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1.
Article in English | IMSEAR | ID: sea-165396

ABSTRACT

Objectives: In rice-consuming countries, multi-micronutrient fortified rice (MMFR) is a promising cost-effective strategy to control micronutrient deficiencies. The FORISCA project evaluated the impact of MMFR distributed through the WFP school meal program (SMP) on micronutrient status, health, and cognition of Cambodian schoolchildren. Here, effects on anemia, iron and vitamin A (VA) status are presented. Methods: The FORISCA-UltraRice+NutriRice study was a cluster-randomized, double-blinded, placebo-controlled trial in 9500 schoolchildren. Sixteen schools participating in WFP-SMP were randomly assigned to receive either MMFR including VA (MMFR+VA), MMFR without VA (MMFRVA), or unfortified rice (placebo) as breakfast distributed 6 days/week for 6 months. Four additional schools not participating in WFP-SMP were randomly selected as control. Twenty-five percent of schoolchildren from grade 1-6 participated in the biochemical study. Hemoglobin (Hb), iron and VA status were measured at baseline, 3 and 6 months. Results: Baseline prevalence of iron deficiency (ID), anemia and (marginal) vitamin A deficiency (VAD) were 51.6%, 15.7% and 8.6% respectively. Hemoglobinopathy (OR 2.5) , VAD (OR 2.1) and total body iron (TBI) were the strongest predictors of anemia (all p<0.01). The intervention had no overall impact on Hb or anemia prevalence. MMFR+VA significantly reduced VAD from 13.5% to 7.1% (p<0.05), whereas VAD increased in the other groups over the intervention (6.1% to 12.7%). Conclusions: Micronutrient deficiencies were prevalent with especially hemoglobinopathy and VAD and to a lesser extent iron status being risk factors for anemia. Fortified rice containing VA significantly improved VA status of schoolchildren. Funded by USDA/FAS, WFP-DSM consortium and IRD.

2.
Article in English | IMSEAR | ID: sea-165232

ABSTRACT

Objectives: Malnutrition in early childhood predisposes to a higher risk for non-communicable diseases such as obesity and cardio-vascular diseases later in life through not fully understood metabolic alterations. Little is known about body composition in early childhood in relation to micronutrient status. Methods: Infants were recruited through the WinFood project which studied the effectiveness of fortified complementary foods (FCF) in improving health and growth. Anthropometry (weight, height, MUAC, skinfolds), body composition (deuterium dilution) and micronutrient status (iron, zinc, vitamin A) were measured at 6 mo and 15 mo of age. Results: From 269 Cambodian infants data on body composition and micronutrient status were available for both time-points. Lean body mass increased with 1.96 ±0.59 kg, whereas percentage body fat decreased from 21.7% to 14.9% over the study period (P<0.001). At 6 and 15 mo of age, body fat was strongly correlated to ponderal growth (WHZ, P<0.01) but not to length growth (HAZ) or gender. Vitamin A and zinc status were not related to fat mass. Iron status at 6 and 15 months of age significantly correlated with body composition, with infants with no iron stores at endpoint having a higher fat mass (14.0% vs 15.5%, P=0.02). Infants without iron deficiency during the study had significant lower fat mass (13.3%) than infants who were iron deficient at both timepoints (16.4%, P<0.01) Conclusions: Iron status, but not vitamin A or zinc status, was related to body composition in Cambodian infants. FCF aimed at improving iron status in early childhood may have long-term health benefits.

3.
Article in English | IMSEAR | ID: sea-165210

ABSTRACT

Objectives: Nutritional status can have a large impact on schoolperformance in children, with micronutrient deficiencies affecting cognitive performance and school attendance through increased morbidity. The FORISCA-UltraRice+NutriRice Trial in Cambodia tested impact of multimicronutrient fortified rice (MMFR) through the WFP school meal program (SMP) on micronutrient status, health and cognitive performance. Methods: The FORISCA-UltraRice+NutriRice study was a cluster-randomized, double-blinded, placebo-controlled trial in 9500 schoolchildren. Sixteen schools participating in WFP-SMP were randomly assigned to receive either MMFR including vitamin A (MMFR+VA), MMFR without VA (MMFR-VA) or unfortified rice (placebo) as breakfast distributed 6 days/week for 6 months. Four additional schools not participating in SMP were randomly selected as control group. Cognitive performance (Raven's Colored Matrices, Block Design and Picture completion), and vitamin A and iron status were determined in 25% of the schoolchildren. Results: Cognitive performance was significantly correlated to stunting (P<0.05) and total body iron (TBI) at baseline and endline (P<0.05), but not to vitamin A status. Cognitive performance improved in all children (P<0.001). Children receiving MMFR-VA (iron without vitamin A) had significant higher improvements in Block Design scores as compared to children receiving MMFR+VA (iron plus vitamin A, P<0.001) or control (P=0.022), and tended to be higher than placebo (P=0.09). Conclusions: Iron status, as well as chronic nutritional deprivation (stunting) are both important determinants of cognitive performance in schoolchildren. Improving iron status through fortified SMP can enhance schoolperformance, but interactions with other micronutrients may modify this effect. The optimal dose of micronutrients needs to be established. Funded by USDA/FAS, WFPDSM consortium and IRD.

4.
Article in English | IMSEAR | ID: sea-165140

ABSTRACT

Objectives: Vitamin A deficiency (VAD) in infancy remains an important health problem. Postpartum maternal high-dose vitamin A supplementation (MHDVAS) was recommended but recently cancelled by WHO as efficacy was unclear. We investigated effects of inflammation and timing of MHDVAS on VA status in mothers and newborns. Methods: In a randomized, double-blinded placebo-controlled trial, 400 pregnant women were randomly assigned at 28–32 weeks gestation, to receive MHDVAS within 1 week after delivery (WK1) or 6 weeks post-partum (WK6). Breastmilk, plasma VA and inflammation markers were measured at several time-points during the first 6 months post-partum. Results: Retinol concentrations during pregnancy and 6 months post-partum were strongly correlated (R=0.53, P<0.001). Prevalence of VAD(<0.70 μmol/L) in mothers 6 months post-partum was low (2.7%), but high in infants (33.6%), regardless of intervention. 77.6% of infants had retinol concentrations <1.05 μmol/L. Breastmilk vitamin A concentrations (<1.05 μmol/L) were deficient in only 5% of the women first week post-partum, but increased to 28% of the women 6 months postpartum and tended to be higher in the WK1 compared to the WK6 (31.4% and 24.5%,P<0.10). Retinol liver stores were significantly higher in children from mothers receiving MHDVAS at WK6 as compared to WK1 (P<0.001), with 27% and 46.9% of the infants having insufficient VA liver stores respectively. Conclusions: Lactation caused depletion of vitamin A stores in mothers. Delaying the high-dose VAS post-partum from WK1 to WK6 did not affect circulating retinol, but did significantly increased VA liver stores in infants 6 months after birth. Health-benefits should be evaluated in a larger trial.

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