Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico.
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.
Rivera
Juan A
JA
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
Shamah
Teresa
T
Villalpando
Salvador
S
Monterrubio
Eric
E
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
D002097:C-Reactive Protein; D005293:Ferritins; D006442:Glycated Hemoglobin; D007501:Iron; D033862:Iron-Binding Proteins; D011956:Receptors, Cell Surface; C027293:ferritin receptor