Eficacia comparada de suplemento y complemento alimentario en el tratamiento de la anemia ferropénica en niños peruanos / Comparative efficacy of supplement and dietary supplement in the treatment of iron deficiency anemia in Peruvian children

Introducción: La anemia es la deficiencia nutricional más frecuente en niños menores de tres años, afectando su desarrollo cognitivo y psicomotor, siendo necesario identificar estrategias innovadoras para su prevención y un tratamiento terapéutico efectivo a corto plazo.Objetivo: comparar la eficacia del consumo de Nutrihem versus Sprinkles en el nivel de hemoglobina de niños 12 a 35 meses de edad con anemia ferropénica. Materiales y Métodos: bajo un enfoque cuantitativo se desarrolló una investigación de diseño experimental, tipo ensayo clínico pragmático sin enmascaramiento, la muestra estuvo conformada por 72 niños de 12 a 35 meses de edad, con diagnóstico de anemia ferropénica leve o moderada; al inicio de la intervención, fueron distribuidos en forma aleatoria en dos grupos experimentales, quienes recibieron el complemento alimentario Nutrihem o el suplemento Sprinkles por un periodo continuo de 90 días y un grupo control. El nivel de hemoglobina se determinó con un hemoglobinómetro portátil calibrado, evaluándose al inicio y término de la intervención. Para comparar y evaluar la eficacia se utilizó la prueba estadística ANOVA y la prueba post hoc T3 de Dunnett. Resultados: Al inicio de la intervención el 84.7% presentó anemia leve y el 15.3% anemia moderada. El grupo experimental que consumió el suplemento Nutrihem, al término de la intervención incrementó su valor de hemoglobina en 1,52 g/dL, obteniendo un valor p = 0,001 (p<0,05); asimismo, el 75% de los participantes normalizaron su valor de hemoglobina según edad. El grupo que consumió el suplemento Sprinkles incrementó el valor de hemoglobina en 0,38 g/dL, obteniendo un valor p = 0,246 (p>0,05); el 32% de niños normalizaron su valor de hemoglobina. Conclusión: El complemento alimentario Nutrihem presentó un mayor aumento del nivel hemoglobina, asimismo, presentó mayor adherencia al tratamiento, siendo una opción efectiva para el tratamiento de la anemia ferropénica en niños.(AU)

Introduction: Anemia is the most common nutritional de-ficiency in children under three years of age, affecting theircognitive and psychomotor development. It is necessary toidentify innovative strategies for its prevention and effectiveshort-term therapeutic treatment.Objective: to compare the effectiveness of the consump-tion of Nutrihem versus Sprinkles in the treatment of anemiain Peruvian children from 12 to 35 months of age.Materials and Methods: under a quantitative approach,an experimental design research, pragmatic clinical trial typewithout blinding, was developed. The sample was made up 72 children from 12 to 35 months of age, with a diagnosis ofmild or moderate iron deficiency anemia. They were randomlydistributed into two experimental groups and a control group;The experimental groups received the Nutrihem dietary sup-plement or the Sprinkles supplement for a continuous periodof 90 days. The hemoglobin level was determined with a cal-ibrated portable hemoglobinometer, and was evaluated at thebeginning and end of the intervention. To compare and eval-uate effectiveness, the ANOVA statistical test and Dunnett’sT3 post hoc test were used. Results: At the beginning of the intervention, 84.7% hadmild anemia and 15.3% had moderate anemia. The experi-mental group that consumed the Nutrihem food supplement,at the end of the intervention increased its hemoglobin valueby 1.52 g/dL, obtaining a p value = 0.001 (p <0.05);Likewise, 75% of the participants normalized their hemoglo-bin value according to age. The experimental group that con-sumed the Sprinkles supplement increased the hemoglobinvalue by 0.38 g/dL, obtaining a p value = 0.246 (p>0.05);32% of children normalized their hemoglobin value.Conclusion: The Nutrihem food supplement presented agreater increase in hemoglobin level, and also presentedgreater adherence to treatment; being an effective option forthe treatment of iron deficiency anemia in children.(AU)

Effectiveness of various methods of home fortification in under-5 children: where they work, where they do not. A systematic review and meta-analysis.

