title: Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania. Combined zinc and iron compared with iron supplementation of diets of 6- to 12-year old village schoolchildren in southern Iran. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. Effect of a milk-based food supplement on maternal nutritional status and fetal growth in underweight Chilean women. Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. Multiple micronutrient supplements improve micronutrient status and anemia but not growth and morbidity of Indonesian infants: a randomized, double-blind, placebo-controlled trial. Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants. Weekly micronutrient supplementation to build iron stores in female Indonesian adolescents. Nutritional efficacy of a fortified weaning rusk in a rural area near Beijing. Multivitamin-multimineral and iron supplementation did not improve appetite of young stunted and anemic Beninese children. Effects of separate delivery of zinc or zinc and vitamin A on hemoglobin response, growth, and diarrhea in young Peruvian children receiving iron therapy for anemia. Multiple micronutrient supplementation improves anemia, micronutrient nutrient status, and growth of Vietnamese infants: double-blind, randomized, placebo-controlled trial. Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: interactions between iron and zinc. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, growth, and morbidity of Peruvian infants. Weekly iron supplementation does not block increases in serum zinc due to weekly zinc supplementation in Bangladeshi infants. Calcium and phosphorus supplementation of iron-fortified infant formula: no effect on iron status of healthy full-term infants. Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y. Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants. Long-term evaluation of a micronutrient-fortified biscuit used for addressing micronutrient deficiencies in primary school children. Effects of a multivitamin and iron supplement on running performance in Gambian children. Vitamin A supplementation in children with poor vitamin A and iron status increases erythropoietin and hemoglobin concentrations without changing total body iron. The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants The effects of high energy and micronutrient supplementation on iron status in nutritionally at risk infants. Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children Micronutrient and iron supplementation and effective antimalarial treatment synergistically improve childhood anaemia. Effect of routine prophylactic supplementation with iron and folic acid on preschool child mortality in southern Nepal: community-based, cluster-randomised, placebo-controlled trial Biochemical indices and neuromuscular function tests in rural Gambian schoolchildren given a riboflavin, or multivitamin plus iron, supplement. Identification of an appropriate strategy to control anemia in adolescent girls of poor communities. Relationships of Schistosoma hematobium, hookworm and malarial infections and metrifonate treatment to hemoglobin level in Kenyan school children. Running performance in Gambian children: effects of water-soluble vitamins or iron. Randomized intervention study comparing several regimens for the treatment of moderate anemia among refugee children in Kigoma Region, Tanzania. Effect of supplementary vitamins and iron on malaria indices in rural Gambian children. Fortification of maize meal improved the nutritional status of 1-3-year-old African children.
abstract: BACKGROUND Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies . OBJECTIVE We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children ( aged 6 - 11 y ) attending primary schools . DESIGN In this r and omized , double-blind , placebo-controlled efficacy trial , children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo . RESULTS There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status , serum retinol , and anthropometry . At the 6-mo follow-up , among children with anemia ( hemoglobin < 110 g/L ) , there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group ( 9.2 and 0.2 g/L , respectively ) . Of those who were anemic at baseline , 69.4 % in the nonfortified group and 55.1 % in the fortified group remained anemic at follow-up ( RR : 0.79 ) , a cure rate of 21 % . The prevalence of children with low serum retinol concentrations ( < 200 microg/L ) dropped significantly from 21.4 % to 11.3 % in the fortified group compared with a nonsignificant change ( 20.6 % to 19.7 % ) in the nonfortified group . At follow-up , mean incremental changes in weight ( 1.79 compared with 1.24 kg ) , height ( 3.2 compared with 2.6 cm ) , and BMI ( 0.88 compared with 0.53 ) were significantly higher in the fortified group than in the nonfortified group . CONCLUSION The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency The effects of supplementation of the diets of 6- to 12-year-old children in a village near Shiraz in Iran with  zinc plus iron or iron alone , together with the indispensable amino acids in the form of egg white protein , vitamins , minerals , and corn oil have been evaluated . Initially 48 of 59 children had zinc concentrations  below the minimum found in well-nourished persons . Eight months of supplementation with zinc plus iron ( 20 mg daily of elemental zinc as carbonate and 20 mg ferrous iron as fumarate ) failed to stimulate growth or bone development or to bring about an increase in plasma zinc concentrations . However , supplementation with iron in the above amount was associated with an acceleration of growth in height and weight . The persistence of low concentrations of zinc in plasma and the failure of supplemental zinc to stimulate growth are attributed to the poor availability of both dietary and supplemental zinc result ing from sequestering action of fiber and phytate present in large amounts in the unleavened whole meal bread consumed by villagers . In addition , the results suggest that simultaneous administration of iron and zinc supplements may impair utilization of the metals Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with anemia ( hemoglobin < 110 g/L ) , 16 % vitamin A deficiency ( plasma retinol < 0.7 micromol/L ) , 47 % zinc deficiency ( plasma zinc < 10.7 micromol/L ) , 2 % underweight , and 11 % stunting . There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study . The DMM was the most effective intervention tested , not only for improving anemia but also for improving iron , zinc , riboflavin , and tocopherol status BACKGROUND Micronutrient deficiencies remain common in preschool children in developing countries . Interventions focus on single micronutrients and often lack effectiveness . Weekly instead of daily supplementation may improve effectiveness . OBJECTIVE The efficacy of weekly and daily supplementation in reducing anemia prevalence and in improving the zinc , vitamin A , and growth status of 6 - 24-mo-old Vietnamese children was investigated . DESIGN In this double-blind , placebo-controlled trial , the daily group ( n = 55 ) received 8 mg elemental Fe ( as iron sulfate ) , 5 mg elemental Zn ( as zinc sulfate ) , 333 microg retinol , and 20 mg vitamin C 5 d/wk for 3 mo . The weekly group ( n = 54 ) received 20 mg Fe , 17 mg Zn , 1700 microg retinol , and 20 mg vitamin C once a week . A third group ( n = 54 ) received a placebo only .  