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Meta-Analysis
. 2017 Nov 23;11(11):CD009666.
doi: 10.1002/14651858.CD009666.pub2.

Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age

Luz Maria De-Regil  1 , Maria Elena D Jefferds, Juan Pablo Peña-Rosas
Affiliations
Meta-Analysis

Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age

Luz Maria De-Regil et al. Cochrane Database Syst Rev. .

Abstract

Background: Approximately 600 million children of preschool and school age are anaemic worldwide. It is estimated that at least half of the cases are due to iron deficiency. Point-of-use fortification of foods with micronutrient powders (MNP) has been proposed as a feasible intervention to prevent and treat anaemia. It refers to the addition of iron alone or in combination with other vitamins and minerals in powder form, to energy-containing foods (excluding beverages) at home or in any other place where meals are to be consumed. MNPs can be added to foods either during or after cooking or immediately before consumption without the explicit purpose of improving the flavour or colour.

Objectives: To assess the effects of point-of-use fortification of foods with iron-containing MNP alone, or in combination with other vitamins and minerals on nutrition, health and development among children at preschool (24 to 59 months) and school (five to 12 years) age, compared with no intervention, a placebo or iron-containing supplements.

Search methods: In December 2016, we searched the following databases: CENTRAL, MEDLINE, Embase, BIOSIS, Science Citation Index, Social Science Citation Index, CINAHL, LILACS, IBECS, Popline and SciELO. We also searched two trials registers in April 2017, and contacted relevant organisations to identify ongoing and unpublished trials.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs trials with either individual or cluster randomisation. Participants were children aged between 24 months and 12 years at the time of intervention. For trials with children outside this age range, we included studies where we were able to disaggregate the data for children aged 24 months to 12 years, or when more than half of the participants were within the requisite age range. We included trials with apparently healthy children; however, we included studies carried out in settings where anaemia and iron deficiency are prevalent, and thus participants may have had these conditions at baseline.

Data collection and analysis: Two review authors independently assessed the eligibility of trials against the inclusion criteria, extracted data from included trials, assessed the risk of bias of the included trials and graded the quality of the evidence.

Main results: We included 13 studies involving 5810 participants from Latin America, Africa and Asia. We excluded 38 studies and identified six ongoing/unpublished trials. All trials compared the provision of MNP for point-of-use fortification with no intervention or placebo. No trials compared the effects of MNP versus iron-containing supplements (as drops, tablets or syrup).The sample sizes in the included trials ranged from 90 to 2193 participants. Six trials included participants younger than 59 months of age only, four included only children aged 60 months or older, and three trials included children both younger and older than 59 months of age.MNPs contained from two to 18 vitamins and minerals. The iron doses varied from 2.5 mg to 30 mg of elemental iron. Four trials reported giving 10 mg of elemental iron as sodium iron ethylenediaminetetraacetic acid (NaFeEDTA), chelated ferrous sulphate or microencapsulated ferrous fumarate. Three trials gave 12.5 mg of elemental iron as microencapsulated ferrous fumarate. Three trials gave 2.5 mg or 2.86 mg of elemental iron as NaFeEDTA. One trial gave 30 mg and one trial provided 14 mg of elemental iron as microencapsulated ferrous fumarate, while one trial gave 28 mg of iron as ferrous glycine phosphate.In comparison with receiving no intervention or a placebo, children receiving iron-containing MNP for point-of-use fortification of foods had lower risk of anaemia prevalence ratio (PR) 0.66, 95% confidence interval (CI) 0.49 to 0.88, 10 trials, 2448 children; moderate-quality evidence) and iron deficiency (PR 0.35, 95% CI 0.27 to 0.47, 5 trials, 1364 children; moderate-quality evidence) and had higher haemoglobin (mean difference (MD) 3.37 g/L, 95% CI 0.94 to 5.80, 11 trials, 2746 children; low-quality evidence).Only one trial with 115 children reported on all-cause mortality (zero cases; low-quality evidence). There was no effect on diarrhoea (risk ratio (RR) 0.97, 95% CI 0.53 to 1.78, 2 trials, 366 children; low-quality evidence).

Authors' conclusions: Point-of-use fortification of foods with MNPs containing iron reduces anaemia and iron deficiency in preschool- and school-age children. However, information on mortality, morbidity, developmental outcomes and adverse effects is still scarce.

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Conflict of interest statement

  1. LD‐R is a full‐time staff member of Nutrition International (formerly Micronutrient Initiative), an international non‐for‐profit organisation that delivers multiple micronutrient powders (MNP) to children, women of reproductive age and pregnant women. Nutrition International supports the implementation of large‐scale research projects that provide multiple MPN to children aged six to 23 months. None of them met the inclusion criteria of this review (Criteria for considering studies for this review). Nutrition International is a partner of the Home Fortification Technical Advisory Group and receives funds from the Canadian Department of Foreign Affairs. LD‐R was an Editor for the Cochrane Developmental, Psychosocial and Learning Problems Group.

  2. MJ participated in UNICEF/Centers for Disease Control and Prevention (CDC) regional workshops on scaling up MNP interventions for young children aged six to 23 months; is coauthor on two publications included in a September 2013 Sign and Life supplement on MNP interventions and was an editor of the supplement. MJ is the lead author or coauthor of multiple journal articles on MNP programmes. She was an investigator on the first global assessment of home fortification interventions (UNICEF/CDC 2013) and provided technical assistance on the design, analysis and dissemination of the results of the 2013 and later MNP global assessment (UNICEF 2014). With colleagues from CDC and UNICEF, MJ provides technical assistance in the development of a home fortification toolkit and webinar series, which have a heavy focus on MNP. She also co‐ordinated and wrote the Monitoring Manual for Home Fortification Interventions, including MNP, (HF‐TAG 2013) for the Home Fortification Technical Advisory Group (HF‐TAG). MJ has participated in executive committee meetings and strategic planning of the HF‐TAG, and became a member of the executive committee in 2016. She is a coauthor on a Cochrane Review of MNP interventions in children six to 23 months (De‐Regil 2011b).

  3. JP‐R co‐ordinates the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, which received financial resources for the biennium 2016 to 2017 from the Bill & Melinda Gates Foundation (2013 to 2019); US CDC (2014 to 2019); Nutrition International (formerly Micronutrient Initiative) (2014 to 2017) and United States Agency for International Development (USAID; 2014 to 2017). Donors do not fund specific guidelines and do not participate in any decision related to the guideline development process, including the composition of policy questions, membership of the guideline groups, the conduct and interpretation of systematic reviews, or the formulation of recommendations.

