Journal
FOOD SCIENCE & NUTRITION
Volume 8, Issue 7, Pages 3566-3577Publisher
WILEY
DOI: 10.1002/fsn3.1639
Keywords
Africa; anemia; cluster-randomized controlled trial; iron fortification; nutritional status; under-five children
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Funding
- Nestle Nutrition Institute of Africa
- Helen Keller Foundation for Research and Education
- Cameroon Ministry of Public Health
- UNICEF
- National Statistics Institute
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Complementary foods in Africa are often poor sources of bioavailable iron. We assessed the efficacy of iron-fortified wheat-based infant cereal (IC) to reduce the risk of iron deficiency anemia in children aged 18-59 months in Cameroon. A 6-month double-blind, cluster-randomized controlled trial was conducted in 2017 among anemic (hemoglobin 7-11 g/dl) but otherwise healthy children. In conjunction with usual diet, children received two 50 g servings/day of a standard, micronutrient-fortified IC (providing 3.75 mg iron/serving; n = 106) or the same IC without iron fortification (n = 99). Anthropometric measurements, blood sampling, and systematic deworming were performed in all children at baseline (pre-intervention), 3, and 6 months. Mean hemoglobin, ferritin adjusted for C-reactive protein (CRP), serum iron, transferrin saturation, prevalence of anemia, iron deficiency, and iron deficiency anemia as well as anthropometrics were compared between the groups at baseline, 3, and 6 months. Compared to the control group, children consuming the iron-fortified IC had significantly higher baseline-adjusted mean hemoglobin (10.0 +/- 1.8 vs. 9.7 +/- 1.4 g/dl, respectively; p = .023), ferritin adjusted for CRP (16.1 +/- 8.3 vs. 9.5 +/- 7.5 mu g/L, p < .001), serum iron (14.5 +/- 3.9 vs. 11.2 +/- 4.4 mu g/dl; p < .001), and transferrin saturation (19.0 +/- 17.4 vs. 10.7 +/- 12.5%; p < .001) at 6 months. The prevalence of anemia, iron deficiency, and iron deficiency anemia at 6 months decreased by a larger extent in the iron-fortified group versus controls (all p < .01). In addition, at 6 months, children in the iron-fortified group demonstrated higher weight-for-age z-scores (p = .016) compared to the control group. Wheat-based IC fortified with 7.5 mg ferrous fumarate administered daily for 6 months improved iron and nutritional status and decreased the prevalence of iron deficiency anemia in children aged 18-59 months in Salapoumbe, Cameroon.
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