Venous blood sample s were collected at the start and end of the supplementation period and anthropometric measurements were taken at the start and 3 mo after the end of supplementation . RESULTS At baseline , 45.6 % of subjects had hemoglobin concentrations < 110 g/L , 36.3 % had zinc concentrations < 10.71 micromol/L , and 45.6 % had retinol concentrations < 0.70 micromol/L. Hemoglobin , retinol , and zinc concentrations of both the weekly and daily groups increased similarly compared with the placebo group ( P < 0.001 ) . There was no significant difference in growth between the supplemented groups and the placebo group . However , the height-for-age of subjects stunted at baseline increased with z scores of 0.48 ( P < 0.001 ) and 0.37 ( P < 0.001 ) for the daily and weekly groups , respectively . CONCLUSIONS Weekly and daily supplementation improved hemoglobin , zinc , and retinol concentrations similarly . Neither intervention affected growth of the overall population , but growth of children stunted at baseline was improved through both types of supplementation The effects on  pregnancy outcome  and  maternal iron status of powdered milk ( PUR ) and a milk-based fortified product ( V-N ) were compared in a group of underweight gravidas . These take-home products were distributed during regular prenatal visits . Women in the V-N group had greater weight gain ( 12.29 vs 11.31 kg , p less than 0.05 ) and mean birth weights ( 3178 vs 3105 g , p less than 0.05 ) than those in the PUR group . Values for various indicators of maternal Fe status were also higher in the V-N group . Compared with self-selected noncompliers , similar in all control variables to compliers , children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g , respectively . Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant Multiple micronutrient deficiencies are highly prevalent in Indonesia , but the interventions are still focused on single micronutrients . This study aim ed to investigate the efficacy of multiple micronutrient supplements for improving micronutrient status , anemia , growth , and morbidity of Indonesian infants . In this double-blind , placebo-controlled trial , 284 infants aged 6 - 12 mo were r and omly allocated to 4 treatment groups for 23 wk ; 260 ( 92 % ) infants completed the study . Group 1 ( DMM ) received one adequate intake of multiple micronutrient supplements daily ( n = 66 ) ; group 2 ( WMM ) received 2 adequate intakes of multiple micronutrient on 1d plus 6 d of placebo ( n = 60 ) ; group 3 ( DI ) received 10 mg of iron supplement daily ( n = 69 ) ; group 4 received a placebo supplement daily ( n = 65 ) . Blood sample s were collected at baseline and at posttreatment to assess anemia and micronutrient status . Anthropometric measurements were taken monthly , and morbidity was recorded daily . At baseline , 58.1 % of infants were anemic , 34.2 % were iron deficient , 21.3 % were vitamin A deficient , and 11 % were zinc deficient . The DMM and DI supplements both corrected iron deficiency , but DMM supplements were more efficacious in improving hemoglobin levels of anemic infants than the other supplements . However , anemia still persisted in one-third of DMM infants posttreatment . The DMM supplement was more efficacious than WMM or DI supplementation in improving infant status of other micronutrients , including zinc , tocopherol , and riboflavin , whereas DI exacerbated zinc deficiency . There were no significant differences in growth and morbidity among treatment groups , and growth faltering was not prevented BACKGROUND Iron and zinc deficiency are prevalent during infancy in low-income countries . OBJECTIVES The objectives were to examine whether a weekly supplement of iron , zinc , iron+zinc , or a micronutrient mix ( MM ) of 16 vitamins and minerals would alter infant development and behavior . DESIGN The participants were 221 infants from rural Bangladesh at risk of micronutrient deficiencies .  Development and behavior were evaluated at 6 and 12 mo of age by using the Bayley Scales of Infant Development II and the Home Observation Measurement of Environment ( HOME ) scale . In this double-blind trial , the infants were r and omly assigned to 1 of 5 treatment conditions : iron ( 20 mg ) , zinc ( 20 mg ) , iron+zinc , MM ( 16 vitamins and minerals , including iron and zinc ) , or riboflavin weekly from 6 to 12 mo . Multivariate analyses were conducted to examine the change in development and behavior for each supplementation group , with control for maternal education , HOME score , months breastfed , anemia , growth at 6 mo , and change in growth from 6 to 12 mo . RESULTS Iron and zinc administered together and with other micronutrients had a beneficial effect on infant motor development .  Iron and zinc administered individually and in combination had a beneficial effect on orientation-engagement . Two-thirds of the infants were mildly anemic , no treatment effects on hemoglobin concentration were observed , and hemoglobin was not associated with measures of development or behavior . CONCLUSION The beneficial effects of weekly iron and zinc supplementation on motor development and orientation-engagement suggest that infants benefit from these minerals when administered together Different supplementation schemes to build iron stores in female Indonesian adolescents were investigated . Subjects were 273 high-school girls allocated r and omly to four treatment groups . During a 3-mo period one group received 60 mg Fe , 750 micrograms retinol , 250 micrograms folic acid , and 60 mg vitamin C per day ; a second group received 60 mg Fe , 6000 micrograms retinol , 500 mg folic acid , and 60 mg vitamin C once a week ; a third group received 120 mg Fe and the same amount of the other three micronutrients as the second group once a week ; and a fourth group received only placebos . All subjects were dewormed and supplement allocation was double blind . Blood sample s were collected at baseline , after 2 and 3 mo of supplementation , and 6 mo after the last supplement . After 2 mo of supplementation , groups supplemented weekly and daily showed similar significant improvements ( P < 0.001 ) in hemoglobin and retinol concentrations , and supplementation for 3 instead of 2 mo did not significantly increase these two indicators . After 3 mo , the increase in ferritin was approximately equal to 27 micrograms/L in the daily and 14 - 15 micrograms/L in the weekly groups ( P < 0.001 ) , the latter having a final concentration of 42 - 45 micrograms/L. At 6 mo postsupplementation there were no significant differences among daily and weekly groups , but the ferritin concentration was still approximately equal to 10 - 12-micrograms/L higher ( P < 0.001 ) than in the placebo group . The group supplemented weekly with 60 mg Fe complained less about side effects than the other supplemented groups ( P < 0.05 ) . Weekly supplementation with 60 mg Fe and 6000 micrograms retinol for 3 mo was optimal for improving the iron status of the adolescents for approximately equal to 9 mo A micronutrient-fortified rusk for weanling