Disclaimer: Luz Maria De‐Regil is a full‐time staff member of Nutrition International (formerly Micronutrient Initiative), Maria Elena del Socorro Jefferds is full‐time staff member of the US CDC, and Juan Pablo Peña‐Rosas is full‐time staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the official position, decisions, policy or views of these organisations.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Point‐of‐use fortification of foods with micronutrients powders versus no intervention/placebo, outcome: 1.11 Haemoglobin (g/L).
1.1
1.1. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 1 Anaemia.
1.2
1.2. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 2 Anaemia by anaemic status of participants at start of intervention.
1.3
1.3. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 3 Anaemia by age of children at start of intervention.
1.4
1.4. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 4 Anaemia by malaria status of study site at time of trial.
1.5
1.5. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 5 Anaemia by frequency.
1.6
1.6. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 6 Anaemia by duration of intervention.
1.7
1.7. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 7 Anaemia by iron content of product.
1.8
1.8. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 8 Anaemia by type of iron compound.
1.9
1.9. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 9 Anaemia by number of nutrients accompanying iron.
1.10
1.10. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 10 Anaemia by micronutrient composition.
1.11
1.11. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 11 Haemoglobin (g/L).
1.12
1.12. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 12 Haemoglobin by anaemic status of participants at start of intervention (g/L).
1.13
1.13. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 13 Haemoglobin by age of children at start of intervention.
1.14
1.14. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 14 Haemoglobin by malaria status of study site at time of trial.
1.15
1.15. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 15 Haemoglobin by frequency (g/L).
1.16
1.16. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 16 Haemoglobin by duration of intervention.
1.17
1.17. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 17 Haemoglobin by iron content of product.
1.18
1.18. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 18 Haemoglobin by type of iron compound (g/L).
1.19
1.19. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 19 Haemoglobin by number of nutrients accompanying iron (g/L).
1.20
1.20. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 20 Haemoglobin by micronutrient composition (g/L).
1.21
1.21. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 21 Iron deficiency.
1.22
1.22. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 22 Iron deficiency by anaemia status at start of intervention.
1.23
1.23. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 23 Iron deficiency by age of children at start of intervention.
1.24
1.24. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 24 Iron deficiency by malaria status of study site at time of trial.
1.25
1.25. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 25 Iron deficiency by frequency.
1.26
1.26. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 26 Iron deficiency by duration of intervention.
1.27
1.27. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 27 Iron deficiency by iron content of product.
1.28
1.28. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 28 Iron deficiency by type of iron compound.
1.29
1.29. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 29 Iron deficiency by number of nutrients accompanying iron.
1.30
1.30. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 30 Iron deficiency by micronutrient composition.
1.31
1.31. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 31 Ferritin (μg/L).
1.32
1.32. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 32 All‐cause mortality.
1.33
1.33. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 33 Diarrhoea.
1.34
1.34. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 34 Adverse effects.
1.35
1.35. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 35 Iron deficiency anaemia.
1.36
1.36. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 36 All‐cause morbidity.
1.37
1.37. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 37 Acute respiratory infection.
1.38
1.38. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 38 Growth (height‐for‐age Z‐score).
1.39
1.39. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 39 Growth (weight‐for‐age Z‐score).
1.40
1.40. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 40 Growth (weight‐for‐height Z‐score).
1.41
1.41. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 41 Adherence.
1.42
1.42. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 42 Serum/plasma retinol (mmol/L).
1.43
1.43. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 43 Serum/plasma zinc concentrations (mmol/L).
1.44
1.44. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 44 Iron status (iron‐binding capacity) (non‐prespecified) (µmol/kg).
1.45
1.45. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 45 Iron status (serum‐transferrin receptors; non‐prespecified) (mg/L).
1.46
1.46. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 46 Serum vitamin E (non‐prespecified) (µg/dL).
1.47
1.47. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 47 Serum vitamin B12 (non‐prespecified) (pg/mL).
1.48
1.48. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 48 Zinc deficiency (non‐prespecified).
1.49
1.49. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 49 Vitamin A deficiency (non‐prespecified).
1.50
1.50. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 50 Serum folate concentration (ng/mL).
1.51
1.51. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 51 Height (non‐prespecified) (cm).
1.52
1.52. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 52 Weight (non‐prespecified) (kg).
1.53
1.53. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 53 Fever (non‐prespecified).
1.54
1.54. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 54 Stunting (non‐prespecified).
1.55
1.55. Analysis
Comparison 1 Point‐of‐use fortification of foods with micronutrients powders (MNP) versus no intervention or placebo, Outcome 55 Angular stomatitis (non‐prespecified).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009666

References

References to studies included in this review

Inayati 2012 (C) {published data only}
    1. Inayati DA, Scherbaum V, Purwestri RC, Wirawan NN, Suryantan J, Hartono S, et al. Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia. Asia Pacific Journal of Clinical Nutrition 2012;21(3):361‐73. [PUBMED: 22705425] - PubMed
    1. Inayati DA, Scherbaum V, Purwestri RC, Wirawan NN, Suryantan J, Hartono S, et al. Improved nutrition knowledge and practice through intensive nutrition education: a study among caregivers of mildly wasted children on Nias Island, Indonesia. Food and Nutrition Bulletin 2012;33(2):117‐27. [DOI: 10.1177/156482651203300205; PUBMED: 22908693] - DOI - PubMed
    1. Purwestri RC, Scherbaum V, Inayati DA, Wirawan NN, Suryantan J, Bloem MA, et al. Supplementary feeding with locally‐produced ready‐to‐use food (RUF) for mildly wasted children on Nias Island, Indonesia: comparison of daily and weekly programme outcomes. Asia Pacific Journal of Clinical Nutrition 2012;21(3):374‐9. [PUBMED: 22705426] - PubMed
    1. Scherbaum V [pers comm]. Your paper on MNP. Email to: LM De‐Regil 5 February 2013.
Kemmer 2012 (C) {published data only}
    1. Kemmer TM, Omer PS, Gidvani‐Diaz VK, Coello M. Acceptance and effect of ferrous fumarate containing micronutrient sprinkles on anemia, iron deficiency and anthropometrics in Honduran children. In: Silverberg DS editor(s). Anemia. Rijeka (Croatia): InTech, 2012. [DOI: 10.5772/30987] - DOI
Kounnavong 2011 (C) {published data only}
    1. Kounnavong S, Sunahara T, Mascie‐Taylor CG, Hashizume M, Okumura J, Moji K, et al. Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial. Nutrition Journal 2011;10(129):1‐11. [DOI: 10.1186/1475-2891-10-129; PMC3266642; PUBMED: 22111770] - DOI - PMC - PubMed
Lundeen 2010 (C) {published and unpublished data}
    1. Lundeen E [pers comm]. Kyrgyz Republic MNP data for children 24‐36 months. Email to: M Jefferds 3 November 2011.
    1. Lundeen E, Schueth T, Toktobaev N, Zlotkin S, Hyder SM, Houser R. Daily use of Sprinkles micronutrient powder for 2 months reduces anemia among children 6 to 36 months of age in the Kyrgyz Republic: a cluster‐randomized trial. Food and Nutrition Bulletin 2010;31(3):446‐60. [DOI: 10.1177/156482651003100307; PUBMED: 20973465] - DOI - PubMed
Macharia‐Mutie 2012 {published data only}
    1. Macharia‐Mutie CW, Moretti D, Briel N, Omusundi AM, Mwangi AM, Kok FJ, et al. Maize porridge enriched with a micronutrient powder containing low‐dose iron as NaFeEDTA but not amaranth grain flour reduces anemia and iron deficiency in Kenyan preschool children. Journal of Nutrition 2012;142(9):1756‐63. [DOI: 10.3945/jn.112.157578; PUBMED: 22810982] - DOI - PubMed
    1. Macharia‐Mutie CW, Omusundi AM, Mwai JM, Mwangi AM, Brouwer ID. Simulation of the effect of maize porridge fortified with grain amaranth or micronutrient powder containing NaFeEDTA on iron intake and status in Kenyan children. Public Health Nutrition 2013;16(9):1605‐13. [DOI: 10.1017/S1368980012005174; PUBMED: 23218415] - DOI - PMC - PubMed
Ogunlade 2011 {published and unpublished data}
    1. Jerling J [pers comm]. Regards and question on Ogundale et al 2011 vir Cochrane review. Email to: JP Pena‐Rosas 3 November 2011.
    1. Ogunlade AO, Kruger HS, Jerling JC, Smuts CM, Covic N, Hanekom SM, et al. Point‐of‐use micronutrient fortification: lessons learned in implementing a preschool‐based pilot trial in South Africa. International Journal of Food Sciences and Nutrition 2011;62(1):1‐16. [DOI: 10.3109/09637486.2010.495710; PUBMED: 20701549] - DOI - PubMed
Orozco 2015 (C) {published data only}
    1. Orozco J, Vargas C, Rojas ML, Herrera AM, Montoya L, Sánchez JG, et al. The effect of powdered micronutrients on the hematologic values and nutritional status of healthy preschoolers. Medellín, 2013 [Efecto de los micronutrientes en polvo en el estado nutricional y en los valores hemáticos de preescolares sanos. Medellín, 2013]. Revista Facultad Nacional de Salud Pública 2015;33(2):161‐70. [DOI: 10.17533/udea.rfnsp.v33n2a03] - DOI
Osei 2008 (C) {published data only}
    1. Osei AK, Houser RF, Bulusu S, Hamer DH. Acceptability of micronutrient fortified school meals by schoolchildren in rural Himalayan villages of India. Journal of Food Science 2008;73(7):S354‐8. [DOI: 10.1111/j.1750-3841.2008.00878.x; PUBMED: 18803728] - DOI - PubMed
    1. Osei AK, Rosenberg IH, Houser RF, Bulusu S, Mathews M, Hamer DH. Community‐level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India. Journal of Nutrition 2010;140(6):1146‐54. [DOI: 10.3945/jn.109.114751; PUBMED: 20410083] - DOI - PubMed
Sharieff 2006 (C) {published data only}
    1. Sharieff W, Yin SA, Wu M, Yang Q, Schauer C, Tomlinson G, et al. Short‐term daily or weekly administration of micronutrient Sprinkles has high compliance and does not cause iron overload in Chinese schoolchildren: a cluster‐randomized trial. Public Health Nutrition 2006;9(3):336‐44. [PUBMED: 16684385] - PubMed
    1. Zlotkin S [pers comm]. Regards and question ‐ Sharieff 2006. Email to: JP Peña‐Rosas 2 November 2011.
Troesch 2011b {published data only}
    1. Troesch B [pers comm]. Regards and question on Troesch et al 2011. Email to: JP Peña‐Rosas 1 November 2011.
    1. Troesch B, Stuijvenberg ME, Smuts CM, Kruger HS, Biebinger R, Hurrell RF, et al. A micronutrient powder with low doses of highly absorbable iron and zinc reduces iron and zinc deficiency and improves weight‐for‐age Z‐scores in South African children. Journal of Nutrition 2011;141(2):237‐42. [DOI: 10.3945/jn.110.129247; PUBMED: 21178093] - DOI - PubMed
Varma 2007 (C) {published data only}
    1. Varma JL, Das S, Sankar R, Mannar MG, Levinson FJ, Hamer DH. Community‐level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36‐66 mo. American Journal of Clinical Nutrition 2007;85(4):1127‐33. [PUBMED: 17413115] - PubMed
Vinodkumar 2006 (C) {published data only}
    1. Vinodkumar M, Rajagopalan S. Impact of a multiple‐micronutrient food supplement on the nutritional status of schoolchildren. Food and Nutrition Bulletin 2006;27(3):203‐10. [DOI: 10.1177/156482650602700302; PUBMED: 17542110] - DOI - PubMed
Vinodkumar 2009 (C) {published data only}
    1. Vinodkumar M, Rajagopalan S. Efficacy of fortification of school meals with ferrous glycine phosphate and riboflavin against anemia and angular stomatitis in schoolchildren. Food and Nutrition Bulletin 2009;30(3):260‐4. [DOI: 10.1177/156482650903000307; PUBMED: 19927606] - DOI - PubMed

