title: Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico.
abstract: BACKGROUND
  Anemia during infancy impairs neurodevelopment. Little information has been published about the effectiveness of large-scale programs on anemia and iron-deficiency prevention.
  
  
  OBJECTIVE
  The objective was to assess the effectiveness of a large-scale program that distributes subsidized iron-fortified milk in Mexico on anemia and iron deficiency in children aged 12-30 mo.
  
  
  METHODS
  A double-blinded, group-randomized effectiveness trial was conducted in 12 milk distribution clusters assigned to consume iron-fortified (FM; n = 7) or nonfortified (NFM; n = 5) milk. A daily portion of FM contained 5.28 mg Fe (ferrous gluconate) and 48 mg sodium ascorbate.
  
  
  RESULTS
  Overall treatment effects were documented at 6 and 12 mo for anemia and for iron deficiency assessed by both serum ferritin (SF) and serum soluble transferrin receptor (sTfR) (interaction: P < 0.10). Differential effects at 6 mo (P = 0.004) and 12 mo (P = 0.664) were documented only for sTfR. Estimated prevalences (EPs) of anemia (hemoglobin < 110 g/L) from baseline to 6 and 12 mo decreased from 42.6% to 19.7% and 9.4%, respectively, in the NFM group (n = 210) and from 44.5% to 12.7% and 4.0%, respectively, in the FM group (n = 357). EPs of SF < 12 mug/L from baseline to 6 and 12 mo changed from 36.0% to 41.8% and 17.1%, respectively, in the NFM group (n = 43) and from 29.8% to 18.6% and 5.7%, respectively, in the FM group (n = 144). EPs of sTfR > 3.3 mg/L from baseline to 6 and 12 mo decreased from 16.2% to 8.3% and 2.0%, respectively, in the NFM group (n = 114) and from 15.5% to 0.7% and 1.1%, respectively, in the FM group.
  
  
  CONCLUSIONS
  A large-scale iron-fortified subsidized-milk program was effective at reducing the rates of anemia and iron deficiency in Mexican children during 12 mo of implementation. This trial was registered at clinicaltrials.gov as NCT00508131.
authors.affiliation: Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad 655, Colonia Sta Ma Ahuacatitlán, CP 62508, Cuernavaca, Morelos, Mexico. jrivera@insp.mx
authors.forename: Juan A
authors.initials: JA
authors.lastname: Rivera
authors.forename: Teresa
authors.initials: T
authors.lastname: Shamah
authors.forename: Salvador
authors.initials: S
authors.lastname: Villalpando
authors.forename: Eric
authors.initials: E
authors.lastname: Monterrubio
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D000818:Animals; D000886:Anthropometry; D002097:C-Reactive Protein / Q000378:metabolism; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005527:Food, Fortified; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007223:Infant; D007501:Iron / Q000008:administration & dosage*; D033862:Iron-Binding Proteins / Q000097:blood; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008892:Milk; D011203:Poverty; D015995:Prevalence; D011956:Receptors, Cell Surface / Q000097:blood; D011795:Surveys and Questionnaires
chemical_list: D002097:C-Reactive Protein; D005293:Ferritins; D006442:Glycated Hemoglobin; D007501:Iron; D033862:Iron-Binding Proteins; D011956:Receptors, Cell Surface; C027293:ferritin receptor