Multiple micronutrient

Allen LH, Rosado JL, Casteeline JE, Lopez P, Munoz E, Garcia OP and Martinez H (2000) Lack ofihemoglobin response to iron supplementation in anemic Mexican pre-schoolers with multiple micronutrient deficiencies. Am J Clin Nutr 71 1485-1495. 

Fortification vehicle/country/author Age group (years) Serve size lodine/multiple micronutrient serve or per lOOg or as % RDA Salt used... 

Understandably, biscuits and beverages (Table 75.3), the two most commonly preferred foods of children, are chosen for fortification. Some of the products have been used as intervention products in studies with children. There are multiple micronutrient-fortified products B shown to have a beneficial effect on nutritional status, anthropometric measures and cognition in school-age children (Abrams et ai, 2003 Lantham et al., 2003). 

Several fortification programs focus on the addition of the nutrient to the food and the stability under storage conditions, but not on the bioavailability. Considering that multiple micronutrient deficiencies coexist, fortification programs should also be aligned to provide solutions with multinutrient fortificants. The issues can only be dealt with if there is a concerted effort on the part of the industry, research establishments and the government. 

Nongranular dry-mixed fertilizers are not popular in most areas but are still used in some. One of these areas is in Florida where there are multiple micronutrient deficiencies. Hundreds of formulations are used, often custom mixed, so granulation is impractical. 

B Vitamins and Folate in Multiple Micronutrient Intervention Function and Effects... 

Micronutrient deficiencies are one of the most prevalent public health problems affecting more than two billion people worldwide (UNICEF and MI 2004). The magnitude of the problem is much greater in developing countries, where multiple micronutrient (MMN) deficiencies often occur concurrently as a result of poor quality diet. Although vitamin A, iron and iodine are the major micronutrient deficiencies in populations, deficiencies of zinc, vitamin C, folic add and other B vitamins (vitamin B2, Bg, B12 and niacin) are often present simultaneously (Huffman et al. 1999). MMN deficiencies are common throughout the lifespan, but specially in pregnant women and children. Micronutrient defidencies, if left untreated, can have considerable consequences on health and economic development (UNICEF and MI 2004). 

Table 31,1 Effects of multiple micronutrient intervention (fortification/supplementation) on various nutrition and health status in children based on the findings of available studies.

Eifect of multiple micronutrient supplementation during pregnancy on low birth weight. Random-effects model forest plot shows the effect size (ES) of multiple micronutrient supplementation during pregnancy compared with controls on low birth weight in 12 randomized controlled trials conducted in ten countries using United Nations International Multiple Micronutrient Preparation. 

This chapter focuses on the effects of B vitamins and folate in multiple micronutrient intervention. 

Providing multiple micronutrients, including B vitamins, as a supplement or fortified food can have positive effects on child growth, motor development and cognitive performance. 

Multiple micronutrient supplementation can significantly improve micronutrient status including B vitamins. 

Multiple micronutrient supplements can only marginally improve haemoglobin response in children and adolescent girls compared with iron and folic acid alone. 

Supplementation of multiple micronutrients during pregnancy increases birth weight and significantly reduces the prevalence of low birth weight and small-for-gestational age birth compared with iron and fohc acid... 

Multiple micronutrient supplements have no effect on rates of stillbirth, or early or late neonatal deaths. 

Multiple micronutrient deficiencies often occur concurrently in populations at risk who usually have poor quality diet. 

Multiple micronutrient intervention is the means of providing various micronutrients in addition to diet to meet requirements. 

Eilander, A., Gera, T., Sachdev, H.S., Transler, C., van der Knaap, H.C.M., Kok, F.J., and Osendarp, S.J.M., 2010. Multiple micronutrient supplementation for improving cognitive performance in children systematic review of randomized controlled trials. The American Journal of Clinical Nutrition. 91 115-130. 

Gera, T., Sachdev, H.P.S., and Nestel, P., 2009. Effect of combining multiple micronutrients with iron supplementation on Hb response in children systematic review of randomized controlled trial. Public Health Nutrition. 12 756-773. 

Kawai, K., Spiegelman, D., Shankar, A. H., and Fawzi, W.W., 2011. Maternal multiple micronutrient supplementation and pregnancy outcomes in developing countries meta-analysis and meta-regression. Bulletin of the World Health Organization. 89 402-41 IB. 

Ronsmans, C., Fisher, D.J., Osmond, C., Margetts, B.M., Fall, C.H.D., and the Maternal Micronutiient Supplementation Study Group (MMSSG), 2009. Multiple micronutrient supplementation during pregnancy in low-income countries A meta-analysis of effects on stillbirths and on early and late neonatal mortality. Food and Nutrition Bulletin. 30 S547-S555. 

Untoro, J., Karyadi, E., Wibowo, L., Erhardt, M.W., and Gross, R., 2005. Multiple micronutrient supplements improve micronutrient status and anaemia but not growth and morbidity of Indonesian infants A randomized, double-blind, placebo-controlled trial. Journal of Nutrition. 135 S639-S645. 

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