References to studies excluded from this review

Aboud 2011 {published data only}
    1. Aboud FE, Akhter S. A cluster‐randomized evaluation of a responsive stimulation and feeding intervention in Bangladesh. Pediatrics 2011;127(5):e1191‐7. [DOI: 10.1542/peds.2010-2160; PUBMED: 21502222] - DOI - PubMed
    1. Aboud FE, Moore AC, Akhter S. Effectiveness of a community‐based responsive feeding programme in rural Bangladesh: a cluster randomized field trial. Maternal and Child Nutrition 2008;4(4):275‐86. [DOI: 10.1111/j.1740-8709.2008.00146.x; PUBMED: 18811792] - DOI - PMC - PubMed
    1. Aboud FE, Shafique S, Akhter S. A responsive feeding intervention increases children’s self‐feeding and maternal responsiveness but not weight gain. Journal of Nutrition 2009;139(9):1738‐43. [DOI: 10.3945/jn.109.104885; PUBMED: 19587124] - DOI - PubMed
Ahmed 2003 {published data only}
    1. Ahmed P, Mahmood A, Aziz S, Azim W. Comparison of response between food supplemented with powdered iron and iron in syrup form for iron deficiency anemia. Journal of the College of Physicians and Surgeons Pakistan 2003;13(7):402‐4. [DOI: ; PUBMED: 12887843] - PubMed
Angdembe 2015 {published data only}
    1. Angdembe MR, Choudhury N, Haque MR, Ahmed T. Adherence to multiple micronutrient powder among young children in rural Bangladesh: a cross‐sectional study. BMC Public Health 2015;15(440):1‐10. [DOI: 10.1186/s12889-015-1752-z; PMC4424501; PUBMED: 25925874] - DOI - PMC - PubMed
Bagni 2009 (C) {published data only}
    1. Bagni UV, Baião MR, Souza MM, Luiz RR, Veiga GV. Effect of weekly rice fortification with iron on anaemia prevalence and haemoglobin concentration among children attending public daycare centres in Rio de Janeiro, Brazil [Efeito da fortificaçao semanel do arroz com ferro quelato sobre a frequencia de anemia e concentraçao de hemoglobina em crianças de creches municipais de Rio de Janeiro, Brasil]. Cadernos de Saude Publica 2009;25(2):291‐302. [PUBMED: 19219236] - PubMed
Chen 2008 {published and unpublished data}
    1. Chen K, Li TY, Chen L, Qu P, Liu YX. Effects of vitamin A, vitamin A plus iron and multiple micronutrient‐fortified seasoning powder on preschool children in a suburb of Chongqing, China. Journal of Nutritional Science and Vitaminology 2008;54(6):440‐7. [PUBMED: 19155581] - PubMed
    1. Chen K, Zhang X, Li TY, Chen L, Wei XP, Qu P, et al. Effect of vitamin A, vitamin A plus iron and multiple micronutrient‐fortified seasoning powder on infectious morbidity of preschool children. Nutrition 2011;27(4):428‐34. [DOI: 10.1016/j.nut.2010.04.004; PUBMED: 20605698] - DOI - PubMed
    1. Dr Chen [per comm]. Regards and question on study: effect of vitamin A, vitamin A plus iron and multiple micronutrient‐fortified seasoning powder on infectious morbidity of preschool children. Email to: JP Pena‐Rosas 1 November 2011. - PubMed
Clarke 2015 {published data only}
    1. Clarke SE, Sacko M, Roschnik N, Dicko Y, Diarra S, Thera P, et al. Seasonal malaria chemoprevention combined with micronutrient supplementation delivered through community preschools: findings from a cluster randomized trial in Mali. Tropical Medicine & International Health 2015;20(Suppl 1):25‐6.
De Pee 2007 {published data only}
    1. Pee S, Moench‐Pfanner R, Martini E, Zlotkin SH, Darnton‐Hill I, Bloem MW. Home fortification in emergency response and transition programming: experiences in Aceh and Nias, Indonesia. Food and Nutrition Bulletin 2007;28(2):189‐97. [DOI: 10.1177/156482650702800208; PUBMED: 24683678] - DOI - PubMed
Geltman 2009 {published data only}
    1. Geltman PL, Hironaka LK, Mehta SD, Padilla P, Rodrigues P, Meyers AF, et al. Iron supplementation of low‐income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops. Journal of Pediatrics 2009;154(5):738‐43. - PubMed
Gibson 2010 {published data only}
    1. Gibson R. Fortifying day‐care meals with desiccated beef liver or micronutrient sprinkles to combat anaemia and micronutrient deficiencies in Brazillian pre‐school children. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12610000646044 Date first registered: 9 August 2010.
    1. Gibson R [pers comm]. Regards and question. Email to: JP Peña‐Rosas 9 February 2017.
Hirve 2007 {published and unpublished data}
    1. Hirve S, Bhave S, Bavdekar A, Naik S, Pandit A, Schauer C, et al. Low dose 'Sprinkles' ‐ an innovative approach to treat iron deficiency anemia in infants and young children. Indian Pediatrics 2007;44(2):91‐100. [PUBMED: 17351300] - PubMed
Huamán‐Espino 2012 {published data only}
    1. Huamán‐Espino L, Aparco JP, Nuñez‐Robles E, Gonzáles E, Pillaca J, Mayta‐Tristán P. Consumption of chispitas® multimicronutrient supplements and anemia in 6–35‐month‐old children: cross‐cut study in the context of a populational health intervention in Apurimac, Peru [Consumo de suplementos con multimicronutrientes Chispitas® y anemia en niños de 6 a 35 meses: estudio transversal en el contexto de una intervención poblacional en Apurímac, Perú]. Revista Peruana de Medicina Experimental y Salud Publica 2012;29(3):314‐23. [PUBMED: 23085791] - PubMed
    1. Munayco CV, Ulloa‐Rea ME, Medina‐Osis J, Lozano‐Revollar CR, Tejada V, Castro‐Salazar C, et al. Evaluation of the impact of multiple micronutrient powders on children anemia in three Andean regions in Peru [Evaluación del impacto de los multimicronutrientes en polvo sobre la anemia infantil en tres regiones andinas del Perú]. Revista Peruana de Medicina Experimental y Salud Publica 2013;30(2):229‐34. [PUBMED: 23949507] - PubMed
Ip 2009 {published data only}
    1. Ip H, Hyder SM, Haseen F, Rahman M, Zlotkin SH. Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control. European Journal of Clinical Nutrition 2009;63(2):165‐72. [DOI: 10.1038/sj.ejcn.1602917; PUBMED: 17895911] - DOI - PubMed
Jack 2012 {published data only}
    1. Jack SJ, Ou K, Chea M, Chhin L, Devenish R, Dunbar M, et al. Effect of micronutrient sprinkles on reducing anemia: a cluster‐randomized effectiveness trial. Archives of Pediatrics & Adolescent Medicine 2012;166(9):842‐50. [DOI: 10.1001/archpediatrics.2012.1003; PUBMED: 22801933] - DOI - PubMed
Jaeggi 2015 {published data only}
    1. Barth‐Jaeggi T, Moretti D, Kvalsvig J, Holding PA, Njenga J, Mwangi A, et al. In‐home fortification with 2.5 mg iron as NaFeEDTA does not reduce anaemia but increases weight gain: a randomised controlled trial in Kenyan infants. Maternal & Child Nutrition 2015;11(Suppl 4):151‐62. [DOI: 10.1111/mcn.12163; PUBMED: 25420455] - DOI - PMC - PubMed
