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The effects of high energy and micronutrient supplementation on iron status in nutritionally at risk infants
M A Husaini1, A B Jahari, E Pollitt
1Nutrition Research and Development Centre, Bogor, Indonesia.
Insights
Supplementary feeding improved iron status in 12-month-olds, showing significant increases in hemoglobin and ferritin. Energy-rich supplements were more effective than micronutrients alone, particularly for younger children.
Area of Science:
- Nutrition Science
- Public Health
- Pediatrics
Background:
- Iron deficiency is a major global health concern, particularly affecting infants and toddlers.
- Nutritional interventions are crucial for improving iron status in vulnerable populations.
- Tea plantation communities in West Java face specific challenges related to child nutrition.
Purpose of the Study:
- To assess the impact of supplementary feeding on the iron status of infants and toddlers.
- To compare the efficacy of energy and micronutrient supplementation versus micronutrient-only supplementation.
- To investigate age-related differences in response to iron supplementation.
Main Methods:
- A 180-day clinical trial was conducted with 136 infants and toddlers across 24 day-care centers.
- Participants were divided into two age cohorts (12 and 18 months) and three treatment groups: energy + micronutrient, micronutrient alone, and placebo.
- Iron status was evaluated using hemoglobin, ferritin, transferrin saturation (TS), and free erythrocyte porphyrin (FEP) levels.
Main Results:
- The 12-month cohort receiving energy + micronutrient or micronutrient alone showed significant improvements in hemoglobin, ferritin, and TS, with a decrease in FEP.
- The 18-month cohort showed no significant changes in most iron indicators within the first six months.
- Serum ferritin levels significantly improved in the 18-month cohort during the second six months, suggesting a delayed but positive effect of energy supplementation.
Conclusions:
- Supplementary feeding, especially with energy and micronutrients, effectively improves iron status in 12-month-old children.
- Energy plays a positive role in enhancing iron stores.
- The positive effects on iron status were more pronounced in the younger (12-month) cohort compared to the older (18-month) cohort.
Abstract:
The study assessed the effects of supplementary feeding over 180 consecutive days on iron status of infants and toddlers at six tea plantation in West Java, Indonesia. The design used was a clinical trial: two eohorts (i.e., 12 and 18 months old children) and three treatment groups (i.e., energy + micronutrient, micronutrient alone, and placebo) per cohort. Every day except Sunday, the infants attended day-care centers. Twenty four centers and 136 infants were selected. The infants were screened for weight and length and those meeting the criteria (i.e., < -1 SD of length-for-age, and between -1 and -2 SD of weight-for-length of the NCHS reference) were included. The experimental unit was the day-care centers (DCC), where each DCC was randomly assigned to one of the three treatment. As expected, groups of energy + micronutrient and micronutrient alone of the 12 months cohort experienced a significant upward shift in hemoglobin, ferritin and TS and a downward change in FEP, while the values for the group of placebo remain about the same as at base line. In the first 6 month of treatments, the ANOVA for each iron indicator yielded significant main effects of treatment (P < 0.01) and for Hb with (P = 0.059) on 12 months cohort. On the other hand, the main effects of treatment on hemoglobin, TS, ferritin and FEP were not significant for the 18 months cohort. In the second 6 months of treatments, the only significant of the treatment effect (P < 0.01) was in serum ferritin on 18-month cohort. Under these circumstances, energy has a positive role in improving iron stores. It is likely that the equilibrium of hemoglobin and each iron indicators were reached in 6 months of treatment except ferritin still continued to increase up to 12 month. The effects of treatment on the improvement of iron status was stronger in 12 months than in 18 months.