Growth impairment and micronutrient deficiencies are prevalent among schoolchildren in Himalayan villages of India.

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-randomized 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 samples 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.

Malnutrition is a major problem among children especially in the developing world. In most developing countries children show growth faltering between 6 and 24 months of age due to inadequate complementary feeding. Complementary foods are transitional foods given in addition to breast milk, following exclusive breastfeeding during the first 6 months, to meet the full nutritional requirements of the infant. Strategies to improve the availability of and accessibility to low cost complementary foods can play an important role in improving the nutritional status of infants and young children. Cereals constitute the most suitable vehicle for delivering micronutrients to an at-risk population because of their widespread consumption, stability and versatility. To reduce the vulnerability to the health impacts of micronutrient deficiencies, several developed and developing countries have adopted various innovative, cost-effective strategies to fortify cereal-based complementary foods and to reach children through public programs. This article reviews cereal fortification programs in developing countries, with special reference to low cost fortified complementary foods, and emphasizes the need for public-private-civic sector initiatives to improve the health and wellbeing of people around the world.

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This cross-sectional randomized controlled study assessed the social acceptability of micronutrient fortified cooked lunch meals by schoolchildren in rural Himalayan villages of India, in a program where the cooking and the micronutrient fortification were done at school. Subjects were randomly assigned to treatment (91) and control (90) groups. The treatment group consumed a weighed amount of cooked lunch meals fortified with locally produced multi-micronutrient premix and the control group consumed a weighed amount of the same meals but without added micronutrient premix. After having eaten, subjects were asked to rate, on a 3-point Likert scale using "smiley" faces, the pleasantness of smell, taste, and overall satisfaction with the food. The mean age of study children was 7.96 +/- 1.64 y and 48.6% were males. The average amounts of food consumed by the treatment and control groups were 345 +/- 114 and 360 +/- 102.4 g, respectively. Addition of the multi-micronutrient premix to school meals did not significantly affect the mean amount of food consumed by the schoolchildren (P > 0.05; independent sample t-test). No significant differences were seen between treatment and control groups in terms of ratings for taste, smell, and the general acceptance of the micronutrient fortified or the unfortified school meals. In conclusion, the addition of a multiple micronutrient premix to school meals was well liked by schoolchildren and did not adversely affect their food consumption.