    1. Jaeggi T, Kortman GA, Moretti D, Chassard C, Holding P, Dostal A, et al. Iron fortification adversely affects the gut microbiome, increases pathogen abundance and induces intestinal inflammation in Kenyan infants. Gut 2015;64(5):731‐42. [DOI: 10.1136/gutjnl-2014-307720; PUBMED: 25143342] - DOI - PubMed
    1. Zimmermann M, Kvalsvig J. Changes in microbiota and iron status after iron fortification of complementary foods. clinicaltrials.gov/ct2/show/NCT01111864 Date first received: 23 April 2010.
Khan 2014 {published data only}
    1. Khan WU, Shafique S, Shikder H, Shakur YA, Sellen DW, Chowdhury JS, et al. Home fortification with calcium reduces Hb response to iron among anaemic Bangladeshi infants consuming a new multi‐micronutrient powder formulation. Public Health Nutrition 2014; Vol. 17, issue 7:1578‐86. [DOI: 10.1017/S1368980013001742; PUBMED: 23816321] - DOI - PMC - PubMed
Kikafunda 1998 {published data only}
    1. Kikafunda JK, Walker AF, Allan EF, Tumwine JK. Effect of zinc supplementation on growth and body composition of Ugandan preschool children: a randomized, controlled, intervention trial. American Journal of Clinical Nutrition 1998;68(6):1261‐6. [PUBMED: 9846856] - PubMed
Manger 2008 {published data only}
    1. Manger MS, McKenzie JE, Winichagoon P, Gray A, Chavasit V, Pongcharoen T, et al. A micronutrient‐fortified seasoning powder reduces morbidity and improves short‐term cognitive function, but has no effect on anthropometric measures in primary school children in northeast Thailand: a randomized controlled trial. American Journal of Clinical Nutrition 2008;87(6):1715‐22. [PUBMED: 18541560] - PubMed
    1. Winichagoon P, McKenzie JE, Chavasit V, Pongcharoen T, Gowachirapant S, Boonpraderm A, et al. A multimicronutrient‐fortified seasoning powder enhances the hemoglobin, zinc, and iodine status of primary school children in North East Thailand: a randomized controlled trial of efficacy. Journal of Nutrition 2006;136(6):1617‐23. [PUBMED: 16702330] - PubMed
Menon 2007 {published and unpublished data}
    1. Loechl CU, Menon P, Arimond M, Ruel MT, Pelto G, Habicht JP, et al. Using programme theory to assess the feasibility of delivering micronutrient Sprinkles through a food‐assisted maternal and child health and nutrition programme in rural Haiti. Maternal and Child Nutrition 2009;5(1):33‐48. [DOI: 10.1111/j.1740-8709.2008.00154.x; PUBMED: 19161543] - DOI - PMC - PubMed
    1. Menon P, Ruel MT, Loechl CU, Arimond M, Habicht JP, Pelto G, et al. Micronutrient Sprinkles reduce anemia among 9‐ to 24‐mo‐old children when delivered through an integrated health and nutrition program in rural Haiti. Journal of Nutrition 2007;137(4):1023‐30. [PUBMED: 17374671] - PubMed
Menon 2016 {published data only}
    1. Frongillo EA, Nguyen PH, Saha KK, Sanghvi T, Afsana K, Hague R, et al. Large‐scale behavior‐change initiative for infant and young child feeding advanced language and motor development in a cluster‐randomized program evaluation in Bangladesh. Journal of Nutrition 2017;147(2):256‐63. [DOI: 10.3945/jn.116.240861; PUBMED: 28031374] - DOI - PubMed
    1. Menon P, Nguyen PH, Saha KK, Khaled A, Kennedy A, Tran LM, et al. Impacts on breastfeeding practices of at‐scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: results of cluster‐randomized program evaluations in Bangladesh and Viet Nam. PLoS Medicine 2016;13(10):e1002159. [DOI: 10.1371/journal.pmed.1002159; PUBMED: 27780198] - DOI - PMC - PubMed
    1. Menon P, Nguyen PH, Saha KK, Khaled A, Sanghvi T, Baker J, et al. Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: results of a cluster‐randomized program evaluation in Bangladesh. Journal of Nutrition 2016;146(10):2075‐84. [DOI: 10.3945/jn.116.232314; PUBMED: 27581575] - DOI - PMC - PubMed
    1. Menon P, Rawat R. Impact of behavior change communications and market‐based approach to delivering micronutrient powders on stunting, infant feeding practices and anemia in Bangladesh. clinicaltrials.gov/ct2/show/NCT01678716 Date first received: 29 August 2012.
Neufeld 2008 {published and unpublished data}
    1. Aburto NJ, Ramirez‐Zea M, Neufeld LM, Flores‐Ayala R. The effect of nutritional supplementation on physical activity and exploratory behavior of Mexican infants aged 8‐12 months. European Journal of Clinical Nutrition 2010;64(6):644‐51. [DOI: 10.1038/ejcn.2010.52; PUBMED: 20354559] - DOI - PubMed
    1. Colchero A, Neufeld LM. Cost estimations of different types of micronutrient supplements for children and pregnant women (poster presentation). FASEB Journal 2008; Vol. 22:Abstract 678.21.
    1. García‐Guerra A, Neufeld LM, Domínguez CP, García‐Feregrino R, Hernández‐Cabrera A. Effect of three supplements with identical micronutrient content on anemia in Mexican children (poster presentation). FASEB Journal 2008; Vol. 22:Abstract 677.5.
Osendarp 2007 {published data only}
    1. Osendarp SJ, Baghurst KI, Bryan J, Calvaresi E, Hughes D, Hussaini M, et al. Effect of a 12‐mo micronutrient intervention on learning and memory in well‐nourished and marginally nourished school‐aged children: 2 parallel, randomized, placebo‐controlled studies in Australia and Indonesia. American Journal of Clinical Nutrition 2007;86(4):1082‐93. [PUBMED: 17921387] - PubMed
Paganini 2016 {published data only}
    1. Paganini D, Uyoga MA, Zimmermann MB. Iron fortification of foods for infants and children in low‐income countries: effects on the gut microbiome, gut inflammation, and diarrhea. Nutrients 2016;8(8):1‐11. [DOI: 10.3390/nu8080494; PMC4997407; PUBMED: 27529276] - DOI - PMC - PubMed
Rah 2012 {published data only}
    1. Rah JH, Pee S, Kraemer K, Steiger G, Bloem MW, Spiegel P, et al. Program experience with micronutrient powders and current evidence. Journal of Nutrition 2012;142(1):191‐6S. [DOI: 10.3945/jn.111.140004; PUBMED: 22131547] - DOI - PubMed
Rim 2008 {published data only}
    1. Rim H, Kim S, Sim B, Gang H, Kim H, Kim Y, et al. Effect of iron fortification of nursery complementary food on iron status of infants in the DPR Korea. Asia Pacific Journal of Clinical Nutrition 2008;17(2):264‐9. [PUBMED: 18586646] - PubMed
Samadpour 2011 {published data only}