children was tested in a rural area near Beijing . Two hundred twenty-six children aged 6 - 13 mo were r and omly assigned by village to either a micronutrient-fortified or an unfortified rusk , daily for 3 mo . The fortified rusk contained extra zinc ; iron ; calcium ; vitamins A , D , and B-12 ; thiamin , riboflavin , niacin , and folic acid . Infants receiving the fortified rusk exhibited no decline in hemoglobin concentrations during the study whereas those receiving the unfortified rusk exhibited a significant decline . Improvements were also seen in erythrocyte porphyrin , plasma vitamin A , and riboflavin status , but these improvements were seen in both of the groups . Micronutrient fortification was probably beneficial for iron status and the fortified rusk promises to be an effective vehicle for supplementation In developing countries , low food intake is often reported in children < 5 y old . Reduced appetite may be a contributing factor . We investigated whether a combination of a multivitamin-multimineral supplement and additional iron treatment improved appetite and growth of 18- to 30-mo-old stunted and anemic Beninese children . The study was placebo-controlled using VITALIA tablets ( 11 vitamins and 10 minerals ) and ferrous fumarate tablets ( 66 mg of iron ) . One hundred fifty stunted ( height-for-age Z score < -2 ) and anemic children ( hemoglobin < 110 g/L ) were r and omly assigned to one of four groups : group 1 , multivitamin-multimineral plus iron ; group 2 , multivitamin-multimineral plus placebo ; group 3 , placebo plus placebo ; and group 4 , placebo plus iron . Supplementation was daily and supervised for 6 wk . Appetite , knee-heel length , dietary intakes and morbidity were assessed before and after supplementation . Length , weight , arm circumference and hemoglobin concentration were assessed before , just after supplementation and 4 mo after the intervention . Appetite was assessed by means of an appetite test using a test food , riz-au-gras , eaten ad libitum after an overnight fast . Dietary intakes were assessed during three consecutive days in a sub sample by means of the observed weighed record method . Energy intake from the habitual breakfast was significantly correlated with that from the test food ( r = 0.49 , n = 38 , P = 0.002 ) . There were no differences among groups in changes in appetite and growth performance . The habitual diet of the children was monotonous and contained only small amounts of animal products . The morbidity status of the children was comparable in all study groups , before as well as after supplementation . We conclude that the 6-wk multivitamin-multimineral supplementation with additional iron treatment failed to improve the appetite and growth of the children INTRODUCTION Anemia is the most prevalent nutritional deficiency in the world . Attempts to improve iron indexes are affected by deficiency of and interaction between other micronutrients . OBJECTIVE Our goal was to assess whether zinc added to iron treatment alone or with vitamin A improves iron indexes and affects diarrheal episodes . DESIGN This was a r and omized , placebo-controlled , double-blind trial conducted in Peru . Anemic children aged 6 - 35 mo were assigned to 3 treatment groups : ferrous sulfate ( FS ; n = 104 ) , ferrous sulfate and zinc sulfate ( FSZn ; n = 109 ) , and ferrous sulfate , zinc sulfate , and vitamin A ( FSZnA ; n = 110 ) . Vitamin A or its placebo was supplied only once ; iron and zinc were provided under supervision > /=1 h apart 6 d/wk for 18 wk . RESULTS The prevalence of anemia was 42.97 % . The increase in hemoglobin in the FS group ( 19.5 g/L ) was significantly less than that in the other 2 groups ( 24.0 and 23.8 g/L in the FSZn and FSZnA groups , respectively ) . The increase in serum ferritin in the FS group ( 24.5 mug/L ) was significantly less than that in the other 2 groups ( 33.0 and 30.8 mug/L in the FSZn and FSZnA groups , respectively ) . The median duration of diarrhea and the mean number of stools per day was significantly higher in the FS group than in other 2 groups ( P < 0.005 ) . CONCLUSION Adding zinc to iron treatment increases hemoglobin response , improves iron indexes , and has positive effects on diarrhea . No additional effect of vitamin A was found A r and omized , double-blind , placebo-controlled trial was performed to assess the efficacy of different micronutrient supplementation regimes for improving micronutrient status , preventing anemia , and growth faltering of Vietnamese infants . A population -based sample of 306 infants aged 6 - 12 mo , split in 4 treatment groups , received daily multiple micronutrient ( DMM ) , daily placebo ( P ) , weekly multiple micronutrient ( WMM ) , or daily iron ( DI ) supplements for 6 mo , 7 d/wk , under supervision . Weight and length were measured monthly , and anemia and plasma levels of ferritin , zinc , riboflavin , retinol , tocopherol , and homocysteine were determined before and after the supplementation . Z-scores for length-for-age and weight-for-age worsened significantly in all groups , but the length-for-age Z-score decreased significantly less in the DMM group ( -0.32 + /- 0.05 ) than in the P and WMM groups ( -0.49 + /- 0.05 and -0.51 + /- 0.05 , respectively , P = 0.001 ) . Hemoglobin levels increased significantly more in the DMM group [ mean ( 95%CI ) : 16.4 g/L ( 12.4 - 20.4 ) ] than in the P group [ 8.6 g/L ( 5.0 - 12.2 ) , P = 0.04 ) , with intermediate nonsignificant increases in the WMM [ 15.0 g/L ( 11.5 - 18.5 ) ] and the DI [ 12.9 g/L ( 8.4 - 17.3 ) ] groups . Ferritin changes were significantly greater in DMM ( 12.1 microg/L ) and DI ( 9.5 microg/L ) than in P ( -14.7 microg/L ) and WMM groups ( -9.7 microg/L ) . Of the other micronutrients , only tocopherol showed a significantly greater level in the DMM group compared with P. Anemia still affected a quarter and zinc deficiency affected a third of infants although there was no iron deficiency after 6 mo of supplementation with DMM , suggesting that multiple factors are causing anemia and that the dose of zinc is too small BACKGROUND Iron deficiency anemia is the most prevalent nutrition problem in young children . One possible strategy to prevent iron deficiency anemia in this population group is the fortification of affordable food . OBJECTIVE This study was design ed to assess whether iron-fortified c and ies can improve iron status and are acceptable to children aged 4 - 6 y. DESIGN A double-blind , placebo-controlled intervention study was conducted in Jakarta , INDONESIA : The children were r and omly assigned to 1 of 2 treatment groups : a fortified group ( n = 57 ) and a placebo group ( n = 60 ) . Every week for 12 wk , 30 g ( 10 pieces ) c and y was given to the children . The c and y given to the fortified group contained 1 mg elemental Fe/g and very small amounts of other vitamins and minerals . RESULTS The hemoglobin concentration of the fortified group increased by 10.2 g/L ( 95 % CI : 8.3 , 12 g/L ) whereas that of the placebo group increased by 4.0 g/L ( 2.0 , 6.0 g/L ; P < 0.001 ) . Anemia prevalence decreased from 50.9 % at the start of the intervention to 8.8 % after 12 wk of intervention in the fortified group ( P < 0.001 ) and from 43.3 % to 26.7 % in the placebo group ( P < 0.05 ) . After 12 wk of intervention , the serum ferritin concentration was 71 % higher than at baseline in the fortified group and 28 % higher in the placebo group ( P < 0.001 ) . Acceptability of the iron-fortified c and ies was good . The per capita cost of the supplement was approximately US$ 0.96 - 1.20 for the 12 wk of intervention . CONCLUSION Iron-fortified c and ies were effective for improving the iron status  of young children and might be an affordable way to combat iron deficiency in children of low-to-middle income groups BACKGROUND Combined supplementation with iron and zinc during infancy may be effective in preventing deficiencies of these micronutrients , but knowledge of their potential interactions when given together is insufficient . OBJECTIVE The goal was to compare the effect in infants of combined supplementation with iron and zinc  and of supplementation with single micronutrients on  iron and zinc status . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe + 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Venous blood sample s were collected at the start and end of the study . Five hundred forty-nine infants completed the supplementation and had both baseline and follow-up blood sample s available for analysis . RESULTS Baseline prevalences of anemia , iron deficiency anemia ( anemia and low serum ferritin ) , and low serum zinc ( < 10.7 micromol/L ) were 41 % , 8 % , and 78 % , respectively . After supplementation , the Fe group had higher hemoglobin ( 119.4 compared with 115.3 g/L ; P < 0.05 ) and serum ferritin ( 46.5 compared with 32.3 microg/L ; P < 0.05 ) values than did the Fe+Zn group , indicating an effect of zinc on iron absorption . The Zn group had higher serum zinc ( 11.58 compared with 9.06 micromol/L ; P < 0.05 ) than did the placebo group . There was a dose effect on serum ferritin in the Fe and Fe+Zn groups , but at different levels . There was a significant dose effect on serum zinc in the Zn group , whereas no dose effect was found in the Fe+Zn group beyond 7 mg Zn/d . CONCLUSION Supplementation with iron and zinc was less efficacious than were single supplements in improving iron and zinc status , with evidence of an interaction between iron and zinc when the combined supplement was given Anemia , micronutrient deficiencies , and growth faltering are still common in Peru . The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure , anemia , and  micronutrient deficiencies  in Peruvian infants . Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind , masked , controlled trial in which they were r and omly assigned to receive either a daily dose of iron ( DI ) , a daily dose of multiple micronutrients ( DMM ) , a weekly dose of multiple micronutrients , or a placebo ( P ) for 6 mo . None of the supplements tested prevented growth faltering or the morbidities common during infancy . Anemia and plasma homocysteine concentrations fell significantly in all groups during the study , but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups , and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups . Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron ( DI and DMM ) . There were no significant differences among groups in mean final values or changes in plasma zinc , retinol , tocopherol , or riboflavin . Although the DMM intervention was the most efficacious for preventing anemia , iron , and zinc deficiencies , 15 % , 20 % , and 50 % of this group still remained anemic , zinc deficient , and iron deficient , respectively , at the end of the study . Further research thus should investigate whether higher doses of iron and zinc , together with infection control measures , are more efficacious Because infants and young children in many developing countries are deficient in both iron and zinc , and zinc can affect iron metabolism , evaluation of optimum strategies to simultaneously supplement iron and zinc is an important public health priority . This study evaluated the efficacy of weekly supplementation of iron or zinc or both on iron , zinc , and copper status in Bangladeshi infants . In a double-blind , r and omized , controlled community trial , 6-mo-old infants were assigned to receive weekly supplements of 1 mg riboflavin ( control , n = 82 ) or 1 mg riboflavin + 20 mg iron ( n = 83 ) , 20 mg zinc ( n = 83 ) , or both ( n = 85 ) for 6 mo . Hemoglobin , serum ferritin , transferrin receptor , zinc , and copper concentrations were measured at baseline and at the end of intervention . Serum Zn increased in both groups receiving zinc ; the increase was greatest among children with low baseline serum zinc concentration . Iron status indicators did not differ among the groups before or after 6 mo of supplementation . Supplementation with either zinc or iron decreased serum copper after 6 mo . Joint supplementation did not alter the individual effects of iron or zinc supplementation in these Bangladeshi children . However , the dosing regimen may not have been adequate to achieve the desired biochemical effects One objective of this clinical trial was to determine whether calcium and phosphorus supplementation of infant formula affects the iron status of healthy full-term infants . One hundred three infants were r and omly assigned to receive iron-fortified , cow milk-based infant formula ( 465 mg Ca and 317 mg P/L ) or the same formula with added calcium glycerophosphate ( 1800 mg Ca and 1390 mg P/L ) for 9 mo . Reported calcium intake for supplemented infants was about four times that of control infants , ranging from a mean of 1741 mg/d at baseline to 1563 mg/d at 9 mo . There was no difference by treatment group in mean or median change from baseline of serum ferritin , total-iron-binding capacity , erythrocyte protoporphyrin , or hematocrit at 4 and 9 mo after enrollment . Incidence of iron deficiency was similar for both groups and no infant developed iron deficiency anemia during the trial . This study indicates that the well-documented inhibitory effect of calcium and phosphorus on iron absorption is not clinical ly important in infants fed iron-fortified infant formula BACKGROUND Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded linear growth and reducing anemia in stunted children . DESIGN Saharawi refugee children ( n = 374 ) aged 3 - 6 y with initial height-for-age z scores < -2 were assigned to 1 of 5 groups : fortified spread ( FS ) , fortified spread plus metronidazole ( FS+M ) , unfortified spread ( US ) , unfortified spread plus metronidazole ( US+M ) , or control . Supervised supplementation was given daily for 6 mo . Weight , height , knee-heel length , hematologic indexes , parasitic infections , and morbidity were assessed at 0 , 3 , and 6 mo . RESULTS Linear growth of children fed FS was 30 % faster at 3 mo than in US and control groups , after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups . No additional benefits from metronidazole were observed . Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups ( 37 + /- 40 , 19 + /- 15 , and 16 + /- 17 g/L , respectively ; P < 0.0001 ) , and anemia was reduced by nearly 90 % . CONCLUSIONS FS , and not US , induces catch-up growth in stunted children whose diets are poor in micronutrients . Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 BACKGROUND Maize-meal porridge is used for infant feeding in many African countries , including South Africa . A low-cost , finely milled , maize-meal porridge was fortified with beta-carotene , iron , and zinc ( 100 % of recommended dietary allowance ) , as well as ascorbic acid , copper , selenium , riboflavin , vitamin B-6 , vitamin B-12 , and vitamin E. OBJECTIVE We assessed whether the fortified porridge could reduce anemia and improve the micronutrient status and motor development of infants .  DESIGN Infants aged 6 - 12 mo ( n = 361 ) were r and omly assigned to receive either the fortified or unfortified porridge for 6 mo . Primary outcomes were hemoglobin and serum retinol , zinc , and ferritin concentrations and motor development . Growth was assessed as a secondary outcome . Primary and secondary outcomes were assessed at baseline and 6 mo . RESULTS Two hundred ninety-two infants completed the study . The fortified-porridge group had an intervention effect of 9.4 microg/L ( 95 % CI : 3.6 , 15.1 microg/L ) for serum ferritin and 9 g/L ( 95 % CI : 6 , 12 g/L ) for hemoglobin concentrations . The proportion of infants with anemia decreased from 45 % to 17 % in the fortified-porridge group , whereas it remained > 40 % in the control group . The fortified-porridge group achieved on average 15.5 of the 25 motor development score items , whereas the control group achieved 14.4 items ( P = 0.007 ) . Serum retinol concentration showed an inconsistent effect , and no intervention effect was observed for serum zinc concentrations . CONCLUSIONS This low-cost fortified porridge can potentially have a significant effect in reducing anemia and improving iron status and motor development of infants in poor setting s. The formulation needs some adjustment in terms of zinc fortification OBJECTIVE To evaluate the long-term effect on micronutrient status of a beta-carotene- , iron- and iodine-fortified biscuit given to primary school children as school feeding . DESIGN Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years ( n = 108 ) ; in addition , cross-sectional data from three subsequent surveys conducted in the same school are reported . SETTING A rural community in KwaZulu-Natal , South Africa . SUBJECTS Children aged 6 - 11 years attending the primary school where the biscuit was distributed . RESULTS There was a significant improvement in serum retinol , serum ferritin , haemoglobin , transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention . However , when the school reopened after the summer holidays , all variables , except urinary iodine , returned to pre-intervention levels . Serum retinol increased again during the next 9 months , but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays ; this pattern was repeated in two further cross-sectional surveys . Haemoglobin gradually deteriorated at each subsequent assessment , as did serum ferritin ( apart from a slight increase at the 42-month assessment at the end of the school year ) . CONCLUSIONS This study has shown that fortification of a biscuit with beta-carotene at a level of 50 % of the Recommended Dietary Allowance ( RDA ) was enough to maintain serum retinol concentrations from day to day , but not enough to sustain levels during the long school holiday break . Other long-term solutions , such as local food production programmes combined with nutrition education , should also be examined . The choice of the iron compound used as fortificant in the biscuit needs further investigation Forty boys and girls between 11 and 14.5 years with evidence of sub clinical vitamin deficiencies were allocated to two groups to receive , twice weekly , either a placebo or a multivitamin and iron supplement . Prior to supplementation and on two subsequent occasions about 5 weeks apart , the children performed an exercise regimen on a treadmill during which expired air was collected and heart rate monitored . The supplement result ed in marked improvements in riboflavin and vitamin C status and checked the decline in iron stores seen in the unsupplemented children . During the study the running performance of unsupplemented children deteriorated , and markedly so in a subgroup with initially poor nutrient status . The vitamin and iron supplement prevented this deterioration so as to produce a significant reduction in the energy cost of treadmill running in the more malnourished subgroup , relative to the changes seen in children receiving no supplement BACKGROUND Vitamin A deficiency impairs iron metabolism ; vitamin A supplementation of vitamin A-deficient population s may reduce anemia . The mechanism of these effects is unclear . In vitro and in animal models , vitamin A treatment increases the production of erythropoietin ( EPO ) , a stimulant of erythropoiesis . OBJECTIVE We measured the effect of vitamin A supplementation on hemoglobin , iron status , and circulating EPO concentrations in children with poor iron and vitamin A status . DESIGN In a double-blind , r and omized trial , Moroccan schoolchildren ( n = 81 ) were given either vitamin A ( 200,000 IU ) or placebo at baseline and at 5 mo . At baseline , 5 mo , and 10 mo , hemoglobin , indicators of iron and vitamin A status , and EPO were measured . RESULTS At baseline , 54 % of children were anemic ; 77 % had low vitamin A status . In the vitamin A group at 10 mo , serum retinol improved significantly compared with the control group ( P < 0.02 ) . Vitamin A treatment increased mean hemoglobin by 7 g/L ( P < 0.02 ) and reduced the prevalence of anemia from 54 % to 38 % ( P < 0.01 ) . Vitamin A treatment increased mean corpuscular volume ( P < 0.001 ) and decreased serum transferrin receptor ( P < 0.001 ) , indicating improved iron-deficient erythropoiesis .  Vitamin A decreased serum ferritin ( P < 0.02 ) , suggesting mobilization of hepatic iron stores . Calculated from the ratio of transferrin receptor to serum ferritin , overall body iron stores remained unchanged . In the vitamin A group at 10 mo , we observed an increase in EPO ( P < 0.05 ) and a decrease in the slope of the regression line of log10(EPO ) on hemoglobin ( P < 0.01 ) . CONCLUSION In children deficient in vitamin A and iron , vitamin A supplementation mobilizes iron from existing stores to support increased erythropoiesis , an effect likely mediated by increases in circulating EPO The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status , linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape , South Africa . The study was design ed as an intervention study . In both the experimental and control groups , serum retinol concentration showed a decline over the intervention period of 6 months . The decline was less pronounced in the experimental group . This result ed in a significantly ( P<005 ) higher serum retinol concentration at 12 months in the experimental group ( 26.8±5.8 μg/dl ) compared with the control group ( 21.4±5 μg/dl ) . Serum iron concentration also declined over the intervention period . The decline was less pronounced in the experimental group . No difference was observed in haemoglobin levels between the groups at 12 months . Serum zinc concentration did not differ significantly between the two groups at follow up . Weight gain over the 6 months period did not differ significantly between the experimental ( 2.1±0.9 kg ) and control groups ( 2.1±1.2 kg ) . There was no difference in linear growth between the experimental ( 10.0±1.5 cm ) and control group ( 10.1±2.1 cm ) at the end of the follow-up period . Weight and length at 6 months significantly predicted weight and length at 12 months . No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention . Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group . No benefit was observed in serum zinc concentration , linear growth and psychomotor development The study assessed the effects of supplementary feeding over 180 consecutive days on iron status of infants and toddlers at six tea plantation in West Java , Indonesia . The design used was a clinical trial : two eohorts ( i.e. , 12 and 18 months old children ) and three treatment groups ( i.e. , energy + micronutrient , micronutrient alone , and placebo ) per cohort . Every day except Sunday , the infants attended day-care centers . Twenty four centers and 136 infants were selected . The infants were screened for weight and length and those meeting the criteria ( i.e. , < -1 SD of length-for-age , and between -1 and -2 SD of weight-for-length of the NCHS reference ) were included . The experimental unit was the day-care centers ( DCC ) , where each DCC was r and omly assigned to one of the three treatment . As expected , groups of energy + micronutrient and micronutrient alone of the 12 months cohort experienced a significant upward shift in hemoglobin , ferritin and TS and a downward change in FEP , while the values for the group of placebo remain about the same as at base line . In the first 6 month of treatments , the ANOVA for each iron indicator yielded significant main effects of treatment ( P < 0.01 ) and for Hb with ( P = 0.059 ) on 12 months cohort . On the other h and , the main effects of treatment on hemoglobin , TS , ferritin and FEP were not significant for the 18 months cohort . In the second 6 months of treatments , the only significant of the treatment effect ( P < 0.01 ) was in serum ferritin on 18-month cohort . Under these circumstances , energy has a positive role in improving iron stores . It is likely that the equilibrium of hemoglobin and each iron indicators were reached in 6 months of treatment except ferritin still continued to increase up to 12 month . The effects of treatment on the improvement of iron status was stronger in 12 months than in 18 months BACKGROUND Malaria and anaemia , especially that due to iron deficiency , are two leading causes of morbidity worldwide . Little is known about the relative contribution of Plasmodium falciparum infection and iron deficiency to the aetiology of anaemia in malaria-endemic areas . We undertook a r and omised comparison of different strategies for control of anaemia and malaria in infants , including an assessment of the effect of iron supplementation on malaria susceptibility . METHODS 832 infants born at one hospital in a malaria-hyperendemic area of Tanzania between January and October , 1995 , were r and omly assigned to group DI , receiving daily oral iron ( 2 mg/kg daily ) plus weekly Deltaprim ( 3.125 mg pyrimethamine plus 25 mg dapsone ) ; group IP , receiving iron plus weekly placebo ; group DP , receiving daily placebo plus weekly Deltaprim ; or group PP . supplementation was given from 8 to 24 weeks of age , and the weekly chemoprophylaxis from 8 to 48 weeks . The frequency of severe anaemia ( packed-cell volume < 25 % ) and malaria episodes was assessed through a combination of passive case detection and cross-sectional surveys . FINDINGS The groups that received iron supplementation had a lower frequency of severe anaemia than those that did not receive iron ( 0.62 vs 0.87 cases per person-year ; protective efficacy 28.8 % [ 95 % CI 6.3 - 45.8 ) . Iron supplementation had no effect on the frequency of malaria ( 0.87 vs 1.00 cases per person-year ; protective efficacy 12.8 % [ -12.8 to 32.5 ] ) . The groups that received malaria prophylaxis had lower frequencies of both severe anaemia ( 0.45 vs 1.04 episodes per person-year ; protective efficacy 57.3 % [ 43.0 - 67.9 ] ) and malaria ( 0.53 vs 1.34 episodes per person-year ; protective efficacy 60.5 % [ 48.2 - 69.9 ] ) than the groups that did not receive prophylaxis . After the end of the intervention period , children who had received malaria chemoprophylaxis had higher rates of severe anaemia and malaria than non-chemoprophylaxis groups ( relative risks 2.2 [ 1.3 - 3.7 ] and 1.8 [ 1.3 - 2.6 ] ) . INTERPRETATION Malaria chemoprophylaxis during the first year of life was effective in prevention of malaria and anaemia but apparently impaired the development of natural immunity . Iron supplementation was effective in preventing severe anaemia without increasing susceptibility to malaria . Our findings support iron supplementation of infants to prevent iron-deficiency anaemia , even in malaria-endemic areas Summary Single interventions for helminthic infections and micronutrient deficiencies are effective , but it is not clear whether combined interventions will provide equal , additive or synergistic effects to improve children 's health . The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children . A double-blind , r and omized , placebo-controlled trial in 11 rural South African primary schools r and omly allocated 579 children aged between 8 and 10 years into six study groups , half of whom received antihelminthic treatment at baseline . The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits , either unfortified or fortified with vitamin A and iron or with vitamin A only , given daily for 16 weeks . The outcome measures were anthropometric , micronutrient and parasite status , and scholastic and cognitive test scores . There was a significant treatment effect of vitamin A on serum retinol ( p < 0.01 ) , and the suggestion of an additive effect between vitamin A fortification and de-worming . Fortified biscuits improved micronutrient status in rural primary school children ; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection . The burden of micronutrient deficiency ( anaemia , iron and vitamin A ) and stunting in this study population was low and , coupled with the restricted duration of the intervention ( 16 weeks ) , might have limited the impact of the interventions The control of childhood anaemia in malaria holoendemic areas is a major public health challenge for which an optimal strategy remains to be determined . Malaria prevention may compromise the development of partial immunity . Regular micronutrient supplementation has been suggested as an alternative but its effectiveness remains unsettled . We therefore conducted a r and omised placebo-controlled intervention trial with 207 Tanzanian children aged 5 months to 3 years on the efficacy of supervised supplementation of low-dose micronutrients including iron ( Poly Vi-Sol with iron ) three times per week , with an average attendance of > /= 90 % . The mean haemoglobin ( Hb ) level increased by 8 g/l more in children on supplement ( 95 % CI 3 - 12 ) during the 5-month study . All age groups benefited from the intervention including severely anaemic subjects . The