after its implementation . The food program provided supplementary diet ( wheat and maize — fortified flour , rice or sugar , and fortified soup ) . We performed a prospect i ve , nonexperimental , cross-sectional study in the province of Buenos Aires , Argentina , evaluating pregnant women at baseline ( n = 164 ) and 1 year after PMV implementation ( n = 108 ) .  Biochemical tests ( hemogram , ferritin , vitamin A , zinc , and folic acid ) , anthropometric assessment s ( weight and height ) , and dietary surveys ( 24 h recall ) were performed at the two study points . One year after PMV implementation , no significant changes in anthropometric values were observed . Folic acid deficiency and the risk of vitamin A deficiency ( retinol , 20–30 μg/dl ) decreased significantly ( 35.8 to 6.1 % and 64 to 41 % , respectively ; p < 0.000 ) . Anemia and prevalence of iron and zinc deficiency values did not change . Diet survey results showed that although nutrient intake increased significantly , it was still below recommendations . Implementation of the PMV and of the government nutritional strategies had a high impact on the prevalence of folic acid deficiency . We also observed a decrease in the risk of vitamin A deficiency , and no impact on iron and zinc nutritional status . Adherence to the specific fortified food ( soup ) was not good and intra-family dilution and distribution of food was high Thirty elderly long-stay patients were r and omly allocated to receive either placebo or dietary supplementation with vitamins A , C and E for 28 days . Nutritional status and cell-mediated immune function were assessed before and after the period of supplementation . Following vitamin supplementation , cell-mediated immune function improved as indicated by a significant increase in the absolute number of T cells ( p less than 0.05 ) , T4 subsets ( p less than 0.05 ) , T4 to T8 ratio ( p less than 0.01 ) and the proliferation of lymphocytes in response to phytohaemagglutinin ( p less than 0.01 ) . In contrast , no significant changes were noted in the immune function of the placebo group . We conclude that supplementation with the dietary antioxidants vitamins A , C and E can improve aspects of cell-mediated immune function in elderly long-stay patients OBJECTIVES This study assessed the effects of consuming a highly hydrogenated , vitamin A (VA)-fortified margarine not requiring refrigeration on VA status of preschool children . DESIGN A double-masked r and omized community trial . SETTING Six rural villages in Cavite , Southern Luzon , the Philippines . SUBJECTS 296 and 285 children 3 - 6 y of age in the VA-fortified ( experimental ) and non-fortified ( control ) margarine groups , respectively . INTERVENTION Each week for 6 months households were given 250 g of VA-fortified margarine [ providing 28.8 micrograms retinol equivalents ( RE ) per g ] or non-fortified ( 0 microgram RE ) margarine of identical appearance for each enrolled child . Children 's vitamin A status [ serum retinol , xerophthalmia , and conjunctival impression cytology ( CIC ) status ] and dietary intake were assessed at baseline and follow-up ; margarine intake was monitored throughout the study . RESULTS Daily margarine intake per child averaged 27 g in the experimental group ( providing 776 micrograms RE ) and 24 g ( 0 microgram RE ) in the control group . After 6 months , mean serum retinol increased from 26.4 to 28.8 micrograms/dl in the experimental group but decreased from 26.6 to 25.1 micrograms/dl in controls ( P < 0.001 at 6 months ) ; the multiple-adjusted increment over controls was 2.4 micrograms/dl ( P < 0.01 ) . More importantly , the prevalence of low serum retinol ( < 20 micrograms/dl ) decreased from 25.7 to 10.1 % in the experimental group but remained unchanged in controls ( 26.7 to 27.7 % ) ( P < 0.01 at 6 months ) . At follow-up no experimental children had developed xerophthalmia but 1.4 and 1.8 % of controls developed nightblindness and Bitot 's spots , respectively . There were no differences in CIC between groups . CONCLUSION Consumption of VA-fortified margarine significantly improved VA status of preschool Filipino children 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 BACKGROUND AND AIMS Several studies have suggested that polyunsaturated fatty acids , vitamins and minerals have beneficial effects on lipid profile and systemic inflammation  in