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Multicenter Study
. 2017 Oct;13(4):e12403.
doi: 10.1111/mcn.12403. Epub 2016 Dec 7.

The impact of home fortification with multiple micronutrient powder on vitamin A status in young children: A multicenter pragmatic controlled trial in Brazil

Lara Livia Santos Silva  1 , Rosângela Aparecida Augusto  1 , Daniela Cardoso Tietzmann  2 , Leopoldina Augusta Souza Sequeira  3 , Maria Claret Costa Monteiro Hadler  4 , Pascoal Torres Muniz  5 , Pedro Israel Cabral de Lira  3 , Marly Augusto Cardoso  1 ; ENFAC Working Group
Affiliations
Multicenter Study

The impact of home fortification with multiple micronutrient powder on vitamin A status in young children: A multicenter pragmatic controlled trial in Brazil

Lara Livia Santos Silva et al. Matern Child Nutr. 2017 Oct.

Abstract

Home fortification with multiple micronutrient powder (MNP) is effective in the prevention of anemia in young children. However, the impact on their vitamin A status remains controversial. This study aimed to evaluate the effect of MNP on vitamin A status in young Brazilian children. A multicenter pragmatic, controlled trial was carried out in primary health centers in four Brazilian cities. In the beginning of the study, the control group (CG) consisted of children 11-14 months old (n = 395) attending in routine pediatric health care. In parallel, the intervention group (IG) was composed of children 6-8 months old (n = 399), in the same health centers, who followed the intervention with MNP for 2-3 months. The analysis of the effect of MNP on vitamin A status was performed by comparing the IG with the CG after a 4- to 6-month follow-up when IG children had reached the age of the controls. The prevalence of vitamin A deficiency (VAD; serum retinol <0.70 μmol/L) in the CG was 16.2%, while in the IG was 7.5%-a 55% reduction in the VAD [prevalence ratio (95% confidence interval) = 0.45 (0.28; 0.72)]. This reduction was also significant when stratifying the study centers by coverage of the Brazilian Vitamin A Supplementation Program. The adjusted mean of vitamin A serum concentrations improved in the IG compared with CG children, with a shift to the right in the vitamin A distribution. Home fortification with MNP was effective in reducing VAD among young Brazilian children.

Keywords: home fortification; micronutrients; multiple micronutrient powder; primary health care; vitamin A; young children.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart for the participants from the Estudo Nacional de Fortificação caseira da Alimentação Complementar for analysis of vitamin A status
Figure 2
Figure 2
Prevalence (%) of vitamin A deficiency and prevalence ratio (PR and 95% confidence interval in parentheses) for all children (n = 792), children from cities without NVASP (n = 390), and children from cities covered by NVASP (n = 400), adjusted for city, primary health center, maternal education, maternal age, and child age, according to study groups. Vitamin A deficiency defined as serum retinol <0.70 μmol/L. CG = control group; IG = intervention group; NVASP = the National Vitamin A Supplementation Program
Figure 3
Figure 3
Relative frequency of serum vitamin A concentrations adjusted for city, primary health center, maternal education, maternal age, and child age in multilevel linear regression analysis (kdensity and normalden STATA procedures) by study groups. CG = control group; IG = intervention group; SE = standard error
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References

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