Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants.

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 randomly 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 settings. The formulation needs some adjustment in terms of zinc fortification.

Efficacy of a foodlet-based multiple micronutrient supplement for preventing growth faltering, anemia, and micronutrient deficiency of infants: the four country IRIS trial pooled data analysis.

Diets of infants across the world are commonly deficient in multiple micronutrients during the period of growth faltering and dietary transition from milk to solid foods. A randomized placebo controlled trial was carried out in Indonesia, Peru, South Africa, and Vietnam, using a common protocol to investigate whether improving status for multiple micronutrients prevented growth faltering and anemia during infancy. The results of the pooled data analysis of the 4 countries for growth, anemia, and micronutrient status are reported. A total of 1134 infants were randomized to 4 treatment groups, with 283 receiving a daily placebo (P), 283 receiving a weekly multiple micronutrient supplement (WMM), 280 received a daily multiple micronutrient (DMM) supplement, and 288 received daily iron (DI) supplements. The DMM group had a significantly greater weight gain, growing at an average rate of 207 g/mo compared with 192 g/mo for the WMM group, and 186 g/mo for the DI and P groups. There were no differences in height gain. DMM was also the most effective treatment for controlling anemia and iron deficiency, besides improving zinc, retinol, tocopherol, and riboflavin status. DI supplementation alone increased zinc deficiency. The prevalence of multiple micronutrient deficiencies at baseline was high, with anemia affecting the majority, and was not fully controlled even after 6 mo of supplementation. These positive results indicate the need for larger effectiveness trials to examine how to deliver supplements at the program scale and to estimate cost benefits. Consideration should also be given to increasing the dosages of micronutrients being delivered in the foodlets.

Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants.

Growth faltering, anemia, and multiple micronutrient deficiency are common during infancy in developing countries. This South African trial was part of a multicenter study aimed 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 randomized 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 samples 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.

IRIS. I: a FOODlet-based multiple-micronutrient intervention in 6- to 12-month-old infants at high risk of micronutrient malnutrition in four contrasting populations: description of a multicenter field trial.

Infants in developing countries are at risk of concurrent micronutrient deficiencies, because the same causative factors may lead to deficiencies of different micronutrients. Inadequate dietary intake is considered one of the major causes of micronutrient deficiencies, especially among poor and underprivileged children in developing countries. Operational strategies and distribution systems are often duplicated when supplementation programs for single micronutrients are implemented at the same time. The International Research on Infant Supplementation (IRIS) trial was conducted in four distinct populations on three continents: Africa, Latin America, and Asia. The participating countries were South Africa, Peru, Vietnam, and Indonesia. The study had a randomized, doubleblind, placebo-controlled design. Each country aimed to enroll at least 70 infants per intervention group (65 + 5 anticipated dropouts). The micronutrient vehicle was in the form of a "foodlet" (food-like tablet) manufactured as chewable tablets, which were easy to break and dissolve, and which had the same taste, color, and flavor for all countries. Children were randomly assigned to one of four 6-month intervention groups: group 1 received a daily foodlet containing multiple micronutrients; group 2 received a daily placebo foodlet containing no micronutrients; group 3 received a weekly foodlet that contained multiple micronutrients (twice the dose of the daily foodlet) and placebo foodlets on the other days of the week; group 4 received a daily foodlet containing only 10 mg of elemental iron. The IRIS Trial aimed to examine the prevalence of multi-micronutrient deficiencies in 6- to 12-month-old infants from rural populations, and to examine the efficacy of multi-micronutrient supplementation in infants from the different countries included in the study. This paper describes the general methodology of the IRIS trial and the operational differences among the country sites.

A place for palm fruit oil to eliminate vitamin A deficiency.

There is general consensus that food-based approaches are viable and sustainable options for addressing vitamin A deficiency in populations. One such example is the fortification of food which, if properly monitored, could make a significant contribution towards improving the vitamin A status of populations throughout the world. Red palm fruit oil (RPO) with its high content of natural carotenoids, lends itself exceptionally well to this purpose at both household and commercial level. Results are now available from several feeding trials incorporating RPO into diets at household level or into commercially manufactured products. RPO in the maternal diet was shown to improve the vitamin A status of lactating mothers and their infants. Consumption of RPO incorporated in a sweet snack or biscuits significantly improved plasma retinol concentrations in children with subclinical vitamin A deficiency. There is evidence that if only 35-50% of the recommended daily intake for vitamin A were to be provided by RPO, it may be sufficient to prevent vitamin A deficiency (hypovitaminosis A). Red palm oil has a highly bioconvertible form of alpha- and beta-carotene, a long shelf life, and a higher cost/benefit ratio when compared to other approaches such as high-dose-vitamin A supplements and fortification of foods with retinyl ester fortificants. Consumption of RPO is safe and cannot produce hypervitaminosis A. Considering all the current information about RPO, the initiation of food-based interventions involving its use in developing countries with an endemic vitamin A deficiency problem, appears to be a logical choice.

Effect of palm olein oil in a moderate-fat diet on low-density lipoprotein composition in non-human primates.

Plasma low-density lipoprotein cholesterol (LDL-C) concentrations in vervet monkeys (Cercopithecus aethiops) can be modulated by the type and amount of fat in the diet. There is, however, a paucity of information on the effect of different types and quantity of dietary fat on the plasma LDL composition in vervets. The objective of this study was to determine the effect of different sources of dietary fat on the concentrations and composition of circulating plasma LDL in vervets consuming moderate-fat diets containing either animal fat, sunflower oil or palm olein. Fifty adult male vervets, never exposed to a Western-type atherogenic diet, were randomly assigned to two groups. For 6 weeks 30 vervets were fed a moderate-fat (28%E) moderate-cholesterol (26 mg cholesterol/1000 kJ) diet (MFD) with a polyunsaturated to saturated fatty acid ratio (P/S) of 0.4; 20 vervets were fed a high-fat (34%E) high-cholesterol (98 mg cholesterol/1000 kJ) diet (HFD) with a P/S ratio of 0.6. Fasting blood samples were collected from all 50 vervets for plasma lipid measurements. The 30 vervets receiving the MFD were stratified into three comparable experimental groups of 10 each according to their LDL-C and high-density lipoprotein cholesterol (HDL-C) concentrations and bodyweight. One group continued with the MFD, in which 11%E was derived from lard (MFD-AF); in the other two groups the lard was substituted isocalorically with either sunflower oil (SO) (MFD-SO) or palm olein oil (PO) (MFD-PO). The three groups were fed the respective experimental diets for 24 months and LDL component concentrations and composition were assessed at 6-monthly intervals. In the long-term study the MFD-AF, MFD-SO and MFD-PO groups showed no significant time-specific group differences at 6, 12, 18 or 24 months with regard to the LDL component concentrations, composition, as well as the LDL molecular weight. As expected, after 6 weeks of dietary exposure the HFD group had significantly higher plasma and lipoprotein total cholesterol, LDL component and apolipoprotein AI concentrations, as well as a higher LDL-C : HDL-C ratio compared to the MFD group (P 0.0005). LDL particle size was not significantly different between the HFD and MFD groups, but the HFD group had significantly fewer triacylglycerol and significantly more unesterified cholesterol molecules per LDL particle compared to the MFD group (P 0.0018). PO in a MFD is no different from AF or SO in its effect on LDL component concentrations, composition or particle size. The increased LDL-C concentration seen with the HFD could be accounted for by a more than two-fold increase in the number of circulating LDL particles and not as a result of enrichment of particles with cholesterol.