    1. Samadpour K, Long KZ, Hayatbakhsh R, Marks GC. Randomised comparison of the effects of Sprinkles and Foodlets with the currently recommended supplement (Drops) on micronutrient status and growth in Iranian children. European Journal of Clinical Nutrition 2011;65(12):1287‐94. [DOI: 10.1038/ejcn.2011.124; PUBMED: 21750564] - DOI - PubMed
Sampaio 2013 {published data only}
    1. NCT00967551. The impact of the use of zinc supplementation and other micronutrients on the occurrence of diarrhea diseases and respiratory infections in children of daycare centers. clinicaltrials.gov/show/NCT00967551 Date first received: 27 August 2009.
    1. Sampaio DL, Mattos AP, Ribeiro TC, Leite ME, Cole CR, Costa‐Ribeiro H Jr. Zinc and other micronutrients supplementation through the use of sprinkles: impact on the occurrence of diarrhoea and respiratory infections in institutionalized children [Suplementação de zinco e outros micronutrientes através do uso de sprinkles: impacto na ocorrência de doença diarreica e infecções respiratórias em crianças institucionalizadas]. Jornal de Pediatria 2013;89(3):286‐93. [DOI: 10.1016/j.jped.2012.11.004; PUBMED: 23664200] - DOI - PubMed
Selva Suárez 2011 {published data only}
    1. Selva Suárez LN, Ochoa Alonso AA. Actions for prevention and control of iron‐deficiency anemia in up to five‐years old children [Acciones para la prevención y control de la anemia por deficiencia de hierro en niños hasta cinco años]. Revista Cubana de Salud Pública 2011;37(3):200‐6. [DOI: 10.1590/S0864-34662011000300003] - DOI
Smuts 2005 {published data only}
    1. Smuts CM, Dhansay MA, Faber M, Stuijvenberg ME, Swanevelder S, Gross R, et al. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. Journal of Nutrition 2005;135(3):653‐9S. [PUBMED: 15735110] - PubMed
Soofi 2013 {published data only}
    1. Soofi S, Cousens S, Iqbal SP, Akhund T, Khan J, Ahmed I, et al. Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster‐randomised trial. Lancet 2013;382(9886):29‐40. [DOI: 10.1016/S0140-6736(13)60437-7; PUBMED: 23602230] - DOI - PubMed
Suchdev 2007 (C) {published and unpublished data}
    1. Centers for Disease Control and Prevention. Baseline data from the Nyando Integrated Child Health and Education Project ‐ Kenya, 2007. Morbidity and Mortality Weekly Report 2007;56(42):1109‐13. - PubMed
    1. Jefferds ME, Ogange L, Owuor M, Cruz K, Person B, Obure A, et al. Formative research exploring acceptability, utilization, and promotion in order to develop a micronutrient powder (Sprinkles) intervention among Luo families in western Kenya. Food and Nutrition Bulletin 2010;31(2 Suppl):S179‐85. [DOI: 10.1177/15648265100312S210; PUBMED: 20715602] - DOI - PubMed
    1. Suchdev PS, Ruth LJ, Woodruff BA, Mbakaya C, Mandava U, Flores‐Ayala R, et al. Selling Sprinkles micronutrient powder reduces anemia, iron deficiency, and vitamin A deficiency in young children in Western Kenya: a cluster‐randomized controlled trial. American Journal of Clinical Nutrition 2012;95(5):1223‐30. [DOI: 10.3945/ajcn.111.030072; PMC4697950; PUBMED: 22492366] - DOI - PMC - PubMed
    1. Suchdev PS, Shah A, Jefferds ME, Eleveld A, Patel M, Stein AD, et al. Sustainability of market‐based community distribution of Sprinkles in western Kenya. Maternal and Child Nutrition 2013;9 Suppl 1:78‐88. [DOI: 10.1111/j.1740-8709.2012.00450.x; PUBMED: 23167586] - DOI - PMC - PubMed
Teshome 2017 {published data only}
    1. NCT02073149. Safe and efficacious iron for children in Kenya (SEICK) [Comparison of home fortification with two iron formulations in Kenyan children protected against malaria by artemisinin‐based combination therapy: a placebo‐controlled non‐inferiority trial]. clinicaltrials.gov/ct2/show/record/NCT02073149 Date first received: 25 February 2014.
    1. Teshome EM, Andang'o PEA, Osoti V, Terwel SR, Otieno W, Demir AY, et al. Daily home fortification with iron as ferrous fumarate versus NaFeEDTA: a randomised, placebo‐controlled, non‐inferiority trial in Kenyan children. BMC Medicine 2017;15:89. [doi.org/10.1186/s12916‐017‐0839‐z; PUBMED: 28449690 ] - PMC - PubMed
Troesch 2009 {published data only}
    1. Troesch B. Optimized micronutrient powder containing low levels of highly bioavailable iron and zinc together with EDTA, phytase and ascorbic acid improves the nutritional status of children. Sight and Life Magazine 2010, issue 3:9‐14.
    1. Troesch B, Egli I, Zeder C, Hurrell RF, Pee S, Zimmermann MB. Optimization of a phytase‐containing micronutrient powder with low amounts of highly bioavailable iron for in‐home fortification of complementary foods. American Journal of Clinical Nutrition 2009;89(2):539‐44. [DOI: 10.3945/ajcn.2008.27026; PUBMED: 19106242] - DOI - PubMed
Vuong 2002 {published data only}
    1. Vuong le T, Dueker SR, Murphy SP. Plasma beta‐carotene and retinol concentrations of children increase after a 30‐d supplementation with the fruit Momordica cochinchinensis (gac). American Journal of Clinical Nutrition 2002;75(5):872‐9. [PUBMED: 11976161] - PubMed
Wijaya‐Erhardt 2007 {published data only}
    1. Wijaya‐Erhardt M, Erhardt JG, Untoro J, Karyadi E, Wibowo L, Gross R. Effects of daily or weekly multiple‐micronutrient and iron foodlike tablets on body iron stores of Indonesian infants aged 6‐12 mo: a double‐blind, randomized, placebo‐controlled trial. American Journal of Clinical Nutrition 2007;86(6):1680‐6. [PUBMED: 18065586] - PubMed
Zlotkin 2001 {published data only}
    1. Zlotkin S, Arthur P, Antwi KY, Yeung G. Treatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods. American Journal of Clinical Nutrition 2001;74(6):791‐5. [PUBMED: 11722961] - PubMed
Zlotkin 2003a {published data only}
    1. Zlotkin S, Antwi KY, Schauer C, Yeung G. Use of microencapsulated iron (II) fumarate sprinkles to prevent recurrence of anaemia in infants and young children at high risk. Bulletin of the World Health Organization 2003;81(2):108‐15. [PMC2572396; PUBMED: 12756979] - PMC - PubMed
Zlotkin 2003b {published data only}
    1. Zlotkin S, Arthur P, Schauer C, Antwi KY, Yeung G, Piekarz A. Home‐fortification with iron and zinc Sprinkles of iron Sprinkles alone successfully treats anemia in infants and young children. Journal of Nutrition 2003;133(4):1075‐80. [PUBMED: 12672922] - PubMed
Zlotkin 2013 {published data only}
    1. Zlotkin S, Newton S, Aimone AM, Azindow I, Amenga‐Etego S, Tchum K, et al. Effect of iron fortification on malaria incidence in infants and young children in Ghana: a randomized trial. JAMA 2013;310(9):938‐47. [DOI: 10.1001/jama.2013.277129; PUBMED: 24002280] - DOI - PubMed