adults . METHODS AND RESULTS We examined the effects of a daily intake of milk enriched with longchain polyunsaturated fatty acids , oleic acid , carbohydrates , vitamins , minerals and low in saturated fatty acids ( SFAs ) for 5 months , on several  cardiovascular ( CVD ) risk biomarkers  in healthy children aged 8 - 14 years . In a r and omized double-blind placebo-controlled trial , a total of 107 children of both genders were assigned to two study groups : 1 ) a supplemented group ( SG , n=53 ) who consumed 0.6 L/day of an enriched dairy product , and 2 ) a control group ( CG , n=54 ) who consumed 0.6 L/day of st and ard whole milk . Both groups consumed the dairy drinks for 5 months , in addition to their usual diet . Serum levels of adhesion molecules as indices of vascular endothelial cell activation were assessed in both groups at 0 and 5 months as well as white blood cell counts , lipid profile , serum proteins , total serum calcium , 25-OH vitamin D , glucose , insulin and adiponectin . In the enriched dairy drink supplemented group , adhesion molecules E-selectin and ICAM-1 as well as lymphocyte levels decreased while plasma docosahexaenoic acid ( DHA ) and serum calcium concentrations increased . In the control group , serum total protein , transferrin , total cholesterol , HDL-cholesterol and adiponectin concentrations decreased . CONCLUSION The consumption of a milk enriched with fish oil , oleic acid , minerals and vitamins reduced indices of endothelial cell activation in the studied group of healthy children OBJECTIVE We evaluated the effect of a micronutrient-fortified beverage on growth and morbidity in apparently healthy schoolchildren . METHODS This was a double-blind , placebo-controlled , matched-pair , cluster , r and omized study in semi-urban middle-income residential schoolchildren aged 6 to 16 y.  Anthropometrics ( height and weight ) , clinical symptoms of deficiency , and morbidity data were collected at baseline in the supplemented group ( n = 446 in 10 grade s ) and the placebo group ( n = 423 in 10 grade s ) and after 14 mo of supplementation ( n = 355 in the supplement group and n = 340 in the placebo group from nine pairs ) . RESULTS After 14 mo of supplementation , there was a significant increase in mean increments of height and weight z scores of -0.04 and 0.02 , respectively , in the supplemented group compared with -0.14 and -0.09 in the placebo group . Velocity of weight ( 3.56 versus 3.00 ) was significantly ( P < 0.01 ) higher with supplementation . Although there were no differences in the incidence of common childhood diseases such as fever , cough and cold , diarrhea , and ear infections elicited for a reference period of 1 mo at every quarterly follow-up examination , the mean duration of illness ( calculated per person per year ) was significantly shorter ( 5.0 d ) in the supplemented group than in the placebo group ( 7.4 d ) . CONCLUSIONS The micronutrient-fortified beverage was beneficial in promoting growth and decreasing duration of common illnesses among middle-class residential schoolchildren who had adequate energy and protein intakes 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 Background / Objective : To develop a salt fortified with multiple micronutrients , to test its stability during storage and cooking , and to assess its efficacy in improving the micronutrient status and the health of schoolchildren . Subject/ Methods : A salt fortified with multiple micronutrients was developed containing chelated ferrous sulfate and microencapsulated vitamins A , B1 , B2 , B6 , B12 , folic acid , niacin , calcium pantothenate and iodine . Its stability during 20 min of cooking and 6 months of storage was determined . Thereafter , the efficacy of the salt was assessed in 5- to 15-year-old schoolchildren in Chennai , India . For the experimental group ( N=119 ) , the food in the school kitchen was cooked with fortified salt for a period of 1 year . The control group ( N=126 ) consisted of day scholars who did not eat at the school .  Hemoglobin , red blood cell count , hematocrit , serum vitamin A and urinary iodine were measured at baseline and at the end of the study after 1 year . Results : All micronutrients were stable during cooking and storage . Over the study period , there was a significant improvement ( P<0.05 ) in hemoglobin , red cell count , urinary iodine and serum vitamin A in the experimental group , while there was a significant drop ( P<0.05 ) in hemoglobin , hematocrit , red cell count and urinary iodine in the control group . In the experimental group , there was a mean increase of 0.55 g/dl in hemoglobin , 0.001 l/l in hematocrit , 0.470 million/mm3 in red cell count , 212 μg/l in urinary iodine and 5.6 μg/dl in serum vitamin A. Conclusion : The study shows that the salt fortified with multiple micronutrients is stable during cooking and storage and effective in combating multiple micronutrient deficiencies OBJECTIVE To assess oil consumption , vitamin A intake and retinol status before and a year after the fortification of unbr and ed palm oil with retinyl palmitate . DESIGN Pre-post evaluation between two surveys . SETTING Twenty-four villages in West Java . SUBJECTS Poor households were r and omly sample d.  Serum retinol ( adjusted for sub clinical infection ) was analysed in cross-sectional sample s of lactating mothers ( baseline n 324/endline n 349 ) , their infants aged 6 - 11 months ( n 318/n 335 ) and children aged 12 - 59 months ( n 469/477 ) , and cohorts of children aged 5 - 9 years ( n 186 ) and women aged 15 - 29 years ( n 171 ) , alongside food and oil consumption from dietary recall . RESULTS Fortified oil  improved vitamin A intakes , contributing on average 26 % , 40 % , 38 % , 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12 - 23 months , 24 - 59 months , 5 - 9 years , lactating and non-lactating women , respectively . Serum retinol was 2 - 19 % higher at endline than baseline ( P<0·001 in infants aged 6 - 11 months , children aged 5 - 9 years , lactating and non-lactating women ; non-significant in children aged 12 - 23 months ; P=0·057 in children aged 24 - 59 months ) . Retinol in breast milk averaged 20·5 μg/dl at baseline and 32·5 μg/dl at endline ( P<0·01 ) . Deficiency prevalence ( serum retinol < 20 μg/dl ) was 6·5 - 18 % across groups at baseline , and 0·6 - 6 % at endline ( P≤0·011 ) . In multivariate regressions adjusting for socio-economic differences , vitamin A intake from fortified oil predicted improved retinol status for children aged 6 - 59 months ( P=0·003 ) and 5 - 9 years ( P=0·03 ) . CONCLUSIONS Although this evaluation without a comparison group can not prove causality , retinyl contents in oil , Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children In Vietnam , nutrition interventions do not target school children despite a high prevalence of micronutrient deficiencies . The present r and omised , placebo-controlled study evaluated the impact of providing school children ( n 403 ) with daily multiple micronutrient-fortified biscuits ( FB ) or a weekly Fe supplement ( SUP ) on anaemia and Fe deficiency . Micronutrient status was assessed by concentrations of Hb , and plasma ferritin ( PF ) , transferrin receptor ( TfR ) , Zn and retinol . After 6 months of intervention , children receiving FB or SUP had a significantly better Fe status when compared with the control children ( C ) , indicated by higher PF ( FB : geometric mean 36·9 ( 95 % CI 28·0 , 55·4 ) μg/l ; SUP : geometric mean 46·0 ( 95 % CI 33·0 , 71·7 ) μg/l ; C : geometric mean 34·4 ( 95 % CI 15·2 , 51·2 ) μg/l ; P < 0·001 ) and lower TfR concentrations ( FB : geometric mean 5·7 ( 95 % CI 4·8 , 6·52 ) mg/l ; SUP : geometric mean 5·5 ( 95 % CI 4·9 , 6·2 ) mg/l ; C : geometric mean 5·9 ( 95 % CI 5·1 , 7·1 ) mg/l ; P = 0·007 ) . Consequently , body Fe was higher in children receiving FB ( mean 5·6 ( sd 2·2 ) mg/kg body weight ) and SUP ( mean 6·1 ( sd 2·5 ) mg/kg body weight ) compared with the C group ( mean 4·2 ( sd 3·3 ) mg/kg body weight , P < 0·001 ) . However , anaemia prevalence was significantly lower only in the FB group ( 1·0 % ) compared with the C group ( 10·4 % , P = 0·006 ) , with the SUP group being intermediate ( 7·4 % ) . Children receiving FB had better weight-for-height Z-scores after the intervention than children receiving the SUP ( P = 0·009 ) . Vitamin A deficiency at baseline modified the intervention effect , with higher Hb concentrations in vitamin A-deficient children receiving FB but not in those receiving the SUP . This indicates that vitamin A deficiency is implicated in the high prevalence of anaemia in Vietnamese school children , and that interventions should take other deficiencies besides Fe into account to improve Hb concentrations . Provision of