Abstract
Background: Four fortified complementary food supplements (CFSs) in a randomized controlled trial (RCT) were found to improve childhood linear growth in rural Bangladesh. We hypothesized children receiving these supplements would have improved micronutrient status. Methods: In the RCT, we assessed hemoglobin and serum ferritin, retinol, zinc, C-reactive protein (CRP), and α-1-acid glycoprotein (AGP) at endline (18 mo) in a subsample of children (n = 752). The impact of supplementation on mean concentrations and the prevalence of nutrient deficiency and inflammation were evaluated using adjusted generalized estimating equation (GEE) linear and log-binomial regression models. Results: In the control arm at age 18 months, 13% of children were anemic (hemoglobin < 110 g/L), and 6% were iron (inflammation-adjusted ferritin < 12 μg/L), 8% vitamin A (inflammation-adjusted retinol < 0.70 μmol/L), and 5% zinc (zinc < 9.9 μmol/L) deficient. The prevalence of inflammation by CRP (>5 mg/L) and AGP (>1 g/L) was 23% and 66%, respectively, in the control group. AGP trended lower in CFS groups (p = 0.04), while CRP did not. Mean ferritin (p < 0.001) and retinol (p = 0.007) were higher in all supplemented groups relative to control, whereas hemoglobin improved with two of the four CFSs (p = 0.001), and zinc was equal or lower in supplemented groups relative to control (p = 0.017). Conclusions: CFSs improved iron status and vitamin A concentrations and lowered inflammation in a context of low underlying nutrient deficiency but high inflammation.
Highlights
Micronutrient deficiencies, especially vitamin A, iron, zinc, and iodine, commonly affect children in low- and middle-income countries, often coexisting with stunting and wasting [1,2]
Iron deficiency impairs cognitive development and immune function [3,4,5], vitamin A is required for immune function [6,7], and mild zinc deficiency is associated with stunted linear growth, impaired immune function, and increased severity of diarrhea and pneumonia [8,9]
Zinc concentrations did not differ by group, and zinc deficiency was low at about 4% in the control group
Summary
Micronutrient deficiencies, especially vitamin A, iron, zinc, and iodine, commonly affect children in low- and middle-income countries, often coexisting with stunting and wasting [1,2]. Iron deficiency impairs cognitive development and immune function [3,4,5], vitamin A is required for immune function [6,7], and mild zinc deficiency is associated with stunted linear growth, impaired immune function, and increased severity of diarrhea and pneumonia [8,9]. Prevalence of these deficiencies in South Asia are among the highest worldwide [2,10,11]. Four fortified complementary food supplements (CFSs) in a randomized controlled trial (RCT) were found to improve childhood linear growth in rural Bangladesh.
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