title: Effectiveness of fortification of drinking water with iron and vitamin C in the reduction of anemia and improvement of nutritional status in children attending day-care centers in Belo Horizonte, Brazil.
abstract: BACKGROUND
  Because of the high prevalence of iron-deficiency anemia in Brazil, individual control measures tend to be ineffective, and fortification of foods with iron is considered the most effective method to fight anemia.
  
  
  OBJECTIVE
  To evaluate the effectiveness of fortification of drinking water with iron and vitamin C in the reduction of anemia in children in day-care centers in Belo Horizonte, Brazil.
  
  
  METHODS
  This before-and-after study evaluated 318 children aged 6 to 74 months. Identification data and data on socioeconomic variables were collected; anthropometric and biochemical measurements were performed before and after 5 months of fortification of water with 5 mg of elemental iron and 50 mg of ascorbic acid per liter. The fortified water was used for drinking and cooking at the day-care center. Wilcoxon's nonparametric test was used to evaluate the differences in continuous variables, and McNemar's test was used to compare the prevalence rates of anemia.
  
  
  RESULTS
  The prevalence of anemia decreased significantly from 29.3% before fortification to 7.9% at the end of the study, with a significant increase in hemoglobin levels. Reductions in the prevalence rates of stunting and underweight were observed.
  
  
  CONCLUSIONS
  Fortification of water with iron and vitamin C significantly reduced the prevalence of anemia and improved nutritional status among children attending day-care centers.
authors.affiliation: Universidade Federal da Bahia, Vitória da Conquista, Bahia, Brazil. danisr_nutricao@yahoo.com.br
authors.forename: Daniela da Silva
authors.initials: Dda S
authors.lastname: Rocha
authors.forename: Flávio Diniz
authors.initials: FD
authors.lastname: Capanema
authors.forename: Michele Pereira
authors.initials: MP
authors.lastname: Netto
authors.forename: Carlos Alberto Nogueira
authors.initials: CA
authors.lastname: de Almeida
authors.forename: Sylvia do Carmo Castro
authors.initials: Sdo C
authors.lastname: Franceschini
authors.forename: Joel Alves
authors.initials: JA
authors.lastname: Lamounier
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D060766:Drinking Water / Q000032:analysis; D005260:Female; D006130:Growth Disorders / Q000517:prevention & control; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D019266:Iron, Dietary / Q000008:administration & dosage / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D013851:Thinness / Q000517:prevention & control; D014504:Urban Health; D014881:Water Supply / Q000032:analysis
chemical_list: D060766:Drinking Water; D006454:Hemoglobins; D019266:Iron, Dietary; D001205:Ascorbic Acid