title: Multiple-Micronutrient Fortified Non-Dairy Beverage Interventions Reduce the Risk of Anemia and Iron Deficiency in School-Aged Children in Low-Middle Income Countries: A Systematic Review and Meta-Analysis (i-iv).
abstract: Multiple-micronutrient (MMN) fortification of beverages may be an effective option to deliver micronutrients to vulnerable populations. The aim of the present systematic review and meta-analysis is to evaluate the nutritional impacts of MMN fortified beverages in the context of low-middle income countries. A systematic search of published literature yielded 1022 citations, of which 10 randomized controlled trials (nine in school-aged children and one in pregnant women) met inclusion criteria. Results of school-aged children were included in the meta-analysis. Compared to iso-caloric controls, children who received MMN fortified beverages for 8 weeks to 6 months showed significant improvements in hemoglobin (+2.76 g/L, 95% CI [1.19, 4.33], p = 0.004; 8 studies) and serum ferritin (+15.42 pmol/L, [5.73, 25.12], p = 0.007; 8 studies); and reduced risk of anemia (RR 0.58 [0.29, 0.88], p = 0.005; 6 studies), iron deficiency (RR 0.34 [0.21, 0.55], p = 0.002; 7 studies), and iron deficiency anemia (RR 0.17 [0.06, 0.53], p = 0.02; 3 studies). MMN fortified beverage interventions could have major programmatic implications for reducing the burden of anemia and iron deficiency in school-aged children in low-middle income countries. Additional research is needed to investigate effects on other biochemical outcomes and population subgroups.
authors.affiliation: Section Sanitary Engineering, Department of Water Management, Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft 2600 GA, The Netherlands. gjaaron@gainhealth.org.
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Aaron
authors.affiliation: Global Alliance for Improved Nutrition (GAIN), Rue de Vermont 37-39, Geneva CH-1202, Switzerland. daphnadror@gmail.com.
authors.forename: Daphna K
authors.initials: DK
authors.lastname: Dror
authors.affiliation: United States Department of Agriculture (USDA), Western Human Nutrition Research Center (WHNRC), 430 W. Health Sciences Dr., Davis, CA 95616, USA. yang.zhenyuid@gmail.com.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Yang
mesh_terms: D000740:Anemia / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D018798:Anemia, Iron-Deficiency / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D001628:Beverages; D002648:Child; D003906:Developing Countries; D005527:Food, Fortified; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007182:Income; D007501:Iron / Q000627:therapeutic use; D000090463:Iron Deficiencies; D018977:Micronutrients / Q000172:deficiency / Q000627:therapeutic use*; D011203:Poverty
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D007501:Iron
keywords: beverages; children; fortification; low-income; multiple-micronutrients