biscuits fortified with multiple micronutrients is effective in reducing anaemia prevalence in school children Excessive intake of vitamin A is postulated to have a detrimental effect on bone by inducing osteoporosis . This may lead to an increased risk of fracture , particularly in persons who are already at risk of osteoporosis . However , few studies have specifically examined the association of vitamin A intake through diet and supplement use , with fractures in a cohort of older , community-dwelling women . We prospect ively followed a cohort of 34,703 postmenopausal women from the Iowa Women ’s Health Study to determine if high levels of vitamin A and retinol intake through food and supplement use were associated with an increased risk of hip or all fractures . A semiquantitative food frequency question naire was used to obtain the participants ’ baseline vitamin A and retinol intake . Participants were followed for a mean duration of 9.5 years for incident self-reported hip and nonhip fractures . After multivariate adjustment , it was revealed that users of supplements containing vitamin A had a 1.18-fold increased risk of incident hip fracture ( n=525 ) compared with nonusers ( 95 % CI , 0.99 to 1.41 ) , but there was no evidence of an increased risk of all fractures ( n=6,502 ) among supplement users . There was also no evidence of a dose-response relationship in hip fracture risk with increasing amounts of vitamin A or retinol from supplements . Furthermore , our results showed no association between vitamin A or retinol intake from food and supplements , or food only , and the risk of hip or all fractures . In conclusion , we found little evidence of an increased risk of hip or all fractures with higher intakes of vitamin A or retinol among a cohort of older , postmenopausal women Background : Industrial food fortification is a major strategy to improve dietary micronutrient intakes and prevent deficiencies . Zambia introduced m and atory sugar fortification with vitamin A , at a target of 10 mg/kg , in 1998 . Representative surveys conducted since that time do not support marked improvement in vitamin A status . Objective : To describe vitamin A concentrations in retail sugar , as well as vendor practice s , perceptions of fortified foods , and sugar use practice s. Methods : We conducted a census of sugar vendors in one Zambian community , capturing information on vendors , available br and s and packaging options , and storage conditions . We purchased all br and s and package types of sugar available at each vendor . In a 15 % sub sample , we conducted semi-structured interviews with vendor – consumer pairs . We tested 50 % of sugar sample s at r and om for vitamin A using an iCheck portable fluorimeter . Results : The distribution of vitamin A in sugar in market sample s was highly skewed , with a median of 3.1 mg/kg ( 25th-75th percentiles : 1.8 - 5.5 ) and a range from 0.2 to 29.9 mg/kg . Only 11.3 % of sample s met the 10 mg/kg statutory requirement . Sugar was primarily repackaged and sold in small quantities , with rapid turnover of stocks . Perceptions of fortification by vendors and consumers were generally positive . Conclusions : Vitamin A in fortified sugar fell well below statutory requirements . Our data point to challenges at regional depot and /or poor adherence to fortification st and ards at the factory level . A renewed commitment to monitoring and enforcement will be required for Zambia to benefit from a food fortification strategy Malnutrition is an inclusive term that entails the lack , excess or imbalance of one or more nutrients required to maintain normal nutritional status and optimal health . Malnutrition affects a large segment of the world 's children . 1 It is estimated that the prevalence of childhood malnutrition in South Africa ranges from 5 % to 50 % of the current poputation.2 It is well documented that an inadequate intake of micronutrients causes deficiency disorders and that such deficiencies often accompany malnutrTtion . 