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Meta-Analysis
. 2019 Jan 23;14(1):e0210899.
doi: 10.1371/journal.pone.0210899. eCollection 2019.

Health effects of micronutrient fortified dairy products and cereal food for children and adolescents: A systematic review

Klaus Eichler  1 , Sascha Hess  1 , Claudia Twerenbold  1 , Magalie Sabatier  2 , Flurina Meier  1 , Simon Wieser  1
Affiliations
Meta-Analysis

Health effects of micronutrient fortified dairy products and cereal food for children and adolescents: A systematic review

Klaus Eichler et al. PLoS One. .

Abstract

Introduction: Micronutrient (MN) deficiencies cause a considerable burden of disease for children in many countries. Dairy products or cereals are an important food component during adolescence. Fortification of dairy products or cereals with MN may be an effective strategy to overcome MN deficiencies, but their specific impact on health in this age group is poorly documented.

Methods: We performed a systematic review and meta-analysis (registration number CRD42016039554) to assess the impact of MN fortified dairy products and cereal food on the health of children and adolescents (aged 5-15 years) compared with non-fortified food. We reviewed randomised controlled trials (RCT) using electronic databases (MEDLINE, EMBASE, Cochrane library; latest search: January 2018), reference list screening and citation searches. Three pairs of reviewers assessed 2048 studies for eligibility and extracted data. We assessed the risk of bias and applied GRADE to rate quality of evidence.

Results: We included 24 RCT (often multi MN fortification) with 30 pair-wise comparisons mainly from low- and middle income countries. A very small and non-significant increase of haemoglobin values emerged (0.09 g/dl [95%-CI: -0.01 to 0.18]; 13 RCT with iron fortification; very low quality of evidence). No significant difference was found on anaemia risk (risk ratio 0.87 [95%-CI: 0.76 to 1.01]; 12 RCT; very low quality), but a significant difference in iron deficiency anaemia favouring fortified food was found (risk ratio 0.38 [95%-CI: 0.18 to 0.81]; 5 RCT; very low quality). Similar effects were seen for fortified dairy products and cereals and different fortification strategies (mono- vs. dual- vs. multi-MN). Follow-up periods were often short and the impact on anthropometric measures was weak (low quality of evidence) Very low quality of evidence emerged for the improvement of cognitive performance, functional measures and morbidity.

Conclusions: Fortification of dairy products and cereal food had only marginal health effects in our sample population from 5-15 years. Further evidence is needed to better understand the health impact of fortified dairy products and cereals in this age group.

Systematic review registration: The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 26 May 2016 (registration number CRD42016039554).

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Conflict of interest statement

The authors KE, SH, CT, FM and SW declare that they have no competing interests. MS is an employee of the Nestlé Research Center. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA flow diagram of the systematic review.
Fig 2
Fig 2. Effect of iron fortified dairy products and cereals on haemoglobin (Hb) levels compared with non-fortified food.
Studies with iron fortification included (n = 14 RCT with 19 pair-wise comparisons). Results are provided as weighted mean difference in haemoglobin (WMD: g/dl with 95%-CI; conversion to g/L with factor 10) between intervention and control group.
Fig 3
Fig 3. Effect of iron-fortified dairy products and cereals on anaemia compared with non-fortified food.
Studies with iron fortification included (n = 12 RCT with 17 pair-wise comparisons). Results are provided as risk ratio (RR, 95%-CI) of suffering from anaemia in the intervention group compared with the control group.
Fig 4
Fig 4. Effect of iron-fortified dairy products and cereals on iron deficiency anaemia compared with non-fortified food.
Studies with iron fortification included (n = 5 RCT with 5 pair-wise comparisons). Results are provided as risk ratio (RR, 95%-CI) of suffering from iron deficiency anaemia in the intervention group compared with the control group.
See this image and copyright information in PMC

References

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