title: Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children.
abstract: In Vietnam, nutrition interventions do not target school children despite a high prevalence of micronutrient deficiencies. The present randomised, placebo-controlled study evaluated the impact of providing school children (n 403) with daily multiple micronutrient-fortified biscuits (FB) or a weekly Fe supplement (SUP) on anaemia and Fe deficiency. Micronutrient status was assessed by concentrations of Hb, and plasma ferritin (PF), transferrin receptor (TfR), Zn and retinol. After 6 months of intervention, children receiving FB or SUP had a significantly better Fe status when compared with the control children (C), indicated by higher PF (FB: geometric mean 36·9 (95% CI 28·0, 55·4) μg/l; SUP: geometric mean 46·0 (95% CI 33·0, 71·7) μg/l; C: geometric mean 34·4 (95% CI 15·2, 51·2) μg/l; P < 0·001) and lower TfR concentrations (FB: geometric mean 5·7 (95% CI 4·8, 6·52) mg/l; SUP: geometric mean 5·5 (95% CI 4·9, 6·2) mg/l; C: geometric mean 5·9 (95% CI 5·1, 7·1) mg/l; P = 0·007). Consequently, body Fe was higher in children receiving FB (mean 5·6 (sd 2·2) mg/kg body weight) and SUP (mean 6·1 (sd 2·5) mg/kg body weight) compared with the C group (mean 4·2 (sd 3·3) mg/kg body weight, P < 0·001). However, anaemia prevalence was significantly lower only in the FB group (1·0%) compared with the C group (10·4%, P = 0·006), with the SUP group being intermediate (7·4%). Children receiving FB had better weight-for-height Z-scores after the intervention than children receiving the SUP (P = 0·009). Vitamin A deficiency at baseline modified the intervention effect, with higher Hb concentrations in vitamin A-deficient children receiving FB but not in those receiving the SUP. This indicates that vitamin A deficiency is implicated in the high prevalence of anaemia in Vietnamese school children, and that interventions should take other deficiencies besides Fe into account to improve Hb concentrations. Provision of biscuits fortified with multiple micronutrients is effective in reducing anaemia prevalence in school children.
authors.affiliation: Groupe de Recherche et d'Echanges Technologiques, 45 bis avenue de la Belle Gabrielle, 94736 Nogent-sur-Marne, France.
authors.forename: Nguyen Trung
authors.initials: NT
authors.lastname: Hieu
authors.forename: Fanny
authors.initials: F
authors.lastname: Sandalinas
authors.forename: Agnès
authors.initials: A
authors.lastname: de Sesmaisons
authors.forename: Arnaud
authors.initials: A
authors.lastname: Laillou
authors.forename: Nguyen Phuong
authors.initials: NP
authors.lastname: Tam
authors.forename: Nguyen Cong
authors.initials: NC
authors.lastname: Khan
authors.forename: Olivier
authors.initials: O
authors.lastname: Bruyeron
authors.forename: Frank Tammo
authors.initials: FT
authors.lastname: Wieringa
authors.forename: Jacques
authors.initials: J
authors.lastname: Berger
mesh_terms: D000740:Anemia / Q000097:blood / Q000188:drug therapy*; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy*; D001835:Body Weight / Q000187:drug effects; D002648:Child; D019587:Dietary Supplements; D005260:Female; D005293:Ferritins / Q000097:blood; D005527:Food, Fortified; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D000090463:Iron Deficiencies; D008297:Male; D018977:Micronutrients / Q000494:pharmacology / Q000627:therapeutic use*; D009752:Nutritional Status; D011990:Receptors, Transferrin / Q000097:blood; D014131:Trace Elements / Q000494:pharmacology / Q000627:therapeutic use; D014744:Vietnam; D014802:Vitamin A Deficiency / Q000150:complications
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D011990:Receptors, Transferrin; D014131:Trace Elements; D005293:Ferritins; D007501:Iron