Abstract
In Cambodia, micronutrient deficiencies remain a critical public health problem. Our objective was to evaluate the impact of multi-micronutrient fortified rice (MMFR) formulations, distributed through a World Food Program school-meals program (WFP-SMP), on the hemoglobin concentrations and iron and vitamin A (VA) status of Cambodian schoolchildren. The FORISCA-UltraRice+NutriRice study was a double-blind, cluster-randomized, placebo-controlled trial. Sixteen schools participating in WFP-SMP were randomly assigned to receive extrusion-fortified rice (UltraRice Original, UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. Four additional schools not participating in WFP-SMP were randomly selected as controls. A total of 2440 schoolchildren (6–16 years old) participated in the biochemical study. Hemoglobin, iron status, estimated using inflammation-adjusted ferritin and transferrin receptors concentrations, and VA status, assessed using inflammation-adjusted retinol-binding protein concentration, were measured at the baseline, as well as at three and six months. Baseline prevalence of anemia, depleted iron stores, tissue iron deficiency, marginal VA status and VA deficiency were 15.6%, 1.4%, 51.0%, 7.9%, and 0.7%, respectively. The strongest risk factors for anemia were hemoglobinopathy, VA deficiency, and depleted iron stores (all p < 0.01). After six months, children receiving NutriRice and URN had 4 and 5 times less risk of low VA status, respectively, in comparison to the placebo group. Hemoglobin significantly increased (+0.8 g/L) after three months for the URN group in comparison to the placebo group; however, this difference was no longer significant after six months, except for children without inflammation. MMFR containing VA effectively improved the VA status of schoolchildren. The impact on hemoglobin and iron status was limited, partly by sub-clinical inflammation. MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated.
Highlights
Micronutrient deficiencies, known as hidden hunger, remain a critical public health problem affecting a third of the world’s population [1]
Results are mean SE unless stated, 1 corrected for inflammation; 2 Generalized linear mixed models adjusted for age, gender and baseline characteristics were used to evaluate the effects of timegroup interaction term, B: baseline, M: midline, E: endline, Hb: hemoglobin, FER: ferritin, TfR: transferrin receptors, UltraRice original formulation (URO): UltraRice original formula, URN: UltraRice new formula
Consumption of fortified rice had a significant effect on iron and vitamin A (VA) status when compared with the placebo group receiving normal rice
Summary
Micronutrient deficiencies, known as hidden hunger, remain a critical public health problem affecting a third of the world’s population [1]. Iron deficiency (ID), the primary cause of anemia, has adverse effects on both human health and socioeconomic development, with increased susceptibility to infections, elevated risk of maternal and child mortality, impaired cognitive and physical development of children, and lower work productivity of adults [2,3]. Like ID, vitamin A deficiency (VAD) ranks among the 15 leading causes of the global burden of disease and was estimated to be responsible for. VAD can cause xerophthalmia and impairs the immune system, thereby increasing the severity and mortality risk of infectious diseases such as measles and diarrheal disease [5]. The 2011 estimates suggest anemia affects around 800 million children and women worldwide [3]. Vitamin A, selenium, and copper have been associated with anemia [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
