title: Efficacy of a multi micronutrient-fortified drink in improving iron and micronutrient status among schoolchildren with low iron stores in India: a randomised, double-masked placebo-controlled trial.
abstract: OBJECTIVE
  A multiple micronutrient-fortified drink could be an effective strategy to combating micronutrient deficiencies in school going children. To assess the efficacy of a multiple micronutrient-fortified drink in reducing iron deficiency (ID), ID anemia (IDA), anemia and improving micronutrient status among schoolchildren with low iron stores. The study employed a school-based, randomized, double-blind, placebo-controlled design.
  
  
  METHODS
  Schoolchildren with low serum ferritin (SF <20 μg/l) (n=246), aged 6-12 years were randomly assigned to receive either a multi-micronutrient fortified or an unfortified identical control drink. The drinks were provided 6 days/week for 8 weeks. Anthropometric and biochemical assessments were taken at baseline and endline.
  
  
  RESULTS
  Study groups at baseline were comparable, and compliance to the intervention was similar. The overall prevalence of ID, IDA and anemia was 64%, 19% and 24%, respectively. The prevalence of ID, IDA, vitamin C and vitamin B₁₂ deficiencies significantly reduced by 42%, 18%, 21% and 5%, respectively, in the intervention arm (P<0.01) as compared with the control arm at the end of the study. Similarly, the concentration of hemoglobin, SF, vitamin A, vitamin B₁₂, vitamin C and body iron stores were significantly higher in the intervention arm in comparison to the control arm (P<0.001). Red cell folate levels also improved significantly in the intervention arm (P=0.04), however, serum zinc status did not change in either of the study arms. Children who had received the fortified drink had significantly lower odds of being ID (0.15; 95% confidence interval (CI): 0.09-0.27), IDA (0.14; 95% CI: 0.04-0.52), vitamin B₁₂ deficient (0.36; 95% CI: 0.18-0.73) and vitamin C deficient (0.24; 95% CI: 0.13-0.46), after adjusting for baseline age, gender and weight.
  
  
  CONCLUSIONS
  The multi micronutrient-fortified drink was efficacious in reducing the prevalence of ID, IDA, vitamin C and vitamin B₁₂ deficiency and improved micronutrient status in schoolchildren.
authors.affiliation: Division of Nutrition, St John's National Academy of Health Sciences, Bangalore, India. praxmail@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Thankachan
authors.forename: S
authors.initials: S
authors.lastname: Selvam
authors.forename: D
authors.initials: D
authors.lastname: Surendran
authors.forename: S
authors.initials: S
authors.lastname: Chellan
authors.forename: M
authors.initials: M
authors.lastname: Pauline
authors.forename: S A
authors.initials: SA
authors.lastname: Abrams
authors.forename: A V
authors.initials: AV
authors.lastname: Kurpad
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000178:diet therapy* / Q000453:epidemiology / Q000503:physiopathology; D001206:Ascorbic Acid Deficiency / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology; D001628:Beverages / Q000009:adverse effects / Q000032:analysis*; D002648:Child; D002657:Child Development; D004311:Double-Blind Method; D005260:Female; D005522:Food Services; D005527:Food, Fortified / Q000009:adverse effects / Q000032:analysis*; D006801:Humans; D007194:India / Q000453:epidemiology; D059012:Lost to Follow-Up; D008297:Male; D018977:Micronutrients / Q000032:analysis / Q000097:blood / Q000172:deficiency* / Q000627:therapeutic use*; D009752:Nutritional Status; D010349:Patient Compliance; D015995:Prevalence; D012574:Schools; D012720:Severity of Illness Index; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology
chemical_list: D018977:Micronutrients