Efficacy of fortification of school meals with ferrous glycine phosphate and riboflavin against anemia and angular stomatitis in schoolchildren.

OBJECTIVE: Multiple micronutrient deficiencies exist in many developing countries. We conducted a study to test the efficacy of ferrous glycine phosphate in reducing anemia and of riboflavin in reducing angular stomatitis when these micronutrients were added to the noon meal for schoolchildren. METHODS: A pre- and post-test design was used to study children 5 to 9 years of age, with an experimental and a control group. Two schools in the same locality in Chennai were chosen for the study. The experimental school had 65 children and the control school had 71 children, all of whom consumed a noon meal at the school daily. The children in the experimental school received a powder containing ferrous glycine phosphate and riboflavin, which was added to the meal during cooking every day for 6 months. The dosage was 28 mg of elemental iron and 1 mg of riboflavin per child per day. The children attended school for 5 days each week from Monday to Friday, except for holidays; they received the fortificants on 100 days during the 6-month period. There was no intervention in the control school. Children in the experimental and control groups were matched by socioeconomic status, age, and eating habits at baseline. All the children in the experimental and control schools were dewormed at baseline and at endline after 6 months. Hemoglobin was measured by the cynamethemoglobin method at baseline and endline. RESULTS: Binary logistic regression showed a significant (p < .001) time x group interaction for anemia. The prevalence of anemia in the experimental school was 69.0% at baseline and 32.8% after 100 days of intervention over 6 months, a statistically significant change (p < .001). The prevalence of anemia in the control school was 91.5% at baseline and increased to 97.2% at endline; the increase was not statistically significant. The prevalence of angular stomatitis was reduced from 21% at baseline to 0% at endline in the experimental school, whereas it was 23% at baseline and 20% at endline in the control school. CONCLUSIONS: The added fortificants reduced the prevalence of the micronutrient deficiencies.

Impact of a multiple-micronutrient fortified salt on the nutritional status and memory of schoolchildren.

OBJECTIVE: This study was conducted to test the efficacy of a multiple micronutrient-fortified cooking salt. METHODS: A randomized controlled trial with a pre- and post-test design was used to study children 5 to 18 years of age, with an experimental (n=213) and control group (n=189). The children were sampled from 3 residential schools and were studied for 9 months. The experimental group received a multiple micronutrient-fortified salt containing vitamins A, B(1), B(2), B(6), B(12), as well as folic acid, niacin, iron, iodine, and zinc. The control group received iodized salt. Biochemical measurements [hemoglobin, serum ferritin (SF), serum transferrin receptor (sTfR), C-reactive protein (CRP), alpha-1 acid glycoprotein (AGP), serum retinol, serum vitamin B(12), serum folic acid, serum zinc, and urinary iodine (UI)] were measured at baseline and post-intervention. Hemoglobin was measured in all the children three times during the study period, while the remaining biochemical measurements were performed in a subsample of children. Children between 11 and 18 years of age were given cognitive tests to assess memory and attention. RESULTS: There was a significant improvement (p<0.05) in all the biochemical measurements and memory tests in the experimental group when compared with the control group. Post-intervention in the experimental group, the increase in hemoglobin was 0.67 g/dL (p<0.05). Iron status and body iron stores increased significantly (p<0.05) in the experimental group compared to the control group, while serum zinc increased by 50 mug/dL (p<0.05), and the prevalence of retinol deficiency decreased from 57.1 % at baseline to 16 % post-intervention (p<0.05). CONCLUSION: The multiple micronutrients from the multiple micronutrient-fortified cooking salt were absorbed in the children and helped in combating micronutrient deficiencies.

A multicenter community study on the efficacy of double-fortified salt.

BACKGROUND: Iron and iodine deficiencies affect more than 30% of the world's population. Typical Indian diets contain adequate amounts of iron, but the bioavailability is poor. This serious limiting factor is caused by low intake of meat products rich in heme iron and intake of phytates in staple foods in the Indian diet, which inhibits iron absorption. OBJECTIVE: To test the stability of double-fortified salt (DFS) during storage and to assess its efficacy in improving the iron and iodine status of the communities. METHODS: The stability of both iodized salt and DFS during storage for a 2-year period was determined. The bioefficacy of DFS was assessed in communities covering three states of the country for a period of 1 year. This was a multicenter, single-blind trial covering seven clusters. The experimental group used DFS and the control group used iodized salt. The salts were used in all meals prepared for family members, but determination of hemoglobin by the cyanmethemoglobin method was performed in only two or three members per family, and not in children under 10 years of age (n = 393 and 436 in the experimental and control groups, respectively). The family size was usually four or five, with a male: female ratio of 1:1, consisting of two parents with two or three children. Hemoglobin was measured at baseline, 6 months (midpoint), and 12 months (endpoint). Urinary iodine was measured in only one cluster at baseline and endpoint. All the participants were dewormed at baseline, 6 months, and 12 months. RESULTS: The iron and iodine in the DFS were stable during storage for 2 years. Over a period of 1 year, there was an increase of 1.98 g/dL of hemoglobin in the experimental group and 0.77 g/dL of hemoglobin in the control group; the latter increase may have been due to deworming. The median urinary iodine changed from 200 microg/dL at baseline to 205 microg/dL at the end of the study in the experimental group and from 225 microg/dL to 220 microg/dL in the control group. There was a statistically significant (p < .05) improvement in the median urinary iodine status of subjects who were iodine deficient (urinary iodine < 100 microg/L) in both the experimental and the control groups, a result showing that DFS was as efficient as iodized salt in increasing urinary iodine from a deficient to sufficient status. There was a statistically significant increase (p < .05) in hemoglobin in all seven clusters in the experimental group compared with the control. CONCLUSIONS: The iron and iodine in the DFS are stable in storage for 2 years. The DFS has proved beneficial in the delivery of bioavailable iron and iodine.