mean erythrocyte cell volume ( MCV ) increased but Hb in children > /= 24 months improved independently of MCV and no relation was found with hookworm infection . The data therefore suggest that micronutrients other than iron also contributed to Hb improvement . In the supplement group of children who had received sulfadoxine-pyrimethamine ( SP ) treatment , the mean Hb level increased synergistically by 22 g/l ( 95 % CI 13 - 30 ) compared to 7 g/l ( 95 % CI 3 - 10 ) in those without such treatment . Supplementation did not affect malaria incidence . In conclusion , micronutrient supplementation  improves childhood anaemia in malaria holoendemic areas and this effect is synergistically enhanced by temporary clearance of parasitaemia INTRODUCTION Iron deficiency is widespread in the developing world and is especially common in young children who live on the Indian subcontinent . Supplementation with iron and folic acid alleviates severe anaemia and enhances neurodevelopment in deficient population s , but little is known about the risks of mortality and morbidity associated with supplementation . METHODS We did a community-based , cluster-r and omised , double-masked , placebo-controlled , 2x2 factorial trial in children aged 1 - 36 months and residing in southern Nepal . We r and omly assigned children daily oral supplementation to age 36 months with : iron ( 12.5 mg ) and folic acid ( 50 microg ; n=8337 ) , zinc alone ( 10 mg ) , iron , folic acid , and zinc ( n=9230 ) , or placebo ( n=8683 ) ; children aged 1 - 11 months received half the dose . Our primary outcome measure was all-cause mortality , and our secondary outcome measures included cause-specific mortality and incidence and severity of diarrhoea , dysentery , and acute respiratory illness . Analyses were by intention to treat . This study is registered at , number NCT00109551 . FINDINGS The iron and folic acid-containing groups of the study were stopped early in November , 2003 , on the recommendation of the data and safety monitoring board ; mortality in these groups did not differ from placebo and there was low power to detect positive or negative effects by the time enrollment was completed . We continued to enroll children to the placebo and zinc alone groups . 25,490 children participated and analyses are based on 29,097.3 person-years of follow-up . There was no difference in mortality between the groups who took iron and folic acid without or with zinc when compared with placebo ( HR 1.03 , 95 % CI 0.78 - 1.37 , and 1.00 , 0.74 - 1.34 , respectively ) . There were no significant differences in the attack rates for diarrhoea , dysentery , or respiratory infections between groups , although all the relative risks except one indicated modest , non-significant protective effects . INTERPRETATION Daily supplementation of young children in southern Nepal with iron and folic acid with or without zinc has no effect on their risk of death , but might protect against diarrhoea , dysentery , and acute respiratory illness Ninety preselected children , aged between 8 and 14 years , living in two rural West African ( Gambian ) villages , were r and omly divided into three groups , matched for age and sex . One group received a placebo ( lactose ) tablet , one received riboflavin ( 5 mg ) on 5 d every week , which was sufficient to correct an endemic riboflavin deficiency , and one received a multivitamin supplement ( Protovit ; Hoffmann La Roche ) , on 5 d every week , together with FeSO4 ( 200 mg ) once weekly , and the supplements were given for 1 year . Neuromuscular tests , including arm tremor and manipulative skills , were performed on three occasions : once just before the introduction of the supplements ; again 6 weeks after commencing the supplements ; and again 1 year later . Venous blood sample s were collected at the same time as the first two sets of neuromuscular tests . These sample s were used for haematology and nutrient status indices : plasma ferritin , ascorbic acid , cyanocobalamin and pyridoxal phosphate , and erythrocyte tests for folate status , for riboflavin status ( erythrocyte glutathione reductase activation coefficient ) and thiamine status ( erythrocyte transketolase activation coefficient ) . The riboflavin in both supplements achieved a clear-cut response in biochemical status , which was dose-dependent . The pyridoxine , ascorbic acid and Fe components of the multivitamin also affected the associated biochemical indices . Although overall the arm tremor and related neuromuscular function tests did not respond significantly to the supplements , significant improvement was seen in the boys for the arm-tremor test in both the supplemented groups OBJECTIVES To obtain baseline data on hemoglobin ( Hb ) levels of adolescent girls belonging to the low-socio-economic groups ; investigate the comparative efficacy of once ' weekly ' and ' daily ' administration of iron-folate tablets with respect to impact on the Hb levels ; and find out the effect of added ascorbic acid supplementation on the efficacy of iron-folate administration with respect to increment in Hb levels . DESIGN R and omized experimental . SETTING Adolescent girls of poor communities in urban areas of Delhi and rural parts of Bharatpur ( Rajasthan ) . METHODS The baseline investigations included measurements of height , weight , and Hb levels . The Hb levels of the participating subjects were measured again after 3 months and 6 months of supplementation . RESULTS 61.9 % of the subjects in the urban and 85.4 % in the rural area were anemic . The response of Hb levels to daily iron/folate supplementation was better in comparison to once-weekly supplementation . The increment in Hb levels of subjects due to addition of vitamin C to iron/folate supplementation was more than that with supplementation of iron/folate alone . CONCLUSIONS Considering compliance , feasibility and cost-factors , a public-health approach consisting of once-weekly distribution of iron/folate supplementation through schools and welfare centers is better and can be recommended as an appropriate strategy for combating anemia in adolescent girls of poor communities in developing countries like India Relationships between hemoglobin level and S. hematobium , hookworm , and malarial infection before and six months after metrifonate treatment were studied in Kenyan primary school children in an area where anemia , S. hematobium and hookworm are common ( prevalences 61 % , 46 % , and 95 % , respectively ) and malaria is holoendemic . The mean hemoglobin level in children from one school , both with and without S. hematobium infection ( n = 250 ) , was significantly lower in children with higher S. hematobium egg counts , heavier hookworm infections , positive Plasmodium slides , and larger spleens . All children with light-moderate S. hematobium infection ( 1 - 500 eggs/10 ml adj ) in four schools were examined ( Exam 1 ) , allocated at r and om to either placebo ( MIP , n = 198 ) or metrifonate treatment ( MIT , n = 202 ) groups , treated , and examined again six months later ( Exam 2 ) . Hemoglobin levels rose significantly in both groups between exams , but the rise in the MIT group was 30 % higher than in the MIP group ( 1.3 vs. 1.0 g/dl , P less than 