CONTEXT: The common approaches of home fortification (HF) for prevention and/or treatment of micronutrient deficiencies are micronutrient powders (MNPs), foodlets, and lipid-based nutrient supplements (LNSs). There are mixed results for the impact of HF on growth and nutritional status of young children. OBJECTIVE: This systematic review was prepared in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate current evidence from randomized controlled trials including children younger than 5 years to assess the effect of strategies of HF on growth and micronutrient status. METHODS: The MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar databases were searched to July 2018. A total of 1301 studies were found in a preliminary search. After screening of titles and abstracts, 30 studies were selected. RESULTS: Treatment with MNPs, foodlets, and LNSs effectively increased hemoglobin concentrations by at least 2.52 g/L, 4.59 g/L, and 4.4 g/dL, respectively, as compared with a control. There was a significant decrease in risk of anemia development after foodlet intervention compared with a control or iron drops (odds ratio, 0.27; 95%CI, 0.10-0.74; P = 0.01). However, these interventions did not result in any significant improvement in z-scores for changes of height for age, weight for age, and weight for height. The results indicated that MNP (7.16; 95%CI, 0.31-14.01; P = 0.04) and foodlet treatment (4.92; 95%CI, 0.28-9.57; P = 0.04) could increase serum zinc levels. However, none of the home fortification methods improved vitamin A status in the target group. CONCLUSION: Home fortification can be used as an effective method to improve hemoglobin, iron, and zinc status, although in this study it had no effect on vitamin A or anthropometric indicators of the target population. More investigations are warranted for newer approaches of HF to improve a broader range of micronutrients as well as child growth indices and for evaluation of the coverage, compliance, and consistency of such interventions at the population level. PROSPERO REGISTRATION NO: CRD42018109279.

Acceptability of locally-produced Ready-to-Use Supplementary Food (RUSF) for children under two years in Cambodia: A cluster randomised trial.

In Cambodia, existing food products for treating or preventing undernutrition have met with limited success. Therefore, in 2014, alternative ready-to-use foods were developed. This trial aimed to assess the acceptability of the novel ready-to-use supplementary food (RUSF) as a snack or mixed with borbor (white rice porridge), compared with corn-soy blend plus plus (CSB++) and borbor fortified with micronutrient powder (MNP). The nonblinded, randomised 4 × 4 crossover trial recruited 95 children aged 9-23 months from communities in peri-urban Phnom Penh. Small quantities (100 g for porridges, 42 g for snack) of each food were offered for three consecutive days at testing sites (homes of health volunteers). Main outcomes were children's consumption, caregivers' assessment of children's preferences, and caregivers' ranking of the foods. Median percentage consumed of the test food servings ranged from 21 to 50% (p = 0.003). The odds of children consuming over 50% were greatest for borbor fortified with MNP versus RUSF snack (unadjusted OR = 6.79, CI = 2.80-16.47, p < 0.001). However, the median energy children received when consuming the RUSF with borbor (57 kcals) or as a snack (48 kcals) was greater than with CSB++ (15 kcals) or borbor fortified with MNP (18 kcals; p < 0.001). Therefore, although children ate less RUSF, it provided approximately three times more kilocalories. Caregivers reported that their children had the highest preference for borbor fortified with MNP. Caregivers themselves ranked the novel RUSF snack highest. Thus, the innovative RUSF was considered sufficiently acceptable to proceed to an effectiveness trial.

Randomised controlled trial to test the effectiveness of a locally-produced ready-to-use supplementary food (RUSF) in preventing growth faltering and improving micronutrient status for children under two years in Cambodia: a study protocol.

BACKGROUND: Existing ready-to-use supplementary and therapeutic foods (RUSFs and RUTFs) have had limited acceptance and effectiveness in Cambodia. This has hampered the treatment and prevention of child malnutrition. An innovative, locally produced, multiple micronutrient fortified lipid-based nutrient supplement (LNS) has been developed for use as an RUSF. Unlike most RUSFs, which contain milk, this product contains fish as the animal protein. Few RUSFs have been formulated using non-milk animal-source foods and they have not been widely tested. An acceptability trial that was conducted on this novel RUSF in June 2015 demonstrated that children will eat the RUSF and that caregivers will feed it to their children. The current trial aims to evaluate the effectiveness of the RUSF in preventing growth faltering and improving micronutrient status in Cambodian children. METHODS AND ANALYSIS: This trial is a six-month, prospective, cluster randomised, non-blinded controlled trial among infants in peri-urban Phnom Penh. The trial aims to establish the superiority of the novel RUSF, compared to three alternatives (Corn-Soy Blend Plus Plus (CSB++) and Sprinkles micronutrient powders as active comparators, and the unimproved diet as a control). The allocation ratio is 1:1. Healthy children (N = 540) aged six to eleven months will be recruited. Data will be collected at baseline, and monthly thereafter for a period of six months. Participants will be provided with a monthly supply of the food to which their village has been allocated. DISCUSSION: There is an urgent need to develop locally produced and culturally acceptable RUSFs, and to compare these with existing options in terms of their potential for preventing malnutrition, in Cambodia and elsewhere. This trial will contribute much-needed data on the effectiveness of supplementary foods with an animal-source food other than milk, by comparing a novel RUSF based on fish to one that uses milk (CSB++). Moreover, it will deepen the understanding of the impact of multiple micronutrients provided with or without macronutrients, by comparing the novel RUSF and CSB++, which combine macronutrients with multiple micronutrients, to Sprinkles, which contains no macronutrients. In addition, it will augment the body of evidence from Asia. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: LNS-CAMB-INFANTS-EFF; NCT02257762 .

