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Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu1

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Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu1 BIOMEDICAL AND ENVIRONMENTAL SCIENCES 22, 194-200 (2009) www.besjournal.com Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu1 + + # * + YU-YING WANG , CHUN-MING CHEN , FU-ZHEN WANG , MEI JIA , AND KE-AN WANG +Chinese Center for Disease Control and Prevention, Beijing 100050, China; #Health Supervision Institute, Health Department of Gansu Province, 730000, *Nestle (China) Co., Ltd. Beijing 100016, China Objective To assess the effectiveness of complementary food supplements with protein and multi-micronutrients on hemoglobin and anemia in infants and young children. Methods In 5 poor counties of Gansu, 984 children aged 6-12 months were enrolled and divided into two groups. In addition to the usual home-made complementary food, all the children were fed one sachet of either Formula I or Formula II supplements each day. Protein and micronutrients were provided in Formula I, while the same energy intake was secured in Formula II as in Formula I. A massive dose of vitamin A was supplemented to all the children every 6 months. Hemoglobin test was done at the same time. Results Prevalence of anemia was about 35% in both Formula I and Formula II group at baseline, and there were no differences in hemoglobin concentration between the two groups. During the 6-month and 12-month supplementation, hemoglobin of children in Formula I group was higher than that in Formula II group (P<0.05), and hemoglobin increase in Formula I group was significantly higher than that in Formula II group (P<0.001). After 6- and 12-month supplementation, the prevalence of anemia in Formula I group dropped to 19.1% and 8.2% respectively, and it was 28.0% and 12.4% in Formula 2 group. The prevalence of anemia in Formula I group was significantly lower than that in Formula II group (P<0.05). After adjusting age and hemoglobin level at baseline, the hemoglobin increase at age of 24 months in formula 1 group was higher (10.7 g/L vs 7.9 g/L, P<0.0001). Conclusion Micronutrient fortified complementary food supplements, with large-dose vitamin A, is effective for children aged 6-12 months in terms of iron deficiency prevention. Key words: Food fortification; Complementary food supplements; Infants and young children; Hemoglobin; Iron deficiency anemia INTRODUCTION example, protein, iron, zinc, calcium, and vitamin A inadequacy in young children is common, and the In most developing countries iron deficiency prevalence of anemia during infancy after weaning anemia (IDA) is one of common nutritional and early childhood is higher than at any other time deficiency diseases in children, especially in infants in the life cycle of the Chinese population. and young children under 2 years of age. While iron Nutrition education programs are encouraged to requirement of infants can not be met by improve complementary feeding by food diversity breastfeeding after age of 6 months, iron fortification and proper use of local food, but the high requirement of complementary food is an essential way to ensure of young children is far beyond the total intake of an optimal growth of the infant[1]. It is estimated that micronutrients in the small amount of food consumed. about 75%-100% of the iron and zinc needed for their So, new approaches such as home-level fortification growth should be provided by complementary food. have been broadly recommended to provide However, in most developing countries, additional micronutrients to regular home made complementary food consists primarily of cereals, complementary food, and Sprinkles, Foodlet, and which are low in vitamins and minerals, resulting in Spread etc. are applied to address nutrition deficiency of iron and zinc among children aged improvement in children under 24 months in [3] under 24 months[2]. Multiple nutrient deficiency, for developing countries . 1This research was supported by Nestle (China) Co., Ltd. 2Correspondence should be addressed to Chun-Ming CHEN. Tel: 86-10-83159165. Fax: 86-10-83159164. E-mail: [email protected] Biographical note of the first author: Yu-Ying WANG, male, born in 1971, Ph. D, associate professor, majoring in children nutrition. 