Abstract
Anaemia affects approximately 69 % of Indian children aged 6-12 months, with Fe deficiency (ID) being a common cause. The effectiveness of micronutrient-fortified infant cereal in improving Fe status and neurodevelopment was evaluated in non-anaemic and mildly anaemic Indian infants. An intervention group (IC) enrolled at age 6 months consumed 50 g/d of rice-based cereal providing 3·75 mg Fe/d as ferrous fumarate for 6 months (n 80) and was compared with a matched static cross-sectional control group (CG) without intervention enrolled at age 12 months (n 80). Mean Hb was higher in IC (118·1 (sd 10·2) g/l) v. CG (109·5 (sd 16·4) g/l) at age 12 months (adjusted mean difference: 9·7 g/l; 95 % CI 5·1, 14·3; P < 0·001), while geometric mean serum ferritin tended to be higher (27·0 (-1 sd 13·4, +1 sd 54·4) v. 20·3 (-1 sd 7·5, +1 sd 55·0) ng/ml); P = 0·085) and soluble transferrin receptor was lower (1·70 (-1 sd 1·19, +1 sd 2·43) v. 2·07 (-1 sd 1·29, +1 sd 3·33) mg/l; P = 0·014). Anaemia (23 v. 45 %; P = 0·007) and ID (17 v. 40 %; P = 0·003) were lower in IC v. CG. Bayley Scales of Infant and Toddler Development Third Edition scores for language (P = 0·003), motor development (P = 0·018), social-emotional (P = 0·004) and adaptive behaviour (P < 0·001), but not cognitive development (P = 0·980), were higher in IC v. CG. No significant difference in anthropometric Z-scores was observed between the groups. Consuming a micronutrient-fortified infant cereal daily for 6 months during complementary feeding promoted better Fe status while reducing the risk for anaemia and ID and was associated with superior neurodevelopmental scores.
Highlights
Infants with IDA are at risk for compromised cognitive, motor, social-emotional and neurophysiological development in the short and long term[3]
In a randomised controlled trial (RCT), Fe deficiency (ID) prevalence was reduced in Ghanaian infants receiving a micronutrient-fortified cereal-legume blend fed ad libitum and providing 12–18 mg additional Fe as electrolytic Fe compared with a control group but did not improve Hb concentration or reduce anaemia[23]
A total of ninety-nine and eighty-five infants were screened for enrolment in the IC and control group (CG), respectively, and eighty infants were recruited in each group (Fig. 1)
Summary
Infants with IDA are at risk for compromised cognitive, motor, social-emotional and neurophysiological development in the short and long term[3]. RCT using ferrous fumarate (FeF) as an Fe compound showed stronger effect on Fe status with higher Hb and serum ferritin (SF) concentration and reduced anaemia and ID in infants receiving additional 5·5 or 12·5 mg Fe/d from a micronutrient-fortified maize porridge compared with their control peers[14,25]. In Chinese infants, a low dose of approximately 1 mg additional Fe/d as FeF from a multi-fortified infant cereal fed for 12 months showed marginally improved SF concentrations and had no effect on Hb[27]. The aim of the present study was to generate data on the effectiveness of a micronutrient-fortified rice-based infant cereal providing a low to moderate dose of additional 3·75 mg Fe/d as FeF in promoting Fe status as well as investigating the effect on neurodevelopment in Indian infants. We hypothesised that infants in the IC would have better Fe status and more favourable neurodevelopmental outcomes than the infants in the CG group at 12 months of age
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