title: Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial.
abstract: BACKGROUND
  Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce.
  
  
  METHODS
  A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment.
  
  
  RESULTS
  In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children.
  
  
  CONCLUSIONS
  MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children.
  
  
  BACKGROUND
  Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b.
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Marly A
authors.initials: MA
authors.lastname: Cardoso
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Rosangela A
authors.initials: RA
authors.lastname: Augusto
authors.affiliation: Coordenação Geral de Alimentação e Nutrição (CGAN), Ministry of Health, Brasília, Brazil.
authors.forename: Gisele A
authors.initials: GA
authors.lastname: Bortolini
authors.affiliation: Department of Health Sciences, Federal University of Acre, Rio Branco, Brazil.
authors.forename: Cristieli S M
authors.initials: CS
authors.lastname: Oliveira
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Daniela C
authors.initials: DC
authors.lastname: Tietzman
authors.affiliation: Department of Nutrition, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Leopoldina A S
authors.initials: LA
authors.lastname: Sequeira
authors.affiliation: School of Nutrition, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Maria Claret C M
authors.initials: MC
authors.lastname: Hadler
authors.affiliation: School of Nutrition, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Maria do Rosario G
authors.initials: Mdo R
authors.lastname: Peixoto
authors.affiliation: Department of Health Sciences, Federal University of Acre, Rio Branco, Brazil.
authors.forename: Pascoal T
authors.initials: PT
authors.lastname: Muniz
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Márcia R
authors.initials: MR
authors.lastname: Vitolo
authors.affiliation: Department of Nutrition, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Pedro I C
authors.initials: PI
authors.lastname: Lira
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Patrícia C
authors.initials: PC
authors.lastname: Jaime
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000178:diet therapy*; D002675:Child, Preschool; D005293:Ferritins / Q000097:blood*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007223:Infant; D018977:Micronutrients / Q000008:administration & dosage*; D015995:Prevalence; D011320:Primary Health Care
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D005293:Ferritins