3 The dietary intake of calcium , iron , zinc , folic acid , riboflavin , vitamin 86 and vitamin C  has been reported to be low , in comparison with the recommended dietary allowances (RDA),4 in a significant proportion of children in the country ; it is often lower than 67 % of the RDA , indicating a population at risk of deficiency.s » In adults 15 - 64 years of age , the dietary intake of such micronutrients as vitamin 8 6 , iron , calcium , magnesium , zinc , copper and folic acid  has also been reported to be significantly lower than the RDA.S , S Fortification of food staples has been successfully implemented in a number of countries to increase the dietary intake of micronutrients . Objectives To study the impact of sorghum diet on growth , and micronutrient status of school going children for a period of 8 mo . Methods Children ( n = 160 boys and n = 160 girls ) aged between 9 to 12 y were r and omly allocated into two groups ( n = 80 in the control and n = 80 in the experimental group ) to receive 60 % sorghum diet and 40 % of rice diet ( Exp G ) and regular rice diet ( 100 % ; CG ) . Anthropometric indices and biochemical parameters were measured at baseline and at 8 mo using st and ardized methods . Results The growth rate was significantly higher ( p < 0.01 ) in the Exp G of girls , whereas in boys it was in the CG . Hemoglobin ( Hb ) , serum ferritin , albumin , retinol binding protein ( RBP ) and iron levels were significantly improved ( p < 0.05 ) in the Exp G of both the genders and in boys , serum folic acid and calcium levels were also improved with sorghum diet . Conclusions Serum micronutrient status , in terms of hemoglobin , serum folic acid , albumin , RBP , ferritin , calcium and iron can be improved with sorghum supplementation in school going children Vitamin A ( VA ) deficiency ( VAD ) continues to be a major nutritional problem in developing countries , including Central America . In Mexico , milk is a well-accepted vehicle for the administration of micronutrients , including VA , to preschoolers . Thus , we conducted a r and omized , controlled , clinical trial to investigate the efficacy of daily consumption of 250 mL of VA-fortified milk ( which provided 196 retinol equivalents/d ) for 3 mo on VA stores in mildly to moderately VAD ( serum retinol concentration 0.35 - 0.7 μmol/L ) preschoolers who were not enrolled in a food assistance program . Twenty-seven mildly to moderately VAD children were r and omly assigned based on screening measurements to either the intervention ( n = 14 ) or control group ( n = 13 ) ( children in the control group  did not receive placebo )  . All children in the control group and 79 % ( n = 11 ) of the children in the intervention group completed the study . The total body VA ( TBVA ) pool size was estimated using the deuterated retinol dilution technique before and after the intervention . After 3 mo , median changes in the serum retinol concentration for the intervention and control groups were 0.13 and -0.21 μmol/L , respectively ( P = 0.009 ) . Median changes in the TBVA stores were 0.06 and 0.01 mmol , respectively ( P = 0.006 ) and estimated median changes in the liver VA concentration were 0.09 and 0.01 μmol/g , respectively ( P = 0.002 ) . The VA-fortified milk was well accepted among preschoolers and significantly increased TBVA stores , liver VA stores , and serum retinol concentration , indicating that it may be an effective means to ameliorate VAD in young Mexican children It was investigated the efficacy of a diet with caloric restriction ( 1350 kcal/day ) in correction of clinical and biochemical parameters in patients with type 2 diabetes mellitus with overweight and obesity . In study showed that the 3 week use of hypocaloric diet allows reduce significantly body overweight , hyperglycemia and hyperholesterolemia in this patients without side effects .  Vitamin and mineral supplements in long use of hypocaloric diet are recommended Concurrent micronutrient deficiencies are prevalent among Vietnamese school children . A school-based program providing food fortified with multiple micronutrients could be a cost-effective and sustainable strategy to improve health and cognitive function of  school children . However , the efficacy of such an intervention may be compromised by the high prevalence of parasitic infestation . To evaluate the efficacy of school-based intervention using multi-micronutrient-fortified biscuits with or without deworming on anemia and micronutrient status in Vietnamese schoolchildren , a r and omized , double-blind , placebo-controlled trial was conducted among 510 primary schoolchildren , aged 6 - 8 y , in rural Vietnam .  