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Multiple micronutrient fortified biscuits decreased prevalence of anemia,
and improved micronutrient status and effectiveness of deworming in
rural Vietnamese school children
Tran Thuy Nga3, Pattanee Winichagoon4, Marjoleine A. Dijkhuizen5, Nguyen Cong Khan3, Emorn Wasantwisut4, Harold Furr6,
Frank T. Wieringa7
Micronutrient status (mean ±SD) among school
ABSTRACT
children before and after the intervention
Concurrent micronutrient deficiencies are prevalent among The study was a randomized, double-blind, placebo-controlled trial Vietnamese school children. The efficacy of a school-based with a 2x2 factorial design. Randomization to treatment groups was ( μmol/L) 2
intervention using multi-micronutrient fortified biscuits with done at individual child level. Children were stratified by sex and Baseline
1.05 ± 0.27
1.01 ± 0.25
1.06 ± 0.27
1.04 ± 0.25
1.04 ± 0.25
or without deworming on anemia and micronutrient status in age and then randomly selected into one of four groups: 1.04 ± 0.24
1.12 ± 0.248
End point
End point
1.08 ± 0.25
1.08 ± 0.23
(0.001, 0.08)
( 0.05, 0.03)
rural Vietnamese schoolchildren was investigated in a 1.non- fortifie d biscuit plu s de wormi ng -placeb o (Pl acebo) -0.013 11
MRDR (DR/R) 2
MRDR (DR/R) 2
randomized, 2x2 factorial, double-blind, placebo-controlled 2. multi-micronutrient-fortified biscuit plus deworming-placebo (MMF) 0.079 ± 0.05
0.06 ± 0.03a
End point 5
End point 5
0.058 ± 0.03a
0.067± 0.05
0.067± 0.05
( 0.02,-0.01)
(-0.014, 0.00)
P asma Zinc
( μmol/L) 2
trial. 510 schoolchildren, aged 6-8 years, received 3. non-fortified biscuit plus deworming (Alb) Baseline
8.8± 2.2
8.5 ± 2.0
8.6 ± 2.2
8.5 ± 2.2
8.5 ± 2.2
deworming with albendazole (400 mg) or placebo at 4. multi-micronutrient-fortified biscuit with deworming (MMF+Alb) 8.8± 1.9
9.4 ± 1.97
End point
End point
9.4 ± 1.9 7
8.7 ± 1.9
8.7 ± 1.9
( .26, 0.95)
( 0.4, 0.30)
Urinary iodine ( μg/L)4
baseline with or without multi-micronutrient fortified biscuits.
Baseline
Micronutrients in the biscuits included iron, zinc, iodine, and (79.8, 157.3)
(77.8, 161)
(79.5, 165)
(72.5, 175.5)
End point 5
End point
vitamin A. Biscuits were given five days a week for four (83.8, 166.3)
(101, 217)
(87, 182)
(121, 210)
(7.68, 37.31)
(-3.04, 26.54)
months. Parasite infestation was highly prevalent, with Hemoglobin & iron status (mean ±SD) among
1NS between groups at baseline. 2 Means ± SD 5 Significant difference among groups: For ratio DR/R (ANOVA): P<0.01, Post-hoc Bonferroni tests (for ratio DR/R), values in a row with letter superscripts (a) were different from >80% of the children infected with either Trichuris or children before and after the intervention
placebo. 6, 7, 8 Paired t test: 6 P < 0.05; 7 P < 0.01; 8 P < 0.001 12 Adjusted for age, baseline outcome values, and CRP levels (ANCOVA): 9 P < 0.05; 10 P < 0.01; 11 P<0.001 Ascaris. The majority of the children had a low intensity of Prevalences of Ascaris and Trichuris infections at
infection. Multi-micronutrient fortification significantly baseline, and after 2 and 4 mo of intervention
improved concentrations of hemoglobin (+1.87 g/L, 95% CI: 0.78 – 2.96), plasma ferritin (+7.5 μg/L; 2.8 – 12.6), body iron (+ 0.56 mg/kg body weight; 0.29 – 0.84), plasma zinc (+0.61 μmol/L; 0.26 – 0.95), plasma retinol (+0.041 μmol/L; 0.001 – 0.08), and urinary iodine (+22.49 μmol/L; 7.68 – 37.31). Fortification reduced the risk of anemia, and deficiencies of zinc and iodine by >40%. Parasitic infestation had no significant effect on fortification efficacy,but fortification significantly enhanced deworming efficacy, CONCLUSION
with the lowest re-infection rates in children receiving both 1 NS among groups at baseline. 3 Geometric means and 25th-75th percentiles 6, 7, 8 Paired t test: 6 P Fortification of multiple vitamins & minerals in micronutrients and albendazole. The addition of vitamins through a school-based program are an efficacious and 12 Adjusted for age, baseline outcome values, and CRP levels (ANCOVA): 9 P < 0.05; 10 P < 0.01; 11 and minerals in fortified foods through a school-based feasible means to supply micronutrients for school children atrisk of micronutrient deficiencies and an effective strategy to program is an effective strategy for school children at risk of Prevalence of anemia and iron deficiencies in school
reduce anemia & micronutrient deficiencies. Parasitic micronutrient deficiency in rural Vietnam, and significantly children at baseline and after four mo of intervention
infestation had no significant effect on fortification efficacy, enhances the effectiveness of routine deworming.
but fortification significantly enhanced deworming efficacy, INTRODUCTION
with the lowest re-infection rates in children receiving bothmicronutrients and albendazole. Therefore, fortified school Concurrent micronutrient deficiencies are prevalent among feeding and routine deworming have synergistic effects in Vietnamese school children. A school-based program improving health of school-children.
providing food fortified with multiple micronutrients could be a Acknowledgements: The authors thank technical assistances of the staffs of
Micronutrient Research and Application Department, National Institute of Nutrition.
cost-effective and sustainable strategy to improve the health This study was supported by The Neys-van Hoogstraten Foundation, The and performance of school children. However, the efficacy of Netherlands and the Ellison Medical Foundation, USA.
Reference: Nga TT, Winichagoon P, Dijkhuizen MA, Khan NC, Wasantwisut E, Furr
such an intervention may be compromised by a high H, Wieringa FT. Multi-micronutrient-fortified biscuits decreased prevalence of anemia prevalence of parasitic infestation and vice versa, fortification 1NS among groups at baseline, 2,3,4 McNemar test: 2 P<0.05; 3 P< 0.01; 4 P < 0.0001, 7,8,9 OR and improved micronutrient status and effectiveness of deworming in rural (Adjusted odds ratio): Adjusted for sex, age, and baseline outcome values (ANCOVA): 7 P<0.05; and deworming may have synergistic beneficial effects.
Vietnamese school children. J Nutr. 2009;139(5):1013-20.
3 The National Institute of Nutrition, Hanoi, Vietnam; 4 Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand; 5Dept. Of Human Nutrition, Copenhagen University, Denmark; 6 Dept. of Nutritional Sciences, University ofWisconsin, USA; and 7Institut de Recherche pour le Développement UMR-204, Montpellier, France.

Source: http://www.cdc-ffo.cn/micronutrientforum/PDFs/Poster%20Presentations/2_Wednesday/1.%20Food%20Fortification/W36_Tran.pdf