title: Effect of long-term intermittent supplementation with multiple micronutrients compared with iron-and-folic acid supplementation on Hb and micronutrient status of non-anaemic adolescent schoolgirls in rural Bangladesh.
abstract: The present study examined whether long-term supplementation with once- and twice-weekly multiple micronutrients (MMN-1 and MMN-2) can improve Hb and micronutrient status more than twice-weekly Fe-folic acid (IFA-2) supplementation in non-anaemic adolescent girls in Bangladesh. An equal number of 324 rural schoolgirls aged 11-17 years were given MMN-1 or MMN-2 or IFA-2 supplements for 52 weeks in a randomised, double-blind trial. Blood samples were collected at baseline, and at 26 and 52 weeks of supplementation. The girls receiving IFA-2 supplements were more likely to be anaemic than the girls receiving MMN-2 supplements for 26 weeks (OR 5·1, 95% CI 1·3, 19·5; P = 0·018). All three supplements reduced Fe deficiency effectively. Both the MMN-1 and MMN-2 groups showed significantly greater improvements in vitamins A, B(2) and C status than the girls in the IFA-2 group, as might be expected. Receiving a MMN-1 supplement was found to be less effective than MMN-2 supplement in improving Fe, vitamins A, B(2) and folic acid status. Receiving micronutrient supplements beyond 26 weeks showed little additional benefit in improving micronutrient status. In conclusion, given twice-weekly for 26 weeks, MMN supplements can improve micronutrient status effectively with no significant increase in Hb concentration compared with IFA supplements in non-anaemic Bangladeshi adolescent girls. However, it significantly reduces the risk of anaemia. Before any recommendations can be made, further research, including into cost-effectiveness, is needed to see whether MMN supplementation has any additional longer-term health benefits over that of IFA supplementation in this population.
authors.affiliation: Department of Family Sciences, College for Women, Kuwait University, Safat 13060, Kuwait. farukahmed116@gmail.com
authors.forename: Faruk
authors.initials: F
authors.lastname: Ahmed
authors.forename: Moududur R
authors.initials: MR
authors.lastname: Khan
authors.forename: Mohammad
authors.initials: M
authors.lastname: Akhtaruzzaman
authors.forename: Rezaul
authors.initials: R
authors.lastname: Karim
authors.forename: Gail
authors.initials: G
authors.lastname: Williams
authors.forename: Cadi P
authors.initials: CP
authors.lastname: Banu
authors.forename: Badrun
authors.initials: B
authors.lastname: Nahar
authors.forename: Ian
authors.initials: I
authors.lastname: Darnton-Hill
mesh_terms: D000293:Adolescent; D000740:Anemia; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000517:prevention & control*; D001459:Bangladesh; D002648:Child; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D000090463:Iron Deficiencies; D018977:Micronutrients / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D009752:Nutritional Status / Q000187:drug effects*; D012016:Reference Values; D013997:Time Factors; D014815:Vitamins / Q000097:blood
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D014815:Vitamins; D005492:Folic Acid; D007501:Iron