0
Editorial | ONLINE FIRST

More Proof That Home Fortification Is of Value in Children With Iron Deficiency Anemia ONLINE FIRST

Stanley Zlotkin, CM, MD, PhD, FRCPC
Arch Pediatr Adolesc Med. Published online July 16, 2012. doi:10.1001/archpediatrics.2012.1514
Text Size: A A A
Published online

Extract

Most trials examining the impact of micronutrient powders on anemia and iron status have been efficacy studies where variables were controlled and the interventions were closely supervised. A meta-analysis of efficacy trials demonstrated that Sprinkles, a micronutrient powder, were as effective as iron drops and had fewer adverse effects.1 In the prevention trials, the risk for anemia was cut in half.

The trial by Jack et al2 was somewhat unique in that it was designed as an effectiveness trial. Its goal was to determine whether Sprinkles could be successfully delivered to a free-living population of infants through an existing government health service in Cambodia. The trial compared nutrition education alone with the combination of nutrition education and micronutrient powder on nutritional outcomes including anemia status, zinc and vitamin A levels, and anthropometry in infants, starting at 6 months of age. The nutrition education was quite intensive and took the form of verbal and written instructions, pictures, and cooking demonstrations based on Cambodian foods and nutrition recommendations for infants at 6 months of age. All subjects were followed up monthly for 6 months. The results were quite conclusive and not surprising. Nutrition education alone, even when intensively communicated and clearly demonstrated, was inferior to the same nutrition education combined with micronutrient powders in terms of its impact on anemia status in infants between 6 and 11 months of age. When age-appropriate infant foods are fortified, in this case through home fortification with micronutrient powder containing iron, iron status and anemia rates were improved. This is not surprising because we know that human milk is not a good source of iron (20-40 μg/dL; to convert to micromoles per liter, multiply by 0.179), and we know that even if an infant is born at full term with a full endowment of stored iron, by 6 to 9 months of age, the iron will be incorporated into hemoglobin until stores are totally depleted, at which time anemia will become apparent.3 Multiple studies in developing and developed countries have demonstrated higher rates of iron depletion in longer vs shorter duration of exclusive breastfeeding.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Iron Deficiency Anemia

brightcove.createExperiences();