Supplements/supplementation multiple micronutrients

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. 

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. 

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. 

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. 

Although the incremental cost of distributing a multiple micronutrient supplement is likely to be small, the increased benefits may be large. The main cost of the delivery of a nutrient supplement for women of reproductive age is not the cost of the supplement but the cost of the delivery system. Although it may not be working very well, a delivery system already exists for the iron/folate supplements that could be used to provide these other micronutrients. There has been much speculation about the costs of a multiple micronutrient supplement compared to the iron/folate tablet currently procured and provided by UNICEF. Adding the extra nutrients to the iron/folate tablets will not add more than 20% to the cost of the tablet, as long as they are procured in bulk on the international market, as is the case for the current iron/ folate tablets supplied by UNICEF. 

The composition of a multiple micronutrient supplement for use in trials among pregnant and... 

Currently, folic acid is added to most iron supplements for women of fertile age because it reduces the risk of neural-tube defects and because lack of folic acid may limit the hemoglobin response to iron supplements. In the absence of these nutrients such as vitamin A, vitamin Bj2, and riboflavin may also limit the efficacy of iron supplements, and studies are underway to assess the effect of multiple micronutrient supplements on anemia. 

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