title: Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial.
abstract: In Cambodia, micronutrient deficiencies remain a critical public health problem. Our objective was to evaluate the impact of multi-micronutrient fortified rice (MMFR) formulations, distributed through a World Food Program school-meals program (WFP-SMP), on the hemoglobin concentrations and iron and vitamin A (VA) status of Cambodian schoolchildren. The FORISCA-UltraRice+NutriRice study was a double-blind, cluster-randomized, placebo-controlled trial. Sixteen schools participating in WFP-SMP were randomly assigned to receive extrusion-fortified rice (UltraRice Original, UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. Four additional schools not participating in WFP-SMP were randomly selected as controls. A total of 2440 schoolchildren (6-16 years old) participated in the biochemical study. Hemoglobin, iron status, estimated using inflammation-adjusted ferritin and transferrin receptors concentrations, and VA status, assessed using inflammation-adjusted retinol-binding protein concentration, were measured at the baseline, as well as at three and six months. Baseline prevalence of anemia, depleted iron stores, tissue iron deficiency, marginal VA status and VA deficiency were 15.6%, 1.4%, 51.0%, 7.9%, and 0.7%, respectively. The strongest risk factors for anemia were hemoglobinopathy, VA deficiency, and depleted iron stores (all p < 0.01). After six months, children receiving NutriRice and URN had 4 and 5 times less risk of low VA status, respectively, in comparison to the placebo group. Hemoglobin significantly increased (+0.8 g/L) after three months for the URN group in comparison to the placebo group; however, this difference was no longer significant after six months, except for children without inflammation. MMFR containing VA effectively improved the VA status of schoolchildren. The impact on hemoglobin and iron status was limited, partly by sub-clinical inflammation. MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated.
authors.affiliation: Institut de Recherche pour le Développement, Montpellier 34394, France. perignonmarlene@gmail.com.
authors.forename: Marlène
authors.initials: M
authors.lastname: Perignon
authors.affiliation: Institut de Recherche pour le Développement, Montpellier 34394, France. marionfiorentino@hotmail.com.
authors.forename: Marion
authors.initials: M
authors.lastname: Fiorentino
authors.affiliation: Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh 12301, Cambodia. kuong.kh@gmail.com.|Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen 2200, Denmark. kuong.kh@gmail.com.
authors.forename: Khov
authors.initials: K
authors.lastname: Kuong
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen 2200, Denmark. madijkhuizen@gmail.com.
authors.forename: Marjoleine A
authors.initials: MA
authors.lastname: Dijkhuizen
authors.affiliation: United Nations World Food Programme, Phnom Penh 12301, Cambodia. kurt.burja@wfp.org.
authors.forename: Kurt
authors.initials: K
authors.lastname: Burja
authors.affiliation: PATH (Program for Appropriate Technology in Health), Seattle, WA 98121, USA. mparker@path.org.
authors.forename: Megan
authors.initials: M
authors.lastname: Parker
authors.affiliation: Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh 12301, Cambodia. chhounchamnan@gmail.com.
authors.forename: Chhoun
authors.initials: C
authors.lastname: Chamnan
authors.affiliation: Institut de Recherche pour le Développement, Montpellier 34394, France. jacques.berger@ird.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Berger
authors.affiliation: Institut de Recherche pour le Développement, Montpellier 34394, France. franck.wieringa@ird.fr.
authors.forename: Frank T
authors.initials: FT
authors.lastname: Wieringa
mesh_terms: D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology; D002160:Cambodia; D002648:Child; D004032:Diet / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis / Q000187:drug effects; D006801:Humans; D007501:Iron / Q000097:blood; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D009752:Nutritional Status / Q000187:drug effects*; D012275:Oryza; D015995:Prevalence; D012177:Retinol-Binding Proteins / Q000032:analysis; D012574:Schools; D014801:Vitamin A / Q000097:blood; D014802:Vitamin A Deficiency / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D012177:Retinol-Binding Proteins; D014801:Vitamin A; D005293:Ferritins; D007501:Iron
keywords: Cambodia; anemia; iron; malnutrition; micronutrient deficiencies; micronutrient status; nutrition intervention; rice fortification; schoolchildren; vitamin A