Intervención con suplementación nutricional Sprinkles sobre los niveles de hemoglobina en niños de 6-59 meses del Programa Luchito, Lima / Intervention with Sprinkles nutritional supplementation in hemoglobin levels in children 6-59 months of Program Luchito, Lima

Introducción: En la actualidad, la anemia por deficiencia de hierro en los niños sigue siendo para el país un problema de salud pública. La suplementación con Sprinkles constituye una buena estrategia para combatirla, sin embargo puede haber discrepancias en su efecto por limitaciones metodológicas. Objetivo: Determinar el efecto de una intervención con suplementación nutricional ("Sprinkles") sobre los niveles de hemoglobina en niños de 6 a 59 meses del programa Luchito, Lima 2012. Diseño: Estudio de enfoque cuantitativo, cuasi experimental, longitudinal y prospectivo. Lugar: Jurisdicción del distrito de San Martin de Porres. Participantes: 104 niños y niñas de 6 meses a 59 meses beneficiarios del programa Luchito del distrito de San Martin de Porres. Materiales y métodos: La intervención con suplementación "Sprinkles" se dio en un periodo de 6 meses de manera interdiaria. Se evaluó el nivel de hemoglobina al inicio y al final de la intervención y se obtuvo la diferencia de hemoglobina resultante de la intervención con el suplemento nutricional. Se complementó la intervención con sesiones educativas relacionadas a la administración de los Sprinkles a las madres de los niños, y se realizó un monitoreo de la administración en los hogares. Para el procesamiento y análisis de los datos se utilizó el programa SPPSS vs.19.0. El nivel de significancia fue alfa=0.05. Resultados: Se obtuvo un incremento significativo de la concentración de hemoglobina promedio en los niños de 6 a 59 meses de 0.6g/dL luego de 6 meses de administración del suplemento llegando a un máximo promedio de 11.2 gr/dl±1 gr/dl. Las madres que fueron evaluadas mediante la prueba para medir el nivel de conocimiento sobre la importancia del hierro incrementaron su puntaje de 13.3 a 16.8 en una escala de 1 al 20. Conclusiones: Se determinó que la suplementación interdiaria con Sprinkles por un periodo de 6 meses mejora los niveles de hemoglobina en niños, y que es importante el refuerzo con las...

Introduction: Today anemia Iron deficiency is one of the nutritional problems of greater magnitude globally, especially in countries developing as it is our country that is still considered a public health problem due therefore important to consider a strategy to combat this is supplementation with Sprinkles. Objective: To determine the effect of an intervention with nutritional supplementation ("Sprinkles") on hemoglobin levels in children 6 to 59 months of Luchito, Lima 2012 program. Design: Quantitative, quasi- experimental, longitudinal and prospective study. Location: Jurisdiction of the district of San Martin de Porres. Participants: 104 children 6 months to 59 months Luchito program beneficiaries in the district of San Martin de Porres. Methodology: Supplementation intervention with "Sprinkles" was in a period of 6 months interday way. Hemoglobin level at the beginning and end of the intervention was evaluated and the difference in hemoglobin resulting from the intervention with nutritional supplementation was obtained. Intervention with educational sessions related to the administration of Sprinkles mothers of children supplemented, monitoring and administration was conducted in homes. For processing and analysis of the data was used SPPSS vs.19.0 program. The significance level was alpha=0.05. Results: A significant increase in mea n hemoglobin concentration in children 6 to 59 months after 6 months 0.6g/dl management supplement reaching an average maximum of 11.2 g/dl ± 1 g/dl were obtained. Mothers who were evaluated by test to measure the level of knowledge about the importance of iron increased their score of 13.3 to 16.8 on a scale of 1 to 20. Conclusions: It was determined that supplementation with Sprinkles interdary for 6 months improves hemoglobin levels in children, and it is essential to strengthen the educational sessions and supplementation monitoring to ensure their effectiveness.