Albendazole ( Alb ) ( 400 mg ) or placebo was given at baseline . Nonfortified or multi-micronutrient-fortified biscuits including iron ( 6 mg ) , zinc ( 5.6 mg ) , iodine ( 35 microg ) , and vitamin A ( 300 microg retinol equivalents ) were given 5 d/wk for 4 mo . Multi-micronutrient fortification significantly improved the concentrations of hemoglobin ( + 1.87 g/L ; 95 % CI : 0.78 , 2.96 ) , plasma ferritin ( + 7.5 microg/L ; 95 % CI : 2.8 , 12.6 ) , body iron ( + 0.56 mg/kg body weight ; 95 % CI : 0.29 , 0.84 ) , plasma zinc ( + 0.61 micromol/L ; 95 % CI : 0.26 , 0.95 ) , plasma retinol ( + 0.041 micromol/L ; 95 % CI : 0.001 , 0.08 ) , and urinary iodine ( + 22.49 micromol/L ; 95 % CI : 7.68 , 37.31 ) . Fortification reduced the risk of anemia and deficiencies of zinc and iodine by > 40 % . Parasitic infestation did not affect fortification efficacy , whereas fortification significantly enhanced deworming efficacy , with the lowest reinfection rates in children receiving both micronutrients and Alb . Multi-micronutrient fortification of biscuits is an effective strategy to improve the micronutrient status of Vietnamese schoolchildren and enhances effectiveness of deworming OBJECTIVE The aim of this study was to assess the vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns . METHODS  Serum retinol , anthropometric indicators , and dietary intake  were determined for r and omly selected preschool children from two rural areas , i.e. KwaZulu-Natal ( n = 140 ) and Limpopo ( n = 206 ) ; an urban area in the Northern Cape ( n = 194 ) ; and an urban metropolitan area in the Western Cape ( n = 207 ) . RESULTS Serum retinol < 20 μg/dL was prevalent in 8.2 % to 13.6 % children . Between 3 % ( urban-Northern Cape ) and 44.2 % ( rural-Limpopo ) children had received a high-dose vitamin A supplement during the preceding 6 mo . Vitamin A derived from fortified bread and /or maize meal ranged from 65 μg retinol activity equivalents ( 24%-31 % of the Estimated Average Requirement ) to 160 μg retinol activity equivalents ( 58%-76 % Estimated Average Requirement ) . Fortified bread and /or maize meal contributed 57 % to 59 % of total vitamin A intake in rural children , and 28 % to 38 % in urban children . Across the four areas , stunting in children ranged from 13.9 % to 40.9 % ; and overweight from 1.2 % to 15.1 % . CONCLUSION Prevalence of vitamin A deficiency was lower than national figures , and did not differ across areas despite differences in socioeconomics , dietary intake , and vitamin A supplementation coverage . Rural children benefited more from the national food fortification program in terms of vitamin A intake . Large variations in anthropometric status highlight the importance of targeting specific nutrition interventions , taking into account the double burden of overnutrition and undernutrition Background Fortification of flour is one of the approaches for the control and prevention of vitamin and mineral deficiencies . Objective To assess the effect of fortification of flour with seven vitamins and minerals on a population of Chinese women . Methods Farmers who offered their l and for reforestation in 25 northwest provinces of China received compensation in the form of wheat flour ; the amount of flour given depended on the amount of l and that was given up for reforestation . This study observed the effects of providing families with fortified flour in the reforestation areas in Gansu Province . The study was conducted for 3 years . Families in the intervention village who offered l and for reforestation received flour fortified with seven vitamins and minerals , and those in the control village received unfortified flour . Seven surveys , spaced at least 6 months apart , were carried out in each village from 2004 to 2007 . At baseline and at each annual survey , measurements and blood sample s were taken from 300 adult female subjects aged 20 to 60 years to assess dietary intake , height , weight , body fat , hemoglobin , serum retinol , serum iron , free erythrocyte protoporphyrin , serum zinc . Serum folic acid was measured at baseline and 36-month only . At each 6-month survey , data were collected on anthropometric features , hemoglobin , and dietary intake . Results Consumption of fortified flour in the intervention village ranged from 158.7 to 232.7 g per person per day . Serum retinol status was significantly improved after 12-month intervention until the end of the trial compared with both the control