Dietary supplementation with multiple micronutrients: no beneficial effects in pediatric cystic fibrosis patients. The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance. Effect of micronutrient supplement on health and nutritional status of schoolchildren: biochemical status. Micronutrient supplementation improves physical performance measures in Asian Indian school-age children. Efficacy of twice-weekly multiple micronutrient supplementation for improving the hemoglobin and micronutrient status of anemic adolescent schoolgirls in Bangladesh. Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial Effect of a Multiple-Micronutrient-Fortified Fruit Powder Beverage on the Nutrition Status, Physical Fitness, and Cognitive Performance of Schoolchildren in the Philippines Lack of hemoglobin response to iron supplementation in anemic mexican preschoolers with multiple micronutrient deficiencies. Multiple micronutrient supplementation during early childhood increases child size at 2 y of age only among high compliers. Double-Blind, Placebo-Controlled Trial Comparing Effects of Supplementation with Two Different Combinations of Micronutrients Delivered as Sprinkles on Growth, Anemia, and Iron Deficiency in Cambodian Infants Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, growth, and morbidity of Peruvian infants. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. Micronutrient and iron supplementation and effective antimalarial treatment synergistically improve childhood anaemia. Effect of micronutrient supplementation on health and nutritional status of schoolchildren: growth and morbidity. Multiple micronutrient supplements improve micronutrient status and anemia but not growth and morbidity of Indonesian infants: a randomized, double-blind, placebo-controlled trial. Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population. Multiple micronutrient supplementation improves anemia, micronutrient nutrient status, and growth of Vietnamese infants: double-blind, randomized, placebo-controlled trial.
BACKGROUND Cystic fibrosis ( CF ) patients are subjected to increased oxidative stress due to chronic pulmonary inflammation and recurrent infections . Additionally , these patients have diminished skeletal muscle performance and exercise capacity . We hypothesize that a mixture of multiple micronutrients could have beneficial effects on pulmonary function and muscle performance . METHODS A double-blind , r and omized , placebo controlled , cross-over trial with a mixture of multiple micronutrients ( ML1 ) was performed in 22 CF patients ( 12.9+/-2.5 yrs ) with predominantly mild lung disease .  Anthropometric measures , pulmonary function , exercise performance by bicycle ergometry , muscular strength and vitamins A and E were determined . RESULTS Analysis was performed using the paired Student t-test comparing the change in each parameter during ML1 and placebo . Plasma vitamin E and A levels increased during ML1 when compared to placebo . However , no significant difference between the effect of the ML1 or placebo was observed neither for FEV1 , FVC , anthropometry , nor for the parameters for muscle performance . CONCLUSIONS The micronutrient mixture was not superior to placebo with respect to changes in pulmonary function or muscle performance in pediatric CF patients , despite a significant increase in plasma vitamin E concentrations Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies . This study aim ed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status , cognition , physical performance and nutritional deficiencies of 7 - 10 years old south Indian children . A r and omized , double blind placebo controlled study design was used with normal healthy children from low to middle income families , aged 7 - 10 years r and omly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink . The drinks were provided 6 days/week for 5 months . Assessment s included anthropometry , blood biochemistry , physical performance and cognition at baseline and endline . The baseline characteristics of the study groups were similar . The changes in body weight and height were similar between the groups at the end of the study . Levels of vitamin B12 , red cell folate and vitamin B2 significantly improved in the intervention group , while vitamin D , selenium and body iron showed no difference . The Hemoglobin ( Hb ) and serum ferritin levels of the control group decreased at endline , while those in the intervention group maintained their levels . The serum transferrin receptor levels increased in both the groups . The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline . Overall improvement in cognitive and physical performance was seen in both the groups at endline , with no significant differences between the groups . The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2 , Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink . It also reduced anemia and the risk of deficiencies of iron , and B12 , in apparently healthy children . Clinical Trials.gov IdentifierNCT01415557 . Clinical Trial RegistryIndia - REF/2012/12/004332 OBJECTIVE We assessed the effect of a daily intake of a micronutrient-fortified beverage for 14 mo on indicators of biochemical status of important micronutrients in schoolchildren . METHODS A double-blind , placebo-controlled , matched-pair , cluster , r and omization study design was used . Biochemical indicators of micronutrient status were evaluated at baseline and at the end of 14 mo on a sub sample in nine matched pairs . Prevalence ( percentage ) of sub clinical deficiency , mean , and mean increments of each indicator were compared between supplemented and placebo groups . RESULTS Extent of inadequacy at baseline was more or less 100 % for folic acid , 65 % for vitamins B2 and B6 , and 55 % for vitamins C and A. Prevalence of anemia among subjects was 55 % , with inadequacy of vitamin B12 being 40 % and that of vitamin D being 30 % . No subject had inadequacy of iodine based on urinary iodine . Supplementation of a micronutrient-enriched beverage for 14 mo significantly improved the status of many of the nutrients . The effect was significant with respect to vitamins A , B2 , and B12 , folic acid , vitamin D , parathyroid hormone , and thyroid-stimulating hormone in children who received the supplement compared with those who received only placebo .  