title: Effects of micronutrient fortified milk and cereal food for infants and children: a systematic review.
abstract: BACKGROUND
  Micronutrient deficiency is a common public health problem in developing countries, especially for infants and children in the first two years of life. As this is an important time window for child development, micronutrient fortified complementary feeding after 6 months of age, for example with milk or cereals products, in combination with continued breastfeeding, is recommended. The overall effect of this approach is unclear.
  
  
  METHODS
  We performed a Systematic Review and Meta-analysis to assess the impact of micronutrient fortified milk and cereal food on the health of infants and little children (aged 6 months to 5 years) compared to non-fortified food. We reviewed randomized controlled trials using electronic databases (MEDLINE and Cochrane library searches through FEB 2011), reference list screening and hand searches. Three reviewers assessed 1153 studies for eligibility and extracted data. One reviewer assessed risk of bias using predefined forms.
  
  
  RESULTS
  We included 18 trials in our analysis (n = 5'468 children; range of mean hemoglobin values: 9.0 to 12.6 g/dl). Iron plus multi micronutrient fortification is more effective than single iron fortification for hematologic outcomes. Compared to non-fortified food, iron multi micronutrient fortification increases hemoglobin levels by 0.87 g/dl (95%-CI: 0.57 to 1.16; 8 studies) and reduces risk of anemia by 57% (relative risk 0.43; 95%-CI 0.26 to 0.71; absolute risk reduction 22%; number needed to treat 5 [95%-CI: 4 to 6]; 6 Studies). Compared to non-fortified food, fortification increases serum levels of vitamin A but not of zinc. Information about functional health outcomes (e.g. weight gain) and morbidity was scarce and evidence is inconclusive. Risk of bias is unclear due to underreporting, but high quality studies lead to similar results in a sensitivity analysis.
  
  
  CONCLUSIONS
  Multi micronutrient fortified milk and cereal products can be an effective option to reduce anemia of children up to three years of age in developing countries. On the basis of our data the evidence for functional health outcomes is still inconclusive.
authors: Institute of Health Economics, Zurich University of Applied Sciences, St, Georgenstrasse, 70 P.O. Box, Winterthur 8401, CH, Switzerland. klaus.eichler@zhaw.ch
authors: Klaus
authors: K
authors: Eichler
authors: Simon
authors: S
authors: Wieser
authors: Isabelle
authors: I
authors: Rüthemann
authors: Urs
authors: U
authors: Brügger
mesh_terms: D000818:Animals; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D002523:Edible Grain / Q000737:chemistry*; D005527:Food, Fortified / Q000032:analysis*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage*; D008892:Milk / Q000737:chemistry*; D016032:Randomized Controlled Trials as Topic
chemical_list: D018977:Micronutrients