References to ongoing studies

ACTRN12616001245482 {published data only}
    1. ACTRN12616001245482. Food fortification powder for improving micronutrient status in underweight and overweight/obese primary school children [The effect of a multiple micronutrient powder for point‐of‐use fortification of foods on the micronutrient status of underweight and overweight/obese primary school children in Vietnam ‐ a randomised controlled trial]. apps.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12616001245482 Date first registered: 6 September 2016.
NCT01917032 {published data only}
    1. NCT01917032. Effect of home‐fortification with micronutrient powder sprinkles in hematologic and nutritional status in preschool children in Medellín: a randomized clinical trial. clinicaltrials.gov/show/NCT01917032 Date first received: 2 August 2013.
NCT02280330 {published data only}
    1. NCT02280330. Iodine intake & status of preschoolers given micronutrient powder for 6 months. clinicaltrials.gov/ct2/show/NCT02280330 Date first received: 27 October 2014.
NCT02302729 {published data only}
    1. NCT02302729. Early child development and nutrition in Guatemala. clinicaltrials.gov/ct2/show/study/NCT02302729 Date first received: 31 October 2014.
NCT02422953 {published data only}
    1. Kureishy S, Khan GN, Arrif S, Ashraf K, Cespedes A, Habib MA, et al. A mixed methods study to assess the effectiveness of food‐based interventions to prevent stunting among children under‐five years in Districts Thatta and Sujawal, Sindh Province, Pakistan: study protocol. BMC Public Health 2017;17(1):1‐6. [DOI: 10.1186/s12889-016-3976-y; PUBMED: 28056945] - DOI - PMC - PubMed
    1. NCT02422953. Effectiveness of food/nutrient based interventions to prevent stunting among children under five in Thatta and Sajawal districts, Sindh province, Pakistan. clinicaltrials.gov/ct2/show/record/NCT02422953 Date first received: 15 April 2015.
PACTR201607001693286 {published data only}
    1. PACTR201607001693286. The efficacy of multiple micronutrient powder supplementation in children under five years in Arusha District. apps.who.int/trialsearch/Trial2.aspx?TrialID=PACTR201607001693286 Date first registered: 24 June 2016.