Factores de adherencia a la suplementación con sprinkles asociados al incremento de hemoglobina en niños de 6 a 60 meses, de Asentamientos Humanos del Distrito de San Martín de Porres / Factors of adhesion to supplementation with sprinkles associated to the increase of hemoglobin in children 6 to 60 months, of Human Settlements of the District of San Martin de Porres

Introducción: La suplementación con multimicronutrientes es una estrategia de salud para la disminución de la anemia, esta no solo debe centrarse en el cumplimiento del tratamiento, si no también considerar factores que puedan influir en la adherencia al mismo. Objetivo: Determinar los factores de adherencia a la suplementación con Sprinkles asociados al incremento de hemoglobina en niños de 6 a 60 meses de asentamientos humanos del distrito de San Martin de Porres (SMP). Diseño: Descriptivo de prevalencia y asociación cruzada, transversal y Observacional. Lugar: Jurisdicción del Distrito de SMP. Participantes: 112 niños y niñas de 6 meses a 60 meses que recibieron suplementación con Sprinkles, beneficiarios del "Programa de Lucha Contra la Desnutrición Infantil", de 10 asentamientos Humanos, de la jurisdicción de la Municipalidad de San Martin de Porres. Materiales y Métodos: se elaboró un instrumento de evaluación, con escala de Lickert, basada en cinco factores que influyen en la adherencia a tratamiento según la OMS. Se tomó la base de datos del proyecto de suplementación que realizó la Municipalidad de SMP para el análisis del incremento de hemoglobina. Resultados: El incremento de hemoglobina fue en 65 por ciento de niños y niñas. La mayoría de encuestados (41 por ciento) reconocieron que el tratamiento fue interrumpido en el niño(a), debido a infección respiratoria aguda. El 64 por ciento de niños(as) tuvo una adherencia alta. El factor de adherencia que influyo estadísticamente en el incremento de hemoglobina asociado al consumo del multimicronutriente fue el factor relacionado a la persona que suministra el tratamiento, con un (x2=0.020), en el resto de factores no hubo asociación significativa. Conclusión: El factor que influyó en la adherencia al tratamiento fue el factor relacionado a la persona que suministra el tratamiento. El factor más influyente para la No adherencia al tratamiento fue el factor social.

Acciones para la prevención y control de la anemia por deficiencia de hierro en niños hasta cinco años / Actions for prevention and control of iron-deficiency anemia in up to five-years old children

En Cuba la deficiencia de hierro es la carencia específica de micronutrientes más extendida y la principal causa de anemia en lactantes, niñas y niños hasta cinco años, en especial los menores de 24 meses. Las provincias orientales son las de mayor prevalencia con predominio casi absoluto de casos ligeros. El propósito de este trabajo es exponer la implementación de forma secuencial de tres proyectos que se ejecutan entre organismos y organizaciones cubanos y agencias de Naciones Unidas, para contribuir a la reducción de la anemia en niños y niñas hasta cinco años. La implementación de los proyectos se desarrolló con un enfoque de mercadotecnia social. Se aplicaron métodos cuantitativos, cualitativos y la triangulación de sus resultados. Todos los proyectos incluyeron la capacitación a actores clave en temas de alimentación saludable, nutrición y prevención de la anemia y un amplio trabajo educativo con las familias. En dos de ellos se entregó un alimento fortificado con hierro y en el tercero, se distribuyó otro producto tangible: los micronutrientes en polvo "Chispitas". Este último, sin precedentes en el país. Se describen las acciones realizadas en la provincia Holguín en la implementación de los tres proyectos y se exponen los criterios de evaluación. Concluida la intervención, se espera haber fortalecido las capacidades para la prevención y control de la anemia en los 14 municipios de la provincia y haber reducido la frecuencia de anemia en el grupo diana del municipio Calixto García.

