Fortification of maize meal improved the nutritional status of 1-3-year-old African children

Objective: To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1-3-year-old malnourished African children. Design: A randomised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A, thiamine, riboflavin and pyridoxine, while 23 control children and their families received unfortified maize meal. The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households. Methods: Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics' criteria and aged 1-3 years were randomly assigned to an experimental or control group. Baseline measurements included demographic, socio-economic and dietary data, as well as height, weight, haemoglobin, haematocrit, serum retinol and retinol-binding protein (RBP). Anthropometric, blood and serum variables were measured again after 12 months of intervention. Complete baseline measurements were available for 44 children and end data for only 36. Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests, t-tests and analysis of variances using the SPSS program, controlling for expected weight gain in this age group over 12 months. Relationships between changes in variables were examined by calculating correlation coefficients. Results: The children in the experimental group had a significantly (P <= 0.05) higher increase in body weight than control children (4.6 kg vs. 2.0 kg) and both groups had significant (P <= 0.05) but similar increases in height. The children in the experimental group showed non-significant increases in haemoglobin and serum retinol, while the control children had a significant (P=0.007) decrease in RBP. The change in serum retinol showed a significant correlation with baseline retinol (P=0.014), RBP (P=0.007) and weight (P=0.029), as well as with changes in haemoglobin (P=0.029). Conclusion: Despite a small sample size, this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1-3-year-old African children. The study confirmed the relationship between vitamin A and iron status. The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa.