Multiple Micronutrients And Early Learning Interventions Promote Infant Micronutrient Status And Development

Abstract

BackgroundMalnutrition and lack of early learning (EL) opportunities are major causes for children not reaching their developmental potential. 
ObjectiveTo evaluate the impact of multiple micronutrient powder (MNP) and EL intervention on infants' micronutrient status and development.
Methods497 infants (6‐12 mos) were enrolled from 26 villages in rural India and randomized using a 2X2 design to receive MNP (iron, zinc, vitamins A,B2,B12, C and folic acid ) vs. placebo (B2) and EL vs. control. The EL intervention was based on the UNICEF‐developed Care for Child Development and delivered through biweekly home visits. Baseline, post‐intervention (6 mos) and follow‐up (12 mos) evaluations included 2ml venous blood and Mullens Scales of Early Learning. Data were analyzed using 2‐way ANOVA, adjusting for baseline, with MNP X EL interactions to assess intervention synergy. 
ResultsNo baseline differences (66% anemic (Hb<11 g/dL), 31% inadequate iron stores (ferritin>12 µg/L), 20% stunted (HAZ<‐2), 19% underweight (WAZ<‐2). At follow‐up, the prevalence of micronutrient (MN) deficiencies was significantly lower in the MNP group. Significant interactions in motor and language performance showed that children who received either or both interventions had better scores than children who received neither. Table 1. Percent MN Deficiencies at Follow‐Up * p < .05 MNP Placebo Infant % % Hemoglobin (< 11g/dL) * 50.2 74.2 Ferritin (<12 ug/L) * 32.6 81.6 Transferrin receptor (> 2mg/L) * 44.1 81.7 Vitamin B12 (<200p/mL) * 2.6 9.1 Zinc (<65 ug/dL) 2.1 1.8 Table 2. MNP x EL Interaction at Post Intervention: Mean (SE) * p<.05 MNP Placebo EL Control EL Control Gross Motor 50.2 (1.0) 51.8 (1.0) 51.7 (1.0) 48.7 (1.0) * Language 38.9 (0.6) 39.3 (0.6) 40.3 (0.6) 48.1 (0.6) * ConclusionHome MNP and EL can improve infant MN status and development.