Iron deficiency is the most extended specific lack of micronutrients and the main cause of anemia in infants, boys and girls up to five years of age, particularly those aged under 24 months. The Eastern provinces exhibit the highest prevalence with almost absolute predominance of mild cases. The objective of this study is to show the sequential implementation of three projects that are jointly carried out by Cuban bodies and organizations and UN agencies, with a view to reducing anemia in boys and girls aged up to five years. The implementation of these projects had a social marketing approach. Quantitative and qualitative methods and the triangulation of their results were used. All the projects included training of key actors in healthy feeding, nutrition and prevention of anemia as well as extensive educational work with the families. Two projects delivered an iron-fortified foodstuff and the other one distributed an unprecedented tangible product known as powdered micronutrients "Sprinkles". The actions undertaken in Holguin province to implement the three projects and the evaluating criteria were described. After the intervention, it is expected that the capacities for prevention and control of anemia in the 14 municipalities of this province be strengthened and the frequency of anemia in the target group in "Calixto García" municipality be reduced.

Iron deficiency anemia among children: Addressing a global public health problem within a Canadian context.

Despite current Canadian pre- and perinatal nutrition programs, the prevalence of both iron deficiency and iron deficiency anemia (IDA) is very high among young Aboriginal children from Canada's remote north. The major risk factors for IDA include prolonged consumption of evaporated cow's milk, chronic infection and prolonged exclusive breastfeeding. In the present article, the authors discuss IDA as a significant public health problem in Canadian Aboriginal communities. Whereas the prevalence of IDA in Canadian children is between 3.5% and 10.5% in the general population, in two Northern Ontario First Nations communities and one Inuit community, the anemia rate was 36%, with 56% having depleted iron stores. Traditional methods of preventing IDA, including targeted fortification, dietary diversification and supplementation, have not solved the problem. The authors' research group at The Hospital for Sick Children in Toronto, Ontario, conceived of the strategy of 'home fortification' with 'Sprinkles' - single-dose sachets containing micronutrients in a powder form, which are easily sprinkled onto any foods prepared in the household. In Sprinkles, the iron (ferrous fumarate) is encapsulated within a thin lipid layer to prevent the iron from interacting with food. Sprinkles have been shown to be efficacious in the treatment of anemia in many developing countries. Their use in Aboriginal communities to treat and prevent anemia is described in the present paper. The authors believe that children in Aboriginal communities across Canada would potentially benefit if Sprinkles were incorporated into Health Canada's current distribution system, in combination with a social marketing strategy to encourage their use.

APPLICATION OF THE SPRINKLES - A HOME FOOD IRON FORTIFICANT / 营养学报

Iron deficiency (ID) and iron deficiency anemia (IDA) remain prevalent nutritional problems in many parts of the world. Among infants and young children, IDA has adverse effects on growth and development. Mental deficits exhibited in infancy can be long lasting. Efforts are being made to combat these problems. However, in the past decade little success was made. Currently there is interest in developing home fortificants that are versatile, inexpensive, efficacious and effective. One of these is the Sprinkles, which contain iron fumarate coated with a soy lipid and other micronutrients. The Sprinkles is packaged in small sachets and intended to be added to ready-to-eat home-prepared complementary foods once a day. An acceptance test was conducted in 5 cities in China. The Sprinkles was provided for the acceptance by infants aged 6-24 months and children of 2-5 years in 4 successive weeks. Their mothers were interviewed 4 times during the period of the study. The results showed that both the mothers, the infants and young children accepted the foods with added Sprinkles well.

Home fortification with micronutrient sprinkles - A new approach for the prevention and treatment of nutritional anemias.

Despite global goals set by United Nations' agencies over the past decade for significant reductions in iron deficiency anemia (IDA), it remains a largely unaddressed public health problem affecting more than two billion people, one-third of the world's population. The negative impact of IDA on health and human potential are greatest in the developing world, where it is estimated that 51% of children younger than four years of age are anemic, mainly due to a diet that is inadequate in bioavailable iron. Studies in both developed and developing countries have consistently shown mental and motor impairments that may not be reversible in children younger than two years of age with IDA. From a public health standpoint there are four possible interventions for the prevention of anemia: dietary diversification to include foods rich in absorbable iron; fortification of staple foods including targeted fortification of complementary foods for infants and young children; the provision of iron supplements; and 'home-fortification'. In response to a United Nations Children's Fund (UNICEF) request to develop a new approach to IDA, our research group developed 'Sprinkles' for home-fortification of complementary foods. Sprinkles are single-dose sachets (like small packets of sugar) containing micronutrients in powder form (encapsulated iron, zinc, vitamins A, C and D, and folic acid), which are easily sprinkled onto any home-prepared complementary food. Sprinkles were developed to overcome many of the side effects and disadvantages of iron drops. We have demonstrated that Sprinkles are as effective as iron drops in the treatment and prevention of anemia. Sprinkles are easier to use and are, therefore, better accepted than iron drops, which may improve adherence to iron interventions.