title: The impact of home fortification with multiple micronutrient powder on vitamin A status in young children: A multicenter pragmatic controlled trial in Brazil.
abstract: Home fortification with multiple micronutrient powder (MNP) is effective in the prevention of anemia in young children. However, the impact on their vitamin A status remains controversial. This study aimed to evaluate the effect of MNP on vitamin A status in young Brazilian children. A multicenter pragmatic, controlled trial was carried out in primary health centers in four Brazilian cities. In the beginning of the study, the control group (CG) consisted of children 11-14 months old (n = 395) attending in routine pediatric health care. In parallel, the intervention group (IG) was composed of children 6-8 months old (n = 399), in the same health centers, who followed the intervention with MNP for 2-3 months. The analysis of the effect of MNP on vitamin A status was performed by comparing the IG with the CG after a 4- to 6-month follow-up when IG children had reached the age of the controls. The prevalence of vitamin A deficiency (VAD; serum retinol <0.70 μmol/L) in the CG was 16.2%, while in the IG was 7.5%-a 55% reduction in the VAD [prevalence ratio (95% confidence interval) = 0.45 (0.28; 0.72)]. This reduction was also significant when stratifying the study centers by coverage of the Brazilian Vitamin A Supplementation Program. The adjusted mean of vitamin A serum concentrations improved in the IG compared with CG children, with a shift to the right in the vitamin A distribution. Home fortification with MNP was effective in reducing VAD among young Brazilian children.
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Lara Livia Santos
authors.initials: LLS
authors.lastname: Silva
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Rosângela Aparecida
authors.initials: RA
authors.lastname: Augusto
authors.affiliation: Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Daniela Cardoso
authors.initials: DC
authors.lastname: Tietzmann
authors.affiliation: Department of Nutrition, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Leopoldina Augusta Souza
authors.initials: LAS
authors.lastname: Sequeira
authors.affiliation: School of Nutrition, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Maria Claret Costa Monteiro
authors.initials: MCCM
authors.lastname: Hadler
authors.affiliation: Department of Health Sciences, Federal University of Acre, Rio Branco, Brazil.
authors.forename: Pascoal Torres
authors.initials: PT
authors.lastname: Muniz
authors.affiliation: Department of Nutrition, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Pedro Israel Cabral
authors.initials: PIC
authors.lastname: de Lira
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Marly Augusto
authors.initials: MA
authors.lastname: Cardoso
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology* / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005527:Food, Fortified; D006296:Health Services; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D009752:Nutritional Status; D011208:Powders; D015995:Prevalence; D014801:Vitamin A / Q000008:administration & dosage* / Q000097:blood; D014802:Vitamin A Deficiency / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D018977:Micronutrients; D011208:Powders; D014801:Vitamin A
keywords: home fortification; micronutrients; multiple micronutrient powder; primary health care; vitamin A; young children