title: Fortifying milk with ferrous gluconate and zinc oxide in a public nutrition program reduced the prevalence of anemia in toddlers.
abstract: We aimed to assess the efficacy of whole cow's milk fortified with ferrous gluconate and zinc oxide, along with ascorbic acid, in reducing the prevalence of anemia and improving iron status of low income children 10-30 mo of age. Healthy children were randomly assigned to drink 400 mL/d of cow's whole milk, either fortified milk (FM) with 5.8 mg/400 mL of iron as ferrous gluconate, 5.28 mg/400 mL of zinc as zinc oxide, and 48 mg/400 mL of ascorbic acid, or nonfortified milk (NFM) with 0.2 mg iron/400 mL, 1.9 mg zinc/400 mL, and 6.8 mg ascorbic acid/400 mL. Hemoglobin, serum ferritin, soluble transferrin receptors (TfR), and C-reactive protein concentrations were measured at baseline and 6 mo after intervention. The prevalence of anemia declined from 41.4 to 12.1% (P < 0.001), or 29 percentage points, in the FM group; there was no change in the NFM group. Hemoglobin (coefficient = 0.22, P < 0.01) was positively and TfR (coefficient = -0.29, P < 0.001) negatively associated with treatment, controlling for their respective baseline values, age, and gender. Treatment with FM was negatively associated with the likelihood of being anemic (pseudo R(2) = 0.085, P < 0.03) after 6 mo of intervention. Ferrous gluconate added to whole cow's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status of Mexican toddlers. The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1-11 y of age in Mexico.
authors.affiliation: Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, México. svillalp@insp.mx
authors.forename: Salvador
authors.initials: S
authors.lastname: Villalpando
authors.forename: Teresa
authors.initials: T
authors.lastname: Shamah
authors.forename: Juan A
authors.initials: JA
authors.lastname: Rivera
authors.forename: Yaveth
authors.initials: Y
authors.lastname: Lara
authors.forename: Eric
authors.initials: E
authors.lastname: Monterrubio
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000517:prevention & control*; D000818:Animals; D001205:Ascorbic Acid / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000032:analysis; D002675:Child, Preschool; D005260:Female; D005293:Ferritins / Q000097:blood; D005296:Ferrous Compounds / Q000008:administration & dosage*; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008892:Milk / Q000737:chemistry*; D009752:Nutritional Status; D011990:Receptors, Transferrin / Q000097:blood; D015034:Zinc Oxide / Q000008:administration & dosage*
chemical_list: D005296:Ferrous Compounds; D006454:Hemoglobins; D011990:Receptors, Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D001205:Ascorbic Acid; D015034:Zinc Oxide; C011819:ferrous gluconate