Hemoglobin status improved only in children who had anemia in the supplemented group . CONCLUSIONS Prevalence of multiple sub clinical micronutrient deficiencies are high in middle-income Indian school children . Daily consumption of a micronutrient-enriched beverage had positive effects that were confined to those nutrients that were inadequate at baseline Micronutrients are important in physical work capacity and therefore performance . The impact of a multi-micronutrient-fortified nutritional beverage on physical performance measures among clinical ly healthy school-age children was assessed in a double-blind ( for test and placebo groups ) , placebo-controlled , r and omized trial in children aged between 7 and 10.5 y ( n = 300 ) . The participants with height- and weight-for-age Z-scores between 0 and ≥ -3 were r and omized to 1 of 3 study arms : fortified choco-malt beverage powder ( F ) , matched energy equivalent unfortified placebo ( U ) , and untreated control ( C ) . Participants in the F and C groups were given 40 g fortified ( 19 key vitamins and minerals ) and unfortified choco-malt beverage , respectively , daily for 120 d. Primary efficacy outcomes included endurance and aerobic capacity using a 20-m shuttle test and step test . Other physical performance measures included speed ( 40-m sprint ) , visual reaction time , maximal h and grip , and forearm static endurance . Micronutrient status included thiamin , riboflavin , folate , niacin , iron , pyridoxal phosphate , and vitamins B-12 and C. All measurements were made at baseline and the end of the intervention . There was a within-subject increase in aerobic capacity and whole body endurance ( P < 0.05 ) accompanied by a significant improvement in the status of iron thiamin , riboflavin , pyridoxal phosphate , folate , and vitamins C and B-12 in the F group compared to the within-subject changes in the other 2 groups ( P < 0.05 ) . The study suggests that multiple micronutrient supplementation in similar population s may be beneficial in improving micronutrient status and enhancing aerobic capacity and endurance in children BACKGROUND Although iron deficiency is a major cause of anemia , other micronutrient deficiencies may also play a role . OBJECTIVE We examined whether multiple micronutrient supplementation is more efficacious than is supplementation with iron and folic acid alone for improving the hemoglobin and iron status of anemic adolescent girls in Bangladesh . DESIGN Anemic ( hemoglobin < 12.0 g/dL ) girls ( n = 197 ) aged 14 - 18 y from rural schools in Dhaka District were entered into a r and omized double-blind trial and received twice-weekly supplements of iron and folic acid ( IFA group ) or multiple micronutrients ( 15 micronutrients , including iron and folic acid ; MMN group ) for 12 wk . RESULTS At recruitment , the characteristics of the girls in the 2 groups were not significantly different , except for family size and body mass index . At the end of the study , although both groups benefited significantly from supplementation , mean changes in hemoglobin and serum ferritin concentrations were not significantly different between groups . Compared with the IFA group , girls in the MMN group had significantly greater increases in mean serum vitamin A , plasma vitamin C , red blood cell folic acid , and riboflavin concentrations ( assessed as erythrocyte glutathione reductase activation coefficient ) . After 12 wk of supplementation , only the prevalence of vitamins A and C and riboflavin deficiencies decreased more significantly in the MMN group than in the IFA group . CONCLUSIONS Twice-weekly MMN supplementation for 12 wk significantly improved the status of the micronutrients assessed but was not more efficacious than was supplementation with iron and folic acid alone in improving the hematologic status of anemic adolescent girls . More frequent doses may be needed to achieve full benefit Background Multiple micronutrient deficiencies , in particular iron deficiency anaemia ( IDA ) is a severe public health problem in Lao People 's Democratic Republic ( Lao PDR ) . Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children , recently , home-fortification with multivitamins and minerals sprinkles was recommended . This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder ( MMP ) on anaemia prevalence , haemoglobin concentration , and growth in infants and young children in a rural community in Lao PDR . Methods A r and omized trial was conducted in six rural communities . Children aged 6 to 52 months ( n = 336 ) were r and omly assigned to a control group ( n = 110 ) or to one of two intervention groups receiving either two sachets per week ( n = 115 ) or a daily sachet ( n = 111 ) of MMP for 24 weeks ; 331 children completed the study . A finger prick of blood was taken at baseline , at week 12 , and again at week 24 to determine haemoglobin concentration . Anthropometric measurements were taken every 4 weeks . The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups . Results MMP supplementation result ed in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group ( p < 0.001 ) . The severely to moderately anaemic children ( Hb < 100 g/L ) on daily supplementation recovered faster than those on twice weekly supplementation . MMP was well accepted and compliance was high in both treatment groups . Overall , the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups . Conclusions MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration . For severely to moderately anaemic children , daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence . A longer intervention period is probably needed to have a positive effect on growth This study aim ed to determine the effect of a multiple-micronutrient-fortified beverage on the micronutrient status , physical fitness , and cognitive performance of schoolchildren . The study was a r and omized , double-blind , placebo-controlled trial of schoolchildren assigned to receive either the fortified or nonfortified beverage with or without anthelmintic therapy .  Data on hemoglobin level , urinary iodine excretion ( UIE ) level , physical fitness , and cognitive performance were collected at baseline and at 16 weeks post-intervention . The fortified beverage significantly improved iron status among the subjects that had hemoglobin levels < 11 g/dl at baseline . The proportion of children who remained moderately to severely anemic was significantly lower among those given the fortified beverage . In the groups that received the fortified product , the median UIE level increased , whereas among those who received the placebo beverage , the median UIE level was reduced significantly . Iron- and /or iodine-deficient subjects who received the fortified beverage showed significant improvements in fitness ( post-exercise reduction of heart rate ) and cognitive performance ( nonverbal mental ability score ) . The study showed that consumption of a multiple-micronutrient-fortified beverage for 16 weeks had significant effects on iron status , iodine status , physical fitness , and cognitive performance among iron- and /or iodine-deficient Filipino schoolchildren .  Anthelmintic therapy improved iron status of anemic children and iodine status of the iron-adequate children at baseline but it had no effect on physical fitness and cognitive performance . The results from the clinical study showed that a multiple-micronutrient-fortified beverage could play an important role in preventing and controlling micronutrient deficiencies BACKGROUND In developing countries , incomplete resolution of anemia with iron supplementation is often attributed to poor compliance or inadequate duration of supplementation , but it could result from deficiencies of other micronutrients . OBJECTIVE Our objective was to assess children 's hematologic  response to supervised , long-term iron supplementation and the relation of this response to other micronutrient deficiencies , anthropometry , morbidity , and usual dietary intake . DESIGN Rural Mexican children aged 18 - 36 mo ( n = 219 ) were supplemented for 12 mo with either 20 mg Fe , 20 mg Zn , both iron and zinc , or placebo . Children were categorized as iron-unsupplemented ( IUS ; n = 109 ) or iron supplemented ( IS ; n = 108 ) . Hemoglobin , hematocrit , mean corpuscular volume , mean cell hemoglobin , plasma concentrations of micronutrients that can affect hematopoiesis , anthropometry , and diet were assessed at 0 , 6 , and 12 mo ; morbidity was assessed biweekly . RESULTS At baseline , 70 % of children had low hemoglobin ( < /=115 g/L ) , 60 % had low hematocrit , 48 % were ferritin deficient , 10 % had deficient and 33 % had low plasma vitamin B-12 concentrations , 29 % had deficient vitamin A concentrations , and 70 % had deficient vitamin E concentrations . Iron supplementation increased ferritin from 11 + /- 14 microg/L at baseline to 31 + /- 18 microg/L after 6 mo ( P < 0.001 ) and 41 + /- 17 microg/L after 12 mo . However , anemia persisted in 30 % and 31 % of supplemented children at 6 and 12 mo , respectively , and was not significantly different between the IUS and IS groups at 12 mo . Initial plasma vitamin B-12 , height-for-age , and dietary quality predicted the hematopoietic response to iron . CONCLUSION Lack of hemoglobin response to iron was associated with indicators of chronic undernutrition and multiple micronutrient deficiencies BACKGROUND Micronutrient deficiencies are common , even in middle-income countries . OBJECTIVE The objectives were to determine whether multiple micronutrient ( MM ) supplementation from 3 to 24 mo of age improves growth and whether the effect is modified by MM supplementation during pregnancy . DESIGN We conducted a r and omized , double-blind , controlled trial in central Mexico . Singleton live births ( n = 650 ) from a prenatal MM trial were r and omly assigned to receive either MM supplements ( 1 - 1.5 times the Recommended Dietary Allowance of vitamins A , B-6 , B-12 , and C ; folic acid ; iron ; zinc ; and other nutrients ) or supplements containing similar amounts of iron and vitamin A ( Fe-A ) within the maternal supplementation groups ( MM and iron only ) 6 d/wk from 3 to 24 mo of age . Anthropometric measurements were obtained at 3 and 24 mo of age . RESULTS There was no effect of supplement group on child growth in intention-to-treat analyses . However , infants who consumed MM supplements regularly ( greater than the median compliance of 79 % ) were 0.8 ( 95 % CI : -0.4 , 1.9 ) and 1.6 ( 95 % CI : 0.4 , 2.8 ) cm taller at 24 mo in the maternal MM and iron-only groups , respectively , than were those in the Fe-A group ; these differences were 0.2 ( 95 % CI : -1.0 , 1.4 ) and -0.5 ( 95 % CI : -1.7 , 0.7 ) cm among those with compliance below the median . Mean body mass index ( in kg/m(2 ) ) was significantly higher in those exposed to iron only in utero and Fe-A during childhood ( 16.2 ) than in the other groups ( 15.8 ) . CONCLUSIONS MM supplements increased the length of children who consumed them regularly from 3 to 24 mo . Strategