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In preschool-aged children in India, fortified milk helped reduce
Release Date: December 7, 2006; Valid for credit through December 7, 2007
December 7, 2006 ? In preschool-aged children in India, fortified milk helped reduce incidence of diarrhea and pneumonia, according to the results of a randomized controlled trial reported in the November 28 Online First issue of the BMJ.
"National fortification programmes and fortification studies have shown that fortification of common home based food can overcome the limitations inherent to supplementation at a lower cost," write Sunil Sazawal, MD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues. "Milk is a popular food for fortification because it is readily available, widely accepted, and frequently fed to young children. To evaluate acceptability and efficacy of delivering specific micronutrients, including zinc and iron, through fortified milk we conducted a community based, double masked, randomized controlled trial comparing fortified milk with the same milk without fortification for prevention of common childhood morbidities."
In a peri-urban settlement in north India, 633 children aged 1 to 3 years were randomized to receive fortified milk (n = 316) or control milk (n = 317) 3 times daily for 1 year. The fortified milk contained an additional 7.8 mg of zinc, 9.6 mg of iron, 4.2 μg of selenium, 0.27 mg of copper, 156 μg of vitamin A, 40.2 mg of vitamin C, and 7.5 mg of vitamin E in the 3 daily servings. Primary endpoints were days with severe illnesses, incidence and prevalence of diarrhea, and acute lower respiratory tract illness.
Both groups were similar in baseline characteristics and compliance. The mean number of episodes of diarrhea per child was 4.46 ? 3.8 in the fortified milk group and 5.36 ? 4.1 in the control group, and the mean number of episodes of acute lower respiratory tract illness was 0.62 ? 1.1 and 0.83 ? 1.4, respectively.
Consumption of fortified milk was associated with reduced risk for days with severe illnesses by 15% (95% confidence interval [CI], 5% - 24%), for incidence of diarrhea by 18% (95% CI, 7% - 27%), and for incidence of acute lower respiratory tract illness by 26% (95% CI, 3% - 43%). Other benefits in the intervention group included 7% fewer days with high fever, 15% fewer days sick with severe illnesses, lower rates of measles, and reduced use of antibiotics. Children younger than 2 years of age had consistently greater benefits than did older children.
"Milk is well accepted as a means of delivery of micronutrients," the authors write. "Consumption of milk fortified with specific micronutrients can significantly reduce the burden of common morbidities among preschool children, especially in the first two years of life."
Study limitations include inability to determine the contributions of individual micronutrients.
"Given that the latest estimates of the percentage of gross domestic product lost to all forms of vitamin and mineral deficiency is 1-2% in the developing world, there is an urgent need to develop and implement strategies to reduce the burden of these deficiencies," the authors conclude. "We have shown that micronutrients, especially zinc and iron, at levels that have been traditionally delivered by supplementation, can be delivered successfully through fortified milk. This mode of delivery is well accepted and retains the prevention of morbidity shown in zinc supplementation trials while also being able to deliver iron and other specific micronutrients."
Fonterra Brands in Auckland, New Zealand, funded this study and provided the milk powder used in the trial. The authors have disclosed no relevant financial relationships.
BMJ. Published online November 28, 2006.
Note: More info available at web site
In preschool-aged children in India, fortified milk helped reduce
Release Date: December 7, 2006; Valid for credit through December 7, 2007
December 7, 2006 ? In preschool-aged children in India, fortified milk helped reduce incidence of diarrhea and pneumonia, according to the results of a randomized controlled trial reported in the November 28 Online First issue of the BMJ.
"National fortification programmes and fortification studies have shown that fortification of common home based food can overcome the limitations inherent to supplementation at a lower cost," write Sunil Sazawal, MD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues. "Milk is a popular food for fortification because it is readily available, widely accepted, and frequently fed to young children. To evaluate acceptability and efficacy of delivering specific micronutrients, including zinc and iron, through fortified milk we conducted a community based, double masked, randomized controlled trial comparing fortified milk with the same milk without fortification for prevention of common childhood morbidities."
In a peri-urban settlement in north India, 633 children aged 1 to 3 years were randomized to receive fortified milk (n = 316) or control milk (n = 317) 3 times daily for 1 year. The fortified milk contained an additional 7.8 mg of zinc, 9.6 mg of iron, 4.2 μg of selenium, 0.27 mg of copper, 156 μg of vitamin A, 40.2 mg of vitamin C, and 7.5 mg of vitamin E in the 3 daily servings. Primary endpoints were days with severe illnesses, incidence and prevalence of diarrhea, and acute lower respiratory tract illness.
Both groups were similar in baseline characteristics and compliance. The mean number of episodes of diarrhea per child was 4.46 ? 3.8 in the fortified milk group and 5.36 ? 4.1 in the control group, and the mean number of episodes of acute lower respiratory tract illness was 0.62 ? 1.1 and 0.83 ? 1.4, respectively.
Consumption of fortified milk was associated with reduced risk for days with severe illnesses by 15% (95% confidence interval [CI], 5% - 24%), for incidence of diarrhea by 18% (95% CI, 7% - 27%), and for incidence of acute lower respiratory tract illness by 26% (95% CI, 3% - 43%). Other benefits in the intervention group included 7% fewer days with high fever, 15% fewer days sick with severe illnesses, lower rates of measles, and reduced use of antibiotics. Children younger than 2 years of age had consistently greater benefits than did older children.
"Milk is well accepted as a means of delivery of micronutrients," the authors write. "Consumption of milk fortified with specific micronutrients can significantly reduce the burden of common morbidities among preschool children, especially in the first two years of life."
Study limitations include inability to determine the contributions of individual micronutrients.
"Given that the latest estimates of the percentage of gross domestic product lost to all forms of vitamin and mineral deficiency is 1-2% in the developing world, there is an urgent need to develop and implement strategies to reduce the burden of these deficiencies," the authors conclude. "We have shown that micronutrients, especially zinc and iron, at levels that have been traditionally delivered by supplementation, can be delivered successfully through fortified milk. This mode of delivery is well accepted and retains the prevention of morbidity shown in zinc supplementation trials while also being able to deliver iron and other specific micronutrients."
Fonterra Brands in Auckland, New Zealand, funded this study and provided the milk powder used in the trial. The authors have disclosed no relevant financial relationships.
BMJ. Published online November 28, 2006.