Additional references

Allen 2009
    1. Allen LH, Peerson JM, Olney DK. Provision of multiple rather than two or fewer micronutrients more effectively improves growth and other outcomes in micronutrient‐deficient children and adults. Journal of Nutrition 2009;139(5):1022‐30. [DOI: 10.3945/jn.107.086199; PUBMED: 19321586] - DOI - PubMed
Andersson 2012
    1. Andersson M, Karumbunathan V, Zimmermann MB. Global iodine status in 2011 and trends over the past decade. Journal of Nutrition 2012;142(4):744‐50. [DOI: 10.3945/jn.111.149393; PUBMED: 22378324] - DOI - PubMed
Bailey 2015
    1. Bailey LB, Stover PJ, McNulty H, Fenech MF, Gregory JF 3rd, Mills JL, et al. Biomarkers of nutrition for development‐folate review. Journal of Nutrition 2015;145(7):1636S‐80S. [DOI: 10.3945/jn.114.206599; PMC4478945; PUBMED: 26451605] - DOI - PMC - PubMed
Balshem 2011
    1. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 2011;64(4):401‐6. [DOI: 10.1016/j.jclinepi.2010.07.015; PUBMED: 21208779] - DOI - PubMed
Beaton 1999
    1. Beaton GH, McCabe GP. Efficacy of intermittent iron supplementation in the control of iron deficiency anaemia in developing countries. The Micronutrient Initiative. Ottawa (Canada): The Micronutrient Initiative, 1999.
Berger 1997
    1. Berger J, Aguayo VM, Téllez W, Luján C, Traissac P, San Miguel JL. Weekly iron supplementation is as effective as 5 day per week iron supplementation in Bolivian school children living at high altitude. European Journal of Clinical Nutrition 1997;51(6):381‐6. [PUBMED: 9192196] - PubMed
Bhutta 2008
    1. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. Maternal and Child Undernutrition Study Group. What works? interventions for maternal and child undernutrition and survival. Lancet 2008;371(9610):417‐40. [DOI: 10.1016/S0140-6736(07)61693-6; PUBMED: 18206226] - DOI - PubMed
Black 2008
    1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008;371(9608):243‐60. [DOI: 10.1016/S0140-6736(07)61690-0; PUBMED: 18207566] - DOI - PubMed
Borenstein 2009
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta‐Analysis. Oxford (UK): John Wiley & Sons, 2009.
Brown 2009
    1. Brown KH, Peerson JM, Baker SK, Hess SY. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food and Nutrition Bulletin 2009;30(Suppl 1):S12‐40. - PubMed
Christofides 2006
    1. Christofides A, Asante KP, Schauer C, Sharieff W, Owusu‐Agyei S, Zlotkin S. Multi‐micronutrient sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial. Maternal and Child Nutrition 2006;2(3):169‐80. - PMC - PubMed
Commission on Ending Childhood Obesity 2016
    1. Commission on Ending Childhood Obesity. Report of the Commission on Ending Childhood Obesity. Geneva (Switzerland): World Health Organization, 2016.
De Pee 2008
    1. Pee S, Kraemer K, Briel T, Boy E, Grasset C, Moench‐Pfanner R, et al. World Food Programme, Sprinkles Global Health Initiative. Quality criteria for micronutrient powder products: report of a meeting organized by the World Food Programme and Sprinkles Global Health Initiative. Food and Nutrition Bulletin 2008;29(3):232‐41. [DOI: 10.1177/156482650802900309; PUBMED: 18947036] - DOI - PubMed
De Pee 2009
    1. Pee S, Bloem MW. Current and potential role of specially formulated foods and food supplements for preventing malnutrition among 6‐ to 23‐month‐old children and for treating moderate malnutrition among 6‐ to 59‐month‐old children. Food and Nutrition Bulletin 2009;30(Suppl 3):S434‐63. [DOI: 10.1177/15648265090303S305; PUBMED: 19998866] - DOI - PubMed
De‐Regil 2011a
    1. De‐Regil LM, Jefferds MED, Sylvetsky AC, Dowswell T. Intermittent iron supplementation for improving nutrition and development in children under 12 years of age. Cochrane Database of Systematic Reviews 2011, Issue 12. [DOI: 10.1002/14651858.CD009085.pub2] - DOI - PMC - PubMed
De‐Regil 2011b
    1. De‐Regil LM, Suchdev PS, Vist GE, Walleser S, Peña‐Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database of Systematic Reviews 2011, Issue 9. [DOI: 10.1002/14651858.CD008959.pub2] - DOI - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG. Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Dewey 2008
    1. Dewey KG, Adu‐Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Maternal & Child Nutrition 2008;4(Suppl 1):24‐85. [DOI: 10.1111/j.1740-8709.2007.00124.x; PUBMED: 18289157] - DOI - PMC - PubMed
Dewey 2009
    1. Dewey KG, Yang Z, Boy E. Systematic review and meta‐analysis of home fortification of complementary foods. Maternal & Child Nutrition 2009;5(4):283‐321. [DOI: 10.1111/j.1740-8709.2009.00190.x] - DOI
Gera 2007
    1. Gera T, Sachdev HP, Nestel P, Sachdev SS. Effect of iron supplementation on haemoglobin response in children: systematic review of randomised controlled trials. Journal of Pediatric Gastroenterology and Nutrition 2007;44(4):468‐86. [DOI: 10.1097/01.mpg.0000243440.85452.38; PUBMED: 17414146] - DOI - PubMed
GRADEpro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 14 August 2017. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Guyatt 2011
    1. Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. Journal of Clinical Epidemiology 2011;64(4):395‐400. [DOI: 10.1016/j.jclinepi.2010.09.012; PUBMED: 21194891] - DOI - PubMed
HFTAG 2011
    1. Home Fortification Technical Advisory Group (HFTAG). Programmatic guidance brief on use of micronutrient powders (MNP) for home fortification. Geneva (Switzerland): Home Fortification Technical Advisory Group, 2011:1‐8.
Higgins 2011a
    1. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011b
    1. Higgins JPT, Deeks JJ, Altman DG. Chapter 16: Special topics in statistics. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hirve 2013
    1. Hirve S, Martini E, Juvekar SK, Agarwal D, Bavdekar A, Sari M, et al. Delivering Sprinkles Plus through the integrated child development services (ICDS) to reduce anemia in pre‐school children in India. Indian Journal of Pediatrics 2013;80(12):990‐5. [DOI: 10.1007/s12098-013-1063-2; PUBMED: 23723079] - DOI - PubMed
Horton 2010
    1. Horton S, Shekar M, McDonald C, Mahal A, Krystene‐Brooks J. Scaling up Nutrition. What will it cost?. Washington (DC): The International Bank for Reconstruction and Development/The World Bank, 2010.
Hurrell 2010
    1. Hurrell R. Iron and malaria: absorption, efficacy and safety. International Journal of Vitamin Nutrition Research 2010;80(4‐5):279‐92. [DOI: 10.1024/0300-9831/a000035; PUBMED: 21462111] - DOI - PubMed
Hyder 2007
    1. Hyder SM, Haseen F, Rahman M, Tondeur M, Zlotkin SH. Effect of daily versus once‐weekly home fortification with micronutrient Sprinkles on hemoglobin and iron status among young children in rural Bangladesh. Food and Nutrition Bulletin 2007;28(2):156‐64. [DOI: 10.1177/156482650702800204; PUBMED: 24683674] - DOI - PubMed
Jimenez 2010
    1. Jimenez C, Leets I, Puche R, Anzola E, Montilla R, Parra C, et al. A single dose of vitamin A improves haemoglobin concentration, retinol status and phagocytic function of neutrophils in preschool children. British Journal of Nutrition 2010;103(6):798‐802. [DOI: 10.1017/S0007114509992765; PUBMED: 20003622] - DOI - PubMed
King 2016
    1. King JC, Brown KH, Gibson RS, Krebs NF, Lowe NM, et al. Biomarkers of Nutrition for Development (BOND) ‐ zinc review. Journal of Nutrition 2016;146(4):858S‐885S. [DOI: 10.3945/jn.115.220079; PMC4807640; PUBMED: 26962190] - DOI - PMC - PubMed
Kupka 2015
    1. Kupka R. The role of folate in malaria ‐ implications for home fortification programmes among children aged 6‐59 months. Maternal & Child Nutrition 2015;11(Suppl 4):1‐15. [DOI: 10.1111/mcn.12102; PUBMED: 26756732] - DOI - PMC - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Liyanage 2002
    1. Liyanage C, Zlotkin S. Bioavailability of iron from micro‐encapsulated iron sprinkle supplement. Food and Nutrition Bulletin 2002;23(Suppl 3):133‐7. [PUBMED: 12362781] - PubMed
Lozoff 2007
    1. Lozoff B. Iron deficiency and child development. Food and Nutrition Bulletin 2007;28(Suppl 4):S560‐71. [DOI: 10.1177/15648265070284S409; PUBMED: 18297894] - DOI - PubMed
Lutter 2011
    1. Lutter CK, Daelmans BM, Onis M, Kothari MT, Ruel MT, Arimond M, et al. Undernutrition, poor feeding practices, and low coverage of key nutrition interventions. Pediatrics 2011;128(6):1418‐27. [DOI: 10.1542/peds.2011-1392; PUBMED: 22065267] - DOI - PubMed
Martini 2013
