Complementary Foods Fortified with Micronutrients Prevent Iron Deficiency and Anemia in Vietnamese infants ,

Abstract

To investigate whether an intervention including micronutrient-fortified complementary foods can improve iron status, we conducted a randomized controlled trial in 5-mo-old Vietnamese infants (n = 246). Villages (n = 29) were randomly divided into those receiving instant flour (FF) or a food complement (FC) both fortified with micronutrients or nothing [control (C)]. FF and FC infants received daily for 6 mo at least 2 meals of fortified complementary foods. Micronutrient status was assessed by measurement of hemoglobin (Hb) and plasma ferritin (PF), transferrin receptor, zinc, and retinol. Final Hb (mean ± SD) was higher in the FF (112.5 ± 8.0 g/L) and FC (114.0 ± 7.0 g/L) groups compared with C (109.0 ± 8.0 g/L; P = 0.006). PF (geometric mean [95% CI]) was also higher in FF (19.8 μg/L [17.5-22.3]) and FC (20.8 μg/L [18.3-23.6]) compared with C (11.1 μg/L [9.8-12.5]; P < 0.0001). Anemia prevalence decreased more in the FC group (-43.6%) compared with C (-10.3%; P = 0.006). The change in prevalence of PF < 12 μg/L was different in the FF (-16.4%) and FC (-6.7%) groups compared with C (+30.4%; P < 0.01). Endpoint prevalence of iron deficiency (ID) and ID anemia (IDA) were lower in the FF (13.4 and 6.7%, respectively) and FC (15.2 and 3.8%) groups compared with C (57.5 and 37.5%) (P < 0.0001). Retinol and zinc concentrations did not differ among groups, but endpoint prevalence of zinc deficiency was lower in FF infants (36.1%) than in C infants (52.9%; P = 0.04). Micronutrient-fortified complementary foods significantly improved iron status and decreased the prevalence of anemia, ID, and IDA in Vietnamese infants and can be an important tool to reduce ID in infancy in developing countries.

Micronutrient Deficits Are Still Public Health Issues among Women and Young Children in Vietnam

“…In this survey material and procedure were controlled for contamination. The high prevalence of zinc deficiency in both women and children in this survey is intriguing, although consistent with several intervention trials carried-out in Vietnam in the recent years which indicated zinc deficiency prevalence ranging from 32% to 67% in young children under 2 years of age [14], [54] and of 52.1% among rural primary schoolchildren aged 6 to 8 years of age [8]. Moreover, according to a recent review assessing the risk of zinc deficiency, South and Southeast Asia, appear to be at the highest risk of zinc deficiency [59].…”

“…In this age group, the prevalence of anemia was considered as a moderate public health problem and most of anemia was associated with iron deficiency. More than half of children had ID, a finding consistent with intervention trials carried out in previous years in Vietnamese infants and young children [14], [53], [54]. In older children risk for anemia and ID was much lower, although still high for the 18–23 mo group (∼30%).…”

“…Over the last 10 years, a number of trials conducted in Vietnam have demonstrated the efficacy of micronutrient fortification of fish sauce [10], [12], milk [9], biscuits [8], [13], complementary food [14], instant noodles [15], [16] and of micronutrient supplements [17], [18], [19], to reduce micronutrient deficiencies among several population groups (infants, preschool and school-aged children, and women of reproductive age).…”

Micronutrient fortification of food and its impact on woman and child health: a systematic review

“…Of these, 121 [25-145] studies were on infants and children and 79 [146-224] were on women, while one study had both women and children as their study population [33] (Figure 2). Furthermore 125 [25-28,30,32-39,41-44,47,48,51,53],[54,56,59,60,62,63,65-73,75-77],[81-83,85,86,88-90,92,93,95-104,107-109],[111-117,119-127,129,130,132-136,139-144,223,225-228] of these trials were RCTs; the rest were quasi-experimental [46,55,61,74,78,87,91] and before-after studies [29,31,40,45,49,50,52,57],[58,79,80,84,94,95,105,131],[137,138,149,150,153,157,159-169,172],[174,177,181,183-186,189-191,193,195-…”

“…Food vehicles chosen varied for each micronutrient fortification and are described in detail in the relevant section. For the 125 RCTs included in this review, randomization and allocation concealment were adequate in 41 of the studies [33-37,56,60,63,65,68,69,72],[75,77,83,88,92,97,99,101],[103,107,108,112,113,115,116,122],[125,127,132,135,139,140,142,143],[146,147,188,214,217], information regarding attrition rates was adequately discussed with reasons in 110 studies [33-39,41-44,47,48,51,53,54,56],[59,60,62,63,65,67-73,75-77,81-83],[85,86,88-90,92,93,96-104,107-109,111-117],[119-127,129,130,132-136,139-144,171,173,175],[176,178-180,182,187,188,192,194,201],[…”