group and the baseline level of the intervention group . Iron status expressed as FEP and SI levels showed higher than that of the control group and baseline levels only at 36-month . Hemoglobin levels of the intervention group were higher than that of the control group and baseline levels , but anemia prevalence of both the intervention and control groups remained unchanged in the intervention period . Levels of serum zinc showed increases compared with the control group and baseline data at 24-month and 36-month , and levels of serum folic acid of intervention group in 36-month was higher than that of both the control group and baseline level . Conclusions The evidence from this study confirms the positive bioeffectiveness of fortified flour in the rural female population in China , but a higher dosage of electrolytic elementary iron in flour fortification was suggested for anemia prevention and control OBJECTIVE To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1 - 3-year-old malnourished African children . DESIGN A r and omised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A , thiamine , riboflavin and pyridoxine , while 23 control children and their families received unfortified maize meal . The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households . METHODS Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics ' criteria and aged 1 - 3 years were r and omly assigned to an experimental or control group . Baseline measurements included demographic , socio-economic and dietary data , as well as height , weight , haemoglobin , haematocrit , serum retinol and retinol-binding protein ( RBP ) . Anthropometric , blood and serum variables were measured again after 12 months of intervention . Complete baseline measurements were available for 44 children and end data for only 36 . Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests , t-tests and analysis of variances using the SPSS program , controlling for expected weight gain in this age group over 12 months . Relationships between changes in variables were examined by calculating correlation coefficients . RESULTS The children in the experimental group had a significantly ( P < or = 0.05 ) higher increase in body weight than control children ( 4.6 kg vs. 2.0 kg ) and both groups had significant ( P < or = 0.05 ) but similar increases in height . The children in the experimental group showed non-significant increases in haemoglobin and serum retinol , while the control children had a significant ( P = 0.007 ) decrease in RBP . The change in serum retinol showed a significant correlation with baseline retinol ( P = 0.014 ) , RBP ( P = 0.007 ) and weight ( P = 0.029 ) , as well as with changes in haemoglobin ( P = 0.029 ) . CONCLUSION Despite a small sample size , this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1 - 3-year-old African children . The study confirmed the relationship between vitamin A and iron status . The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa Objective : To determine the efficacy of p and esal baked from wheat flour fortified with iron , with or without vitamin A ( VA ) , in improving anemic schoolchildren 's iron and anthropometric status . Methods : Anemic 6- to 12-year-old Filipino children ( n = 250 ) received two 60 g  p and esal daily for 8 months . They were r and omized into 1 of 4 groups : ( 1 ) iron-fortified ( with hydrogen-reduced iron at 80 mg/kg , electrolytic iron at 80 mg/kg , or ferrous fumarate at 40 mg/kg ) , ( 2 ) iron and VA-fortified , ( 3 ) VA-fortified ( at 490 RE/100 g ) , and ( 4 ) nonfortified flour .  Hemoglobin ( Hb ) and zinc protoporphyrin ( ZnPP ) concentrations and weight and height were determined before and after intervention . Analyses of variance and chi-square and multiple regression analyses were performed . Results : Mean Hb increased by 1.3 g/dL ( p < 0.001 ) and mean ZnPP decreased by 24.4 µmol/mol ( p < 0.001 ) after 8 months . Anemia decreased to 26 % and iron deficiency decreased from 58 % to 12 % . After controls were applied for baseline concentration , age , and gender , Hb concentration at post intervention was significantly higher in the Iron + VA group than in the nonfortified group ( coefficient = 0.37 ; p = 0.034 ) . The odds of being iron deficient at post intervention were significantly lower in the Iron group than in the nonfortified group after controls were applied for age , gender , and baseline prevalence ( coefficient = 0.12 ; p = 0.006 ) . None of the 3 fortified groups had significantly different weight-for-age z-score , body mass index-for-age z-score , or height-for-age z-score compared with the nonfortified group after controls were applied for baseline z-scores , age , and gender . Conclusions : Our study shows that in a non – malaria-endemic area , iron fortification of flour significantly reduced the prevalence of iron deficiency among anemic schoolchildren , and double fortification with iron and VA significantly improved Hb status Food fortification is a cost-effective and sustainable strategy to prevent or correct micronutrient deficiencies . A double-blind cluster ( bari ) r and omised controlled trial was conducted in a rural community in Bangladesh to evaluate the impact of consumption of chapatti made of micronutrient-fortified wheat flour for 6 months by school-aged children on their vitamin A , haemoglobin and iron status . A total of 43 baris ( group of households ) were r and omly selected . The baris were r and omly assigned to either intervention or control group . The intervention group received wheat flour fortified with added micronutrients ( including 66 mg hydrogen-reduced elemental iron and 3030 μg retinol equivalent as retinyl palmitate per kilogram of flour ) , while the control group received wheat flour without added micronutrients .  A total of 352 children were enrolled in the trial , 203 in the intervention group and 149 in the control group . Analyses were carried out on children who completed the study ( 191 in the intervention group and 143 in the control group ) . Micronutrient-fortified wheat flour chapatti significantly increased serum retinol concentration at 6 months by 0.12 μmol L(-1 ) [ 95 % confidence interval ( CI ) : 0.06 , 0.19 ; P < 0.01 ] . The odds of vitamin A deficiency was significantly lower for children in the intervention group at 3 months [ odds ratio ( OR ) = 0.26 ; 95 % confidence interval ( CI ) : 0.07 , 0.89 ; P < 0.05 ] and 6 months ( OR = 0.21 ; 95 % CI : 0.06 , 0.68 ; P < 0.01 ) . No demonstrable effect of fortified chapatti consumption on iron status , haemoglobin levels or anaemia was observed . Consumption of fortified chapattis demonstrated a significant improvement in the vitamin A status , but not in iron , haemoglobin or anaemia status OBJECTIVE Improvement of hemoglobin and serum retinol and facilitation of the mobilization of iron storage were achieved with a multiple-micronutrient-fortified diet in preschoolers for 6 mo in a suburb of Chongqing , China . We investigated whether fortification with multiple micronutrients in a diet for preschool children results in changes in children 's infectious morbidity compared with diets fortified solely with vitamin A and with vitamin A plus iron . METHODS From December 2005 to June 2006 , 226 2- to 6-y-old preschool children were recruited from three nurseries r and omly assigned to three different fortified-diet groups for 6 mo . Group I was fortified with vitamin A ; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron , thiamine , riboflavin , folic acid , niacinamide , zinc , and calcium , respectively . The secondary functional outcomes , morbidity of diarrhea and respiratory infection , were collected during supplementation . RESULTS The groups were comparable concerning compliance and loss to follow-up . There was evidence of a lower incidence rate of respiratory-related illnesses , diarrhea-related illness , fewer symptoms of runny nose , cough , and fever , and shorter duration of respiratory-related illnesses and cough for children in group III compared with children in groups I and II . However , there was no significantly or clinical ly important difference between children in groups I and II . CONCLUSION The beneficial effects on infectious morbidity over 6 mo , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a diet for preschool children 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 Vitamin A deficiency is a significant public health problem in many low- and middle-income countries , especially affecting young children , women of reproductive age , and pregnant women .
Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups .
OBJECTIVES To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related outcomes in the general population older than two years of age .