0.014 ) . The increase in hemoglobin level in the MIT group was significantly and positively correlated with decreases between exams in S. hematobium and hookworm egg counts and with higher malarial parasite counts at Exam 1 ( Pearson r 's 0.21 , 0.20 , 0.20 , respectively , P less than 0.01 ) . A stepwise multiple regression equation using hemoglobin rise between exams as the dependent variable showed that decreases in S. hematobium and hookworm egg counts were equally important determinants of hemoglobin rise and that malarial parasite count was almost as important as the changes in intensities of the helminth infections . These results show that treatment for S. hematobium with metrifonate can increase hemoglobin levels in children in an area where S. hematobium and anemia are common . They also emphasize the importance of measuring multiple parasitic infections and using multivariate statistical techniques such as multiple regression analysis in order to define the relationships between parasitic infections and morbidity Sixty-nine boys and girls between 10 and 14 years , with evidence of sub clinical vitamin deficiencies and poor iron status were enrolled into the study at the beginning of the rainy season . Children were allocated to three treatment groups to receive five times weekly either a placebo , 200 mg ferrous sulphate or 5 mg riboflavin and 150 mg ascorbic acid . Before receiving the supplement , and 9 weeks later , children performed an exercise regimen on a treadmill during which expired air was collected and heart rate measured . There was a general deterioration in the running performance of the children during the study period which was not affected by either the iron or the vitamin supplement Anemia-specific mortality was markedly elevated among refugee children < 5 years of age in Tanzania . In a r and omized , double-blind study , 215 anemic children were initially treated for malaria and helminth infection and then received 12 weeks of thrice-weekly oral iron and folic acid . Group I received placebo and chloroquine treatment for symptomatic malaria infection ( i.e. , no presumptive anti-malarial treatment given ) . Group II received placebo and monthly presumptive treatment with sulfamethoxazole-pyrimethamine ( SP ) . Group III also received monthly SP and thrice-weekly vitamins A and C ( VAC ) .  Mean hemoglobin concentration increased from 6.6 to 10.2 g/dL , with no significant differences among groups . Group II had lower mean serum transferrin receptor levels ( TfR ) than group I [ P = 0.023 ] . A greater proportion of participants in group III had normal iron stores ( TfR < 8.5 microg/ mL ) than in group II [ P = 0.012 ] . Initial helminth and malaria treatment , followed by thrice-weekly iron and folic acid supplements result ed in increased hemoglobin levels . Monthly SP and thrice-weekly VAC contributed to improve iron stores . Monthly SP may have a role in situations where asymptomatic disease is prevalent or where access to care is limited . Because administration of VAC also hastened recovery of iron stores over administration of monthly SP alone , health care personnel could add VAC to the treatment for moderate anemia if maximum recovery of iron stores is desired The effect of a combined supplement of iron , thiamine , riboflavin and vitamin C on  malarial incidence in 5 to 14-year-old children was tested in a malnourished rural community in a region of The Gambia noted for high prevalence of malaria during the rainy season . 190 children , divided into 2 matched groups , received either the supplement or a matching placebo for 3 months . No significant difference in malarial incidence was observed between the 2 groups , despite a major improvement in biochemical indices of nutrient status in the supplemented group , especially for riboflavin and vitamin C. Severity of episodes was also similar between groups , but in subjects who developed parasitaemias there was a trend towards higher parasite counts in those receiving the active supplement . Nutritional interventions in malarious areas may have adverse effects on malaria , and the increase in parasitaemia was compatible with the hypothesis that a small but significant reduction in defences had occurred . However , the absence of increases in the incidence of proven malaria cases and their severity must also be taken into account , in order to make a balanced assessment of the possible increase in risk . Further investigations are needed to measure the risk in benefit rates , and to consider the effects of individual nutrients in isolation OBJECTIVE To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1 - 3-year-old malnourished African children . DESIGN A r and omised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A , thiamine , riboflavin and pyridoxine , while 23 control children and their families received unfortified maize meal . The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households . METHODS Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics ' criteria and aged 1 - 3 years were r and omly assigned to an experimental or control group . Baseline measurements included demographic , socio-economic and dietary data , as well as height , weight , haemoglobin , haematocrit , serum retinol and retinol-binding protein ( RBP ) . Anthropometric , blood and serum variables were measured again after 12 months of intervention . Complete baseline measurements were available for 44 children and end data for only 36 . Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests , t-tests and analysis of variances using the SPSS program , controlling for expected weight gain in this age group over 12 months . Relationships between changes in variables were examined by calculating correlation coefficients . RESULTS The children in the experimental group had a significantly ( P < or = 0.05 ) higher increase in body weight than control children ( 4.6 kg vs. 2.0 kg ) and both groups had significant ( P < or = 0.05 ) but similar increases in height . The children in the experimental group showed non-significant increases in haemoglobin and serum retinol , while the control children had a significant ( P = 0.007 ) decrease in RBP . The change in serum retinol showed a significant correlation with baseline retinol ( P = 0.014 ) , RBP ( P = 0.007 ) and weight ( P = 0.029 ) , as well as with changes in haemoglobin ( P = 0.029 ) . CONCLUSION Despite a small sample size , this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1 - 3-year-old African children . The study confirmed the relationship between vitamin A and iron status . The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa
target: Synthesized evidence indicates that addition of multiple micronutrients to Fe supplementation may only marginally improve Hb response compared with Fe supplementation alone .
  However , addition of ' other micronutrients ' may have a negative effect .
  Routine addition of unselected multiple micronutrients to Fe therefore appears unjustified for nutritional anaemia control programmes
background: OBJECTIVES To study the effect of combining multiple ( two or more ) micronutrients with Fe supplementation on Hb response , when compared with placebo and with Fe supplementation , in children .