Objectives
Inadequate dietary diversity during complementary feeding may cause micronutrient deficiencies. A cluster-randomized controlled trial of daily complementary food supplements (CFS) in rural Bangladesh improved linear growth and reduced stunting. Here we investigated CFS effects on micronutrient status.
Methods
Participants (n=5,449) were enrolled at age 6 months and received child feeding counseling only (control) or counseling and one of four micronutrient-fortified (to ~75% of daily requirements) CFS formulations as a daily snack for one year: lipid-based ready-to-use chickpea or rice-lentil, cooked wheat-soy blend++, or commercial Plumpy’doz. At age 18 months, blood was collected from a subset (n=754) balanced by group. Hemoglobin and serum ferritin, retinol, zinc, and inflammation markers C-reactive protein (CRP) and a-1 acid glycoprotein (AGP) were measured. Micronutrient status and inflammation were evaluated by group and as any CFS vs. control using GEE linear regression to account for cluster-randomization.
Results
Prevalence of depleted iron stores (ferritin<12µg/L), anemia (hemoglobin<110g/L), hyporetinolemia (retinol<0.7µmol/L) and zinc deficiency (zinc<650µg/L) were 13.3%, 15.8%, 10.1% and 4.3%, respectively, among controls. Inflammation (CRP>5mg/L, AGP>1g/L or both) affected 60% of participants but did not differ by CFS group. Assignment to any CFS group versus control was associated with higher mean±SE ferritin (+7.8±2.9µg/L), hemoglobin (+2.2±0.9g/L) and retinol (+0.11±0.04µmol/L), all p<0.01, but no difference in serum zinc. Individual CFS vs. control differed only for ferritin for Plumpy'doz and rice-lentil.
Conclusions
Micronutrient deficiencies were uncommon in these rural Bangladeshi children despite prevalent inflammation. Daily food supplements improved iron and vitamin A status but did not measurably impact zinc status.
