Abstract
Background: Within Cambodia, micronutrient deficiencies continue to be prevalent in vulnerable groups, such as women and children. Fortification of staple foods such as rice could be a promising strategy for Cambodia to improve micronutrient status. Objective: Our objective was to investigate the impact of multiple-micronutrient fortified rice (MMFR), distributed through a World Food Program school-meals program (WFP-SMP) on serum zinc concentrations and folate status in a double-blind, cluster-randomized, placebo-controlled trial. Methods: Sixteen schools were randomly assigned to receive one of three different types of extruded-fortified rice (UltraRice Original (URO), UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. A total of 1950 schoolchildren (6–16 years old) participated in the study. Serum zinc (all groups) and folate (only in NutriRice and placebo group) concentrations were assessed from morning non-fasting antecubital blood samples and were measured at three time points (baseline and after three and six months). Results: After six months of intervention, serum zinc concentrations were significantly increased in all fortified rice group compared to placebo and baseline (0.98, 0.85 and 1.40 µmol/L for URO, URN and NutriRice, respectively) (interaction effect: p < 0.001 for all). Children in the intervention groups had a risk of zinc deficiencies of around one third (0.35, 039, and 0.28 for URO, URN, and NutriRice, respectively) compared to the placebo (p < 0.001 for all). The children receiving NutriRice had higher serum folate concentrations at endline compared to children receiving normal rice (+2.25 ng/mL, p = 0.007). Conclusions: This study showed that the high prevalence of zinc and folate deficiency in Cambodia can be improved through the provision of MMFR. As rice is the staple diet for Cambodia, MMFR should be considered to be included in the school meal program and possibilities should be explored to introduce MMFR to the general population.
Highlights
Micronutrient deficiencies remain a critical public health issue in most developing countries, affecting about one third of children and women in reproductive age [1,2]
This study showed that the provision of multiple-micronutrient fortified rice (MMFR) in a school meal program had a significant and positive impact on serum zinc concentrations and lowered the prevalence of zinc deficiency among the school children in comparison to an unfortified rice group
Similar findings of fortified rice were reported from a study in school children in Thailand [26], in which rice fortified with zinc, iron, and vitamin A provided over a five-month period increased the serum zinc concentration by 1.9 μmol/L, from 9.4 μmol/L at baseline to 11.3 μmol/L at endpoint
Summary
Micronutrient deficiencies remain a critical public health issue in most developing countries, affecting about one third of children and women in reproductive age [1,2]. Deficiencies in important micronutrients including vitamin A, iron, zinc, and folate contribute to poor growth, impaired cognitive development, and increase the risk of morbidity and mortality from infectious diseases [3]. This can lead to negative impacts on socio-economic development at individual, community, and national levels [4]. Results: After six months of intervention, serum zinc concentrations were significantly increased in all fortified rice group compared to placebo and baseline (0.98, 0.85 and 1.40 μmol/L for URO, URN and NutriRice, respectively) (interaction effect: p < 0.001 for all).
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