Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children.
What this study found
Daily multi-micronutrient-fortified biscuits produced the clearest benefit, markedly improving iron status and reducing anaemia; weekly iron tablets improved iron status but had a smaller effect on anaemia. In the fortified-biscuit arm, anaemia fell from 45.8% to 1.0%, compared with 10.4% in controls, and hemoglobin increased to 129 g/l, with higher ferritin and lower transferrin receptor than controls (P<0.001 and P=0.007, respectively). Weekly iron also increased ferritin and body iron, but endpoint hemoglobin remained intermediate and was not significantly different from the other groups…
- Study & population
- Randomized controlled trial in primary-school children aged 6 to 9 years in rural Quang Nam province, Vietnam.
- Intervention
- Daily multi-micronutrient-fortified biscuits (FB) provided five biscuits per day, about 30 g per serving, containing 8.8 mg iron as iron fumarate plus other micronutrients, and were eaten at school 5 days per week for 6 months.
- Key limitation
- Arm-specific baseline demographic data were not reported, and some counts were available only for evaluable or blood-sampled subsets rather than the full randomized arms.
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Open PDFOriginal abstract
In Vietnam, nutrition interventions do not target school children despite a high prevalence of micronutrient deficiencies. The present randomised, placebo-controlled study evaluated the impact of providing school children (n 403) with daily multiple micronutrient-fortified biscuits (FB) or a weekly Fe supplement (SUP) on anaemia and Fe deficiency. Micronutrient status was assessed by concentrations of Hb, and plasma ferritin (PF), transferrin receptor (TfR), Zn and retinol. After 6 months of intervention, children receiving FB or SUP had a significantly better Fe status when compared with the control children (C), indicated by higher PF (FB: geometric mean 36·9 (95% CI 28·0, 55·4) μg/l; SUP: geometric mean 46·0 (95% CI 33·0, 71·7) μg/l; C: geometric mean 34·4 (95% CI 15·2, 51·2) μg/l; P < 0·001) and lower TfR concentrations (FB: geometric mean 5·7 (95% CI 4·8, 6·52) mg/l; SUP: geometric mean 5·5 (95% CI 4·9, 6·2) mg/l; C: geometric mean 5·9 (95% CI 5·1, 7·1) mg/l; P = 0·007). Consequently, body Fe was higher in children receiving FB (mean 5·6 (sd 2·2) mg/kg body weight) and SUP (mean 6·1 (sd 2·5) mg/kg body weight) compared with the C group (mean 4·2 (sd 3·3) mg/kg body weight, P < 0·001). However, anaemia prevalence was significantly lower only in the FB group (1·0%) compared with the C group (10·4%, P = 0·006), with the SUP group being intermediate (7·4%). Children receiving FB had better weight-for-height Z-scores after the intervention than children receiving the SUP (P = 0·009). Vitamin A deficiency at baseline modified the intervention effect, with higher Hb concentrations in vitamin A-deficient children receiving FB but not in those receiving the SUP. This indicates that vitamin A deficiency is implicated in the high prevalence of anaemia in Vietnamese school children, and that interventions should take other deficiencies besides Fe into account to improve Hb concentrations. Provision of biscuits fortified with multiple micronutrients is effective in reducing anaemia prevalence in school children.