Abstract
BackgroundHome fortification using sachets of micronutrient powder (e.g. “Sprinkles”) is a food-based approach offering an alternative to high dose vitamin A (VA) supplements for infants. The primary objective was to investigate the impact of VA-home fortification on infant VA pool size. The secondary objective was to compare VA status of infants assessed by the modified relative dose response (MRDR) test before and the 13C-retinol isotope dilution (13C-RID) test in the same infants after vitamin A supplementation.MethodsA randomized-controlled trial was conducted in 7–9 month old infants in Ghana. Eligible children were randomly allocated to receive a daily sachet of “Sprinkles” with or without VA for 5 months added to complementary foods. The MRDR test indirectly determined VA liver reserves at baseline and the 13C-RID determined VA body pool at follow-up in the same cohort of children.ResultsAt baseline, the MRDR values (95 % CI) for infants were comparable in the intervention and control groups: normal at 0·032 (SD 0·018) (0·025–0·038) and 0·031 (SD 0·018) (0·024–0·038), respectively. After intervention, total body stores (TBS) and liver retinol concentrations did not differ between intervention and control groups; TBS were 436 (SD 303) and 434 (SD 186) μmol, respectively, and estimated liver concentrations were 0·82 (SD 0·53) and 0·79 (SD 0·36) μmol/g liver, indicating adequate reserves in all children.ConclusionsBoth the MRDR and 3C-RID tests confirmed that the infants had adequate VA status before and after home fortification of their complementary foods. These tests offered more information than serum retinol concentrations alone, which predicted VA deficiency using current suggested cutoffs not corrected for inflammation status.
Highlights
Home fortification using sachets of micronutrient powder (e.g. “Sprinkles”) is a food-based approach offering an alternative to high dose vitamin A (VA) supplements for infants
The primary objective of this study was to investigate the impact of VA-home fortification on infant VA pool size using the 13C-retinol isotope dilution (13C-RID) test at follow-up among children who received “Sprinkles” with or without VA added to complementary foods
This study explored the use of stable 13C-tracer methodology to assess the VA body pool size in infants who were followed for a 5-months period of micronutrient home fortification with and without VA
Summary
Home fortification using sachets of micronutrient powder (e.g. “Sprinkles”) is a food-based approach offering an alternative to high dose vitamin A (VA) supplements for infants. Infants in developing countries deviate from this satisfactory growth pattern after this period [1]. This has been attributed to lack of nutrient-dense complementary foods and is further exacerbated by persistent micronutrient deficiencies [2] making children in developing countries vulnerable to diseases and death. Newton et al Archives of Public Health (2016) 74:10 supplements are an effective way to ward off the deleterious effects of VA deficiency [10], and reduce mortality [11] and severe morbidity [12, 13] in children 1–5 y of age in less developed countries. Before an infant is introduced to complementary foods, the mother may not be able to provide enough VA to boost the child’s liver stores if she herself has low VA stores [14] or does not consume rich sources of VA during lactation
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