0895-3988/2009 CN 11-2816/Q Copyright © 2009 by China CDC 194 EFFECTS OF COMPLEMENTARY FOOD SUPPLEMENTS ON ANEMIA 195 In the rural counties of western China, the cutoff point of anemia for children was adjusted complementary feeding practice is poor in terms of to 115 g/L[5]. its timing and food diversity[4], and anemia Effect size Effect size reflects the correlation prevalence in children aged 6-24 months in Gansu between processes and outcomes of the research[6]. province was 35% in 2001. Development of effective Specifically, the value of effect size was obtained by and feasible approaches to eliminate anemia is dividing the difference between the average changed extremely needed. This paper presents an values of the Formula I group and the Formula II effectiveness study of a fortified complementary food group by the standard deviation of average change supplement for anemia prevention. values of both groups. In general, effect sizes of 0.2 are considered small, effect sizes of 0.5 are SUBJECTS AND METHODS considered moderately large, and those of 0.8 are considered large. Statistical analysis All data were entered into Study Population EPIDATA 3.02. The data was cleaned and analyzed using SAS 9.1.3. The statistics methods included In 2001, 1 500 children were sampled from the t-test, χ2 test and variance analysis. P value that less children aged 4-12 months in 5 poor counties (Dingxi, than 0.05 was considered statistically significant. Qingshui, Jingtai, Tianzhu, and Jingning) in Gansu of Ethical approval Ethical approval for this study China. In each county, at least 2 townships were was obtained from the Ethics Committee of the selected, where villages were randomly sampled. In Chinese Center for Disease Control and Prevention. the sampled villages all the children aged 4-12 Informed consent was obtained from parents or months were taken until the amount of children guardians of children who were involved in the reached 200; these children were recruited as project. Formula I group, while another 100 children aged 4-12 months were selected as Formula II group in the RESULTS nearby township with similar natural and economic conditions. In this paper only the effect of complementary food supplements on children aged Characteristics of the Sample 6-12 months were discussed. The baseline survey was conducted in Tianzhu, Methods Jingning, Dingxi, Qingshui, and Jingtai of Gansu province from October through November of 2001. A baseline survey on physical growth and Hemoglobin tests were done for 984 children. The complementary feeding status of children was average concentration was 118.0±11.6 g/L, the conducted, and then all children were fed one sachet prevalence of anemia was 35.6%, and no difference of either Formula I or Formula II supplements. was observed between the two groups. There was no Formula I was soybean powder-based and contained difference in age and gender distributions in the two iron (6 mg, in NaFeEDTA), zinc (4 mg, in Zn sulfate), groups. calcium (385 mg, in Ca carbonate), Vitamin D (7 g, Hemoglobin tests were conducted after 6-month in vitamin D3 oil 1 million IU/g), vitamin B2 (0.2 mg, and 12-month supplementation in all children. vitamin B2 10% in Maltodextrin). Formula II was rice Among them, 721 children got full data of baseline powder-based with added vegetable oil to reach the and two follow-ups, and 263 children missed once or same calorie level as that of Formula I, i.e., 44 twice hemoglobin follow-ups, but there was no kcal/10 g. The supplements were either directly to or significant difference in baseline hemoglobin level separately from the usual home-made complementary and anemia prevalence between the two sample food of the child. In addition, a massive dose of groups (P>0.05). During the whole follow-up process, vitamin A was given to children in both groups 671 children were tested for hemoglobin (every 6 months, 1 dose of 100 000 vitamin A for concentration in both the baseline survey and the children aged under 12 months and 200 000 IU for final survey. The hemoglobin concentration and children over 12 months) . prevalence of anemia of all children tested in both surveys had no significant difference with those of Evaluation Index other 313 children at baseline (P>0.05). The above Blood hemoglobin Blood hemoglobin was result indicated that the hemoglobin concentration of measured by the cyanmethemoglobin method every 6 children fed for 12 months and aged 24 months could months. According to the altitude of this study area, represent the overall changes. 196 WANG ET AL. Changes in Hemoglobin Concentration and Prevalence hemoglobin concentrations increased significantly. of Anemia during 12-Month Supplementation Notably, the scope of movement in Formula I group was larger, indicating that changes of hemoglobin At baseline, hemoglobin concentration in concentration in Formula I group were higher than Formula II group was slightly higher than that in those in Formula II group. Formula I group, but the difference was not statistically significant (P>0.05). Hemoglobin concentration of children in Formula I group was significantly higher than that of children in Formula II group after 6- and 12-month supplementation (P<0.05). In both groups hemoglobin concentration was increased along with age increase (P<0.001) (Table 1). TABLE 1 Hemoglobin Concentrations of Children in Both Groups (g/L) Formula I Formula II ()xs Baseline 118.1±11.7 118.5±11.6 6-Month Follow-up 123.3±10.7 121.0±11.2* 12-Month Follow-up 127.8±9.7 126.0±10.0** Note.
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