    1. Martini E. Providing micronutrient powder (MNP) through school feeding to improve health and nutritional status of school children. Presentation at the UNICEF/CDC Regional Workshop on improving the nutritional quality of complementary foods for children 6‐23 months through home fortification in Central and Eastern Europe and Middle East and North Africa; 2013 May 29; Antalya, Turkey 2013.
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. PLoS Medicine 2009;6(7):e1000097. [DOI: 10.1371/journal.pmed1000097] - DOI - PMC - PubMed
Mulinare 1988
    1. Mulinare J, Cordero JF, Erickson JD, Berry RJ. Periconceptional use of multivitamins and the occurrence of neural tube defects. JAMA 1988;260(21):3141‐5. [PUBMED: 3184392] - PubMed
Okebe 2011
    1. Okebe JU, Yahav D, Shbita R, Paul M. Oral iron supplements for children in malaria‐endemic areas. Cochrane Database of Systematic Reviews 2011, Issue 10. [DOI: 10.1002/14651858.CD006589.pub3] - DOI - PubMed
Peña‐Rosas 2012
    1. Peña‐Rosas JP, De‐Regil LM, Rogers LM, Bopardikar A, Panisset U. Translating research into action: WHO evidence‐informed guidelines for safe and effective micronutrient interventions. Journal of Nutrition 2012;142(1):197‐204S. [DOI: 10.3945/jn.111.138834; PUBMED: 22113868] - DOI - PubMed
Prentice 2007
    1. Prentice AM, Ghattas H, Doherty C, Cox SE. Iron metabolism and malaria. Food and Nutrition Bulletin 2007;28(Suppl 4):S524‐39. [DOI: 10.1177/15648265070284S406; PUBMED: 18297891] - DOI - PubMed
Rastogi 2002
    1. Rastogi R, Mathers CD. Global burden of iron deficiency anaemia in the year 2000. www.who.int/healthinfo/statistics/bod_irondeficiencyanaemia.pdf (accessed 27 July 2010).
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Salam 2013
    1. Salam RA, MacPhail C, Das JK, Bhutta ZA. Effectiveness of micronutrient powders (MNP) in women and children. BMC Public Health 2013;13 Suppl 3:S22. [DOI: 10.1186/1471-2458-13-S3-S22] - DOI - PMC - PubMed
SGHI 2008
    1. Sprinkles Global Health Initiative. Micronutrient Sprinkles for use in infants and young children: guidelines on recommendations for use and program monitoring and evaluation. www.sghi.org/resource_centre/GuidelinesGen2008.pdf (accessed on 10 September 2010).
Sharieff 2006
    1. Sharieff W, Bhutta Z, Schauer C, Tomlinson G, Zlotkin S. Micronutrients (including zinc) reduce diarrhoea in children: the Pakistan Sprinkles Diarrhoea Study. Archives of Disease in Childhood 2006;91(7):573‐9. [DOI: 10.1136/adc.2005.086199] - DOI - PMC - PubMed
Stevens 2013
    1. Stevens GA, Finucane MM, De‐Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non‐pregnant women for 1995‐2011: a systematic analysis of population ‐ representative data. Lancet Global Health 2013;1(1):e16‐25. [10.1016/S2214‐109X(13)70001‐9; PMC4547326] - PMC - PubMed
Stevens 2015
    1. Stevens GA, Bennett JE, Hennocq Q, Lu Y, De‐Regil LM, Rogers L, et al. Trends and mortality effects of vitamin A deficiency in children in 138 low‐income and middle‐income countries between 1991 and 2013: a pooled analysis of population‐based surveys. Lancet Global Health 2015;3(9):e528‐36. [DOI: 10.1016/S2214-109X(15)00039-X; PUBMED: 26275329] - DOI - PubMed
Stoltzfus 2004
    1. Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In: Ezzati M, Lopez AD, Rodgers A, Murray CLJ editor(s). Comparative Quantification of Health Risks: Global and Regional Burden of Disease. Geneva (Switzerland): World Health Organization, 2004:163‐209.
Suchdev 2015
    1. Suchdev PS, Peña‐Rosas JP, De‐Regil. Multiple micronutrient powders for home (point‐of‐use) fortification of foods in pregnant women. Cochrane Database of Systematic Reviews 2015, Issue 6. [DOI: 10.1002/14651858.CD011158.pub2] - DOI - PMC - PubMed
Tanumihardjo 2016
    1. Tanumihardjo SA, Russell RM, Stephensen CB, Gannon BM, Craft NE, Haskell MJ, et al. Biomarkers of nutrition for development (BOND) ‐ vitamin A review. Journal of Nutrition 2016;146(9):1816S‐48S. [DOI: 10.3945/jn.115.229708; PMC4997277; PUBMED: 27511929] - DOI - PMC - PubMed
Timmer 2013
    1. Timmer A, Irizarry L, Tripp K, Flores‐Ayala R, Jefferds ME. Regional workshops to scale up home fortification to improve complementary feeding: collaboration between UNICEF, CDC and Partners. Sight and Life Special Supplement 2013;Sept:42‐50.
Troesch 2011a
    1. Troesch B, Stuijvenberg ME, Smuts CM, Kruger HS, Biebinger R, Hurrell RF, et al. A micronutrient powder with low doses of highly absorbable iron and zinc reduces iron and zinc deficiency and improves weight‐for‐age Z‐scores in South African children. Journal of Nutrition 2011;141(2):237‐42. [DOI: 10.3945/jn.110.129247; PUBMED: 21178093] - DOI - PubMed
UNICEF 2014
    1. UNICEF. Nutridash 2013: Global report of the pilot year. UNICEF 2014.
UNICEF/CDC 2013
    1. UNICEF/CDC. Global Assessment of Home Fortification Interventions 2011. Geneva (Switzerland): Home Fortification Technical Advisory Group, 2013.
Viteri 1997
    1. Viteri FE. Iron supplementation for the control of iron deficiency in populations at risk. Nutrition Reviews 1997;55(6):195‐209. [PUBMED: 9279056] - PubMed
WFP/DSM 2010
    1. World Food Programme/DSM. Dealing with diarrhoea in children in refugee, emergency and development situations in the context of micronutrient powder use. Technical Brief 2010; Vol. 1:3.
WHO 2001
    1. World Health Organization. Iron Deficiency Anaemia Assessment Prevention and Control: a Guide for Programme Managers. Geneva (Switzerland): World Health Organization, 2001:132.
WHO 2003
    1. World Health Organization. Strategic directions for improving the health and development of children and adolescents. Geneva (Switzerland): World Health Organization, 2003.
WHO 2009
    1. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva (Switzerland): World Health Organization, 2009.
WHO 2010a
    1. World Health Organization. Malaria. In: Poumerol G, Wilder‐Smith A editor(s). Malaria. International Travel and Health. Situation as on 1 January 2010. Geneva (Switzerland): World Health Organization, 2010.
WHO 2011a
    1. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva (Switzerland): World Health Organization, 2011.
WHO 2011b
    1. World Health Organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva (Switzerland): World Health Organization, 2011.
WHO 2011c
    1. World Health Organization. Guideline: intermittent iron supplementation in preschool and school‐age children. Geneva (Switzerland): World Health Organization, 2011. - PubMed
WHO 2013
    1. World Health Organization. Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. Geneva (Switzerland): World Health Organization, 2013. - PubMed
WHO 2015a
    1. World Health Organization. World Malaria Report 2015. Geneva (Switzerland): World Health Organization, 2015.
WHO 2015b
    1. World Health Organization. The Global Prevalence of Anaemia in 2011. Geneva (Switzerland): World Health Organization, 2015.
WHO 2016
    1. World Health Organization. WHO guideline: Use of multiple micronutrient powders for point‐of‐use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years. Geneva: World Health Organization, 2016. - PubMed
WHO/FAO 2006
    1. World Health Organization, Food, Agricultural Organization of the United Nations. Guidelines on food fortification with micronutrients. Geneva (Switzerland): WHO, 2006.
Winzenberg 2011
    1. Winzenberg T, Powell S, Shaw KA, Jones G. Effects of vitamin D supplementation on bone density in healthy children: systematic review and meta‐analysis. BMJ 2011;342:c7254. [PMC3026600; PUBMED: 21266418] - PMC - PubMed
World Vision Mongolia 2005
    1. World Vision Mongolia. Effectiveness of home‐based fortification with Sprinkles in an integrated nutrition program to address rickets and anemia. Ulaanbaatar, Mongolia: World Vision Mongolia 2005.
Yakoob 2011
    1. Yakoob MY, Theodoratou E, Jabeen A, Imdad A, Eisele TP, Ferguson J, et al. Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. BMC Public Health 2011;11(Suppl 3):S23. [DOI: 10.1186/1471-2458-11-S3-S23; PMC3231897; PUBMED: 21501441] - DOI - PMC - PubMed
Zlotkin 2005
    1. Zlotkin SH, Schauer C, Christofides A, Sharieff W, Tondeur MC, Hyder SM. Micronutrient sprinkles to control childhood anaemia. PLoS Medicine 2005;2(1):e1. [DOI: 10.1371/journal.pmed.0020001; PMC545194] - DOI - PMC - PubMed

References to other published versions of this review

De‐Regil 2012
    1. De‐Regil LM, Jefferds MED, Peña‐Rosas JP. Point‐of‐use fortification of foods with micronutrient powders containing iron in children of preschool and school age. Cochrane Database of Systematic Reviews 2012, Issue 2. [DOI: 10.1002/14651858.CD009666] - DOI - PMC - PubMed

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