Health Effects of Micronutrient Fortified Dairy Products and Cereal Food for Children and Adolescents: A Systematic Review

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Jan 24

PMID 30673769

Citations 10

Authors

Klaus Eichler

Sascha Hess

Claudia Twerenbold

Magalie Sabatier

Flurina Meier

Simon Wieser

Affiliations

Soon will be listed here.

Abstract

Introduction: Micronutrient (MN) deficiencies cause a considerable burden of disease for children in many countries. Dairy products or cereals are an important food component during adolescence. Fortification of dairy products or cereals with MN may be an effective strategy to overcome MN deficiencies, but their specific impact on health in this age group is poorly documented.

Methods: We performed a systematic review and meta-analysis (registration number CRD42016039554) to assess the impact of MN fortified dairy products and cereal food on the health of children and adolescents (aged 5-15 years) compared with non-fortified food. We reviewed randomised controlled trials (RCT) using electronic databases (MEDLINE, EMBASE, Cochrane library; latest search: January 2018), reference list screening and citation searches. Three pairs of reviewers assessed 2048 studies for eligibility and extracted data. We assessed the risk of bias and applied GRADE to rate quality of evidence.

Results: We included 24 RCT (often multi MN fortification) with 30 pair-wise comparisons mainly from low- and middle income countries. A very small and non-significant increase of haemoglobin values emerged (0.09 g/dl [95%-CI: -0.01 to 0.18]; 13 RCT with iron fortification; very low quality of evidence). No significant difference was found on anaemia risk (risk ratio 0.87 [95%-CI: 0.76 to 1.01]; 12 RCT; very low quality), but a significant difference in iron deficiency anaemia favouring fortified food was found (risk ratio 0.38 [95%-CI: 0.18 to 0.81]; 5 RCT; very low quality). Similar effects were seen for fortified dairy products and cereals and different fortification strategies (mono- vs. dual- vs. multi-MN). Follow-up periods were often short and the impact on anthropometric measures was weak (low quality of evidence) Very low quality of evidence emerged for the improvement of cognitive performance, functional measures and morbidity.

Conclusions: Fortification of dairy products and cereal food had only marginal health effects in our sample population from 5-15 years. Further evidence is needed to better understand the health impact of fortified dairy products and cereals in this age group.

Systematic Review Registration: The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 26 May 2016 (registration number CRD42016039554).

Citing Articles

Ten2Twenty-Ghana: a randomised controlled trial on the efficacy of multiple micronutrient-fortified biscuits on the micronutrient status of adolescent girls.

Azupogo F, Abizari A, Feskens E, Verhoef H, Brouwer I Br J Nutr. 2023; 131(4):707-719.

PMID: 37795629 PMC: 10803820. DOI: 10.1017/S0007114523002234.

Dairy fortification as a good option for dietary nutrition status improvement of 676 preschool children in China: A simulation study based on a cross-sectional diet survey (2018-2019).

Ding Y, Han F, Xie Z, Li G, Zhuang Y, Yin J Front Nutr. 2022; 9:1081495.

PMID: 36570132 PMC: 9773072. DOI: 10.3389/fnut.2022.1081495.

Impact of milk on malnutrition and cognitive skills among school children: Evidence from gift milk initiative from a tribal state of India.

Rana R, Nag A, Soren S, Kumar D, Kumar C, Sagar V J Family Med Prim Care. 2022; 11(6):2945-2951.

PMID: 36119240 PMC: 9480738. DOI: 10.4103/jfmpc.jfmpc_2425_21.

Iron Bioavailability from Ferrous Ammonium Phosphate, Ferrous Sulfate, and Ferric Pyrophosphate in an Instant Milk Drink-A Stable Isotope Study in Children.

Hurrell R, Trinidad T, Mallillin A, Sagum R, Foman J, Li Q Nutrients. 2022; 14(8).

PMID: 35458201 PMC: 9031871. DOI: 10.3390/nu14081640.

Dietary Approaches to Iron Deficiency Prevention in Childhood-A Critical Public Health Issue.

Chouraqui J Nutrients. 2022; 14(8).

PMID: 35458166 PMC: 9026685. DOI: 10.3390/nu14081604.

References

Rohner F, Zimmermann M, Amon R, Vounatsou P, Tschannen A, NGoran E . In a randomized controlled trial of iron fortification, anthelmintic treatment, and intermittent preventive treatment of malaria for anemia control in Ivorian children, only anthelmintic treatment shows modest benefit. J Nutr. 2010; 140(3):635-41. DOI: 10.3945/jn.109.114256. View

Field M, Mithra P, Estevez D, Pena-Rosas J . Wheat flour fortification with iron for reducing anaemia and improving iron status in populations. Cochrane Database Syst Rev. 2020; 7:CD011302. PMC: 9503748. DOI: 10.1002/14651858.CD011302.pub2. View

Eichler K, Wieser S, Ruthemann I, Brugger U . Effects of micronutrient fortified milk and cereal food for infants and children: a systematic review. BMC Public Health. 2012; 12:506. PMC: 3444335. DOI: 10.1186/1471-2458-12-506. View

Allen L, Peerson J, Olney D . Provision of multiple rather than two or fewer micronutrients more effectively improves growth and other outcomes in micronutrient-deficient children and adults. J Nutr. 2009; 139(5):1022-30. DOI: 10.3945/jn.107.086199. View

van Stuijvenberg M, Smuts C, Wolmarans P, Lombard C, Dhansay M . The efficacy of ferrous bisglycinate and electrolytic iron as fortificants in bread in iron-deficient school children. Br J Nutr. 2006; 95(3):532-8. DOI: 10.1079/bjn20051669. View

Camargo Jr C, Ganmaa D, Frazier A, Kirchberg F, Stuart J, Kleinman K . Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Pediatrics. 2012; 130(3):e561-7. DOI: 10.1542/peds.2011-3029. View

Suchdev P, Namaste S, Aaron G, Raiten D, Brown K, Flores-Ayala R . Overview of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. Adv Nutr. 2016; 7(2):349-56. PMC: 4785469. DOI: 10.3945/an.115.010215. View

Zimmermann M, Chassard C, Rohner F, NGoran E, Nindjin C, Dostal A . The effects of iron fortification on the gut microbiota in African children: a randomized controlled trial in Cote d'Ivoire. Am J Clin Nutr. 2010; 92(6):1406-15. DOI: 10.3945/ajcn.110.004564. View

Hieu N, Sandalinas F, De Sesmaisons A, Laillou A, Tam N, Khan N . Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children. Br J Nutr. 2012; 108(8):1419-27. DOI: 10.1017/S0007114511006945. View

10.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

11.

Bouhouch R, El-Fadeli S, Andersson M, Aboussad A, Chabaa L, Zeder C . Effects of wheat-flour biscuits fortified with iron and EDTA, alone and in combination, on blood lead concentration, iron status, and cognition in children: a double-blind randomized controlled trial. Am J Clin Nutr. 2016; 104(5):1318-1326. DOI: 10.3945/ajcn.115.129346. View

12.

Bass S, Naughton G, Saxon L, Iuliano-Burns S, Daly R, Briganti E . Exercise and calcium combined results in a greater osteogenic effect than either factor alone: a blinded randomized placebo-controlled trial in boys. J Bone Miner Res. 2006; 22(3):458-64. DOI: 10.1359/jbmr.061201. View

13.

Guyatt G, Oxman A, Sultan S, Brozek J, Glasziou P, Alonso-Coello P . GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol. 2012; 66(2):151-7. DOI: 10.1016/j.jclinepi.2012.01.006. View

14.

Centeno Tablante E, Pachon H, Guetterman H, Finkelstein J . Fortification of wheat and maize flour with folic acid for population health outcomes. Cochrane Database Syst Rev. 2019; 7:CD012150. PMC: 6599881. DOI: 10.1002/14651858.CD012150.pub2. View

15.

Kristjansson E, Robinson V, Petticrew M, Macdonald B, Krasevec J, Janzen L . School feeding for improving the physical and psychosocial health of disadvantaged elementary school children. Cochrane Database Syst Rev. 2007; (1):CD004676. DOI: 10.1002/14651858.CD004676.pub2. View

16.

Neyestani T, Hajifaraji M, Omidvar N, Nikooyeh B, Eshraghian M, Shariatzadeh N . Calcium-vitamin D-fortified milk is as effective on circulating bone biomarkers as fortified juice and supplement but has less acceptance: a randomised controlled school-based trial. J Hum Nutr Diet. 2013; 27(6):606-16. DOI: 10.1111/jhn.12191. View

17.

Sazawal S, Habib A, Dhingra U, Dutta A, Dhingra P, Sarkar A . Impact of micronutrient fortification of yoghurt on micronutrient status markers and growth - a randomized double blind controlled trial among school children in Bangladesh. BMC Public Health. 2013; 13:514. PMC: 3671231. DOI: 10.1186/1471-2458-13-514. View

18.

Ochola S, Masibo P . Dietary intake of schoolchildren and adolescents in developing countries. Ann Nutr Metab. 2014; 64 Suppl 2:24-40. DOI: 10.1159/000365125. View

19.

Garcia-Casal M, Pena-Rosas J, De-Regil L, Gwirtz J, Pasricha S . Fortification of maize flour with iron for controlling anaemia and iron deficiency in populations. Cochrane Database Syst Rev. 2018; 12:CD010187. PMC: 6517107. DOI: 10.1002/14651858.CD010187.pub2. View

20.

Muthayya S, Thankachan P, Hirve S, Amalrajan V, Thomas T, Lubree H . Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. J Nutr. 2012; 142(11):1997-2003. DOI: 10.3945/jn.111.155135. View