Effectiveness of an iron‐fortified milk distribution program on iron status and anemia in infants and young children in Mexico.

Abstract

Iron deficiency and anemia are public health problems in Mexican children. In 2002 the Government began the distribution of subsidized multiple-micronutrient fortified milk to low-income 4.2 million children 1–12 y. Micronutients added to 500 mL of milk (daily amount sold per child) were: 6.6 mg of iron (as gluconate), 6.6 mg of zinc (as oxide), 60 mg of vitamin C, 40.2 mcg of folic Ac. and 0.55 mcg of vitamin B12. The effectiveness on Hb and iron status was assessed in 604 children aged 12–30 mo at baseline from 24 distribution centers where the milk was sold. The 24 centers were randomly assigned to sell either fortified (FM) or not fortified (NFM) milk. Hb (by hemocue), serum ferritin (SF) and sTfR (by ELISA) concentrations were determined at baseline and 6 mo after intervention Baseline prevalences of Hb<11g/L (~44%), SF< 12ng/dL (~34%) and sTfR>3.3 mg/L (~20%) were not different between treatment groups. Program effects on anemia and iron deficiency were assessed using logistic regression models adjusting for cluster effects and for potential confounding factors. After 6 months, adjusted rates of anemia were 10 percent points (pp) lower in FM relative to NFM children (37% reduction) (FM=0.17, NFM=0.27); adjusted rates of ferritin <12 were 17 pp lower in FM relative to NFM (38% reduction) (FM=0.28, NFM=0.45) and adjusted rates of sTfR >3 were 20 pp lower in FM relative to NFM (83% reduction) (FM=0.04, NFM=0.24). We conclude that this large-scale program was effective in reducing anemia and iron deficiency in Mexican infants. Supported by Liconsa, Mexican Ministry of Social Development.