Multi-Micronutrient–Fortified Biscuits Decreased Prevalence of Anemia and Improved Micronutrient Status and Effectiveness of Deworming in Rural Vietnamese School Children

Abstract

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 randomized, 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.

Decreased Parasite Load and Improved Cognitive Outcomes Caused by Deworming and Consumption of Multi-Micronutrient Fortified Biscuits in Rural Vietnamese Schoolchildren

“…37 We reported that multi-micronutrient fortified biscuits significantly reduced the prevalence of anemia and increased micronutrient status. 29 In this study, in-depth analysis of growth outcomes show that multi-micronutrient fortified biscuits only significantly improved MUAC but had no effect on growth in weight or height and four points of skin fold thickness (biceps, triceps, sub-scapular, and suprailiac). The positive intervention effect of fortified biscuits on MUAC compared with non-fortified biscuits is consistent with micronutrientfortified supplementary feeding studies in school children in Botswana 38 and adolescent girls in Bangladesh.…”

“…Child's weight was measured to the nearest 0.1 kg by using a portable battery powered digital scale (AND, Denmark) with children wearing light clothes according to standard procedures. 29 Mid upper arm circumference (MUAC) was measured to the nearest 0.1 cm and biceps, triceps, subscapular, and suprailiac skin fold thickness were measured in triplicate by using a Harpenden caliper following standard methods. 30 Each of these measurements was performed by the same experienced anthropometrist to avoid inter-observer variation.…”

Investment in child and adolescent health and development: key messages from Disease Control Priorities , 3rd Edition

“…Two studies identified increased levels of zinc (Nga and others 2009;Winichagoon and others 2006). The impact of school feeding on micronutrient status may depend on the dose, initial micronutrient status, and interactions with other micronutrients supplemented.…”

Vitamin A-fortified cooking oil reduces vitamin A deficiency in infants, young children and women: results from a programme evaluation in Indonesia

“…For lactating mothers and their infants aged 6-11 months (sampled in pairs), samples Infants aged 6-11 months 320 343 356 324 344 318 335 Children aged 12-23 months 220 248 241 241 239 236 236 Children aged 24-59 months 220 243 251 325 244 233 241 Children aged 5-9 years 220 260 189 248 186 248 (186)* 186 Lactating mothers 320 354 359 324 349 324 349 Women aged 15-29 years 250 274 173 252 171 252 (171)* 171 Targeted sample sizes based on α = 0·05 (95 % CI), statistical power β = 0·80, expected improvement in serum retinol of 0·10-0·20 µg/dl (11) , a design effect of 2 (15) and 10 % drop-out (11) . Baseline mean serum retinol, as additional last parameter to calculate sample sizes, was estimated at 20 (SD 0·2) µg/dl for infants aged 6-11 months (47) , 27 (SD 0·25) µg/dl for children aged 12-59 months, 30 (SD 0·25) µg/dl for children aged 5-9 years (48) , 26 (SD 0·6) µg/dl for lactating mothers and 29 (SD 0·3) µg/dl for non-lactating women aged 15-29 years. Since lactating mothers and infants aged 6-11 months were selected as mother-child pairs, the adjusted sample size for infants was taken to be that for lactating women, which had the larger crude sample size.…”