4. Discussion
wasting, anemia
WASTING, IRON DEFICIENCY, ACUTE AND CHRONIC INFLAMMATION, ANEMIA
This trial showed that one-year supplementation of MNP to 24–59-month-old children significantly improves plasma micronutrient status, hemoglobin levels, and growth parameters, including WAZ and WHZ scores. This is the first community-based study which shows the positive impact of MNP on improving plasma micronutrient levels in a region that has experienced protracted security threats, mass internal population displacement, poor food security, and limited access to quality health services.Significant improvements in the micronutrient status, growth parameters (WAZ and WHZ scores), and hemoglobin levels of children in this trial are in agreement with findings from other studies [In our investigation, the administration of MNPs, which contain 5 ug of vitamin D, resulted in an increase in plasma vitamin D level from 25.71 (±7.43) to 35.15 (±6.13) (ng/mL). There is limited evidence regarding the impact of MNP on plasma vitamin D levels in children. Nevertheless, supplementation of food fortified with vitamin D has shown an increase in plasma vitamin D levels in young children. Brett et al. reported similar results from a study among 2–8-year-old children after supplementation of vitamin D-fortified food for 12 weeks. The study revealed that vitamin D-fortified food supplements significantly increased vitamin D concentration by 7 nmol/L in the intervention group [Irrespective of our study, limited data have been reported on the effectiveness of MNP supplementation on plasma vitamin D levels in children under the age of 5 years. Hence, there is a need to investigate the impact of MNP on plasma vitamin D levels at the community level.Findings regarding the increase in serum zinc level in this study are consistent with the results of previously conducted MNP trials in under-five children [MNP fortification is one of the public health strategies used around the world to reduce iron deficiency and anemia in children [In this clinical research, stunting (2.01%) in children between the ages of 24–59 months did not significantly improve, although there was a reduction in wasting and underweight, estimated at 6.8% and 10.35%, respectively. A cross-sectional study conducted in Nepal highlighted similar findings with a significant reduction in both wasting and underweight, but not in stunting, after supplementation of MNP [We also observed an improvement in plasma albumin levels in the intervention group, while in the control group, even though this biomarker was of lower concentrations, it remained in the normal ranges. Plasma albumin is an acute phase reactant and is influenced by both acute and chronic inflammation which are frequently present alongside micronutrient deficiencies [Findings from this trial are the first evidence regarding the impact of MNP on multiple micronutrient status including vitamin D, which was not reported earlier.The macro- and micronutrient intake in 24 h recall data were measured as lower than the recommended dietary intake in light of the Pakistan Dietary Guideline for Better Nutrition recommendations [This one-year follow-up study evaluated the impact of locally produced MNP nutritional supplements on plasma micronutrient levels, hemoglobin concentration, and growth indicators of children between the ages of 24 and 59 months at the community level. This is the first study in the erstwhile Federally Administrative Tribal Area (FATA) that assesses the impact of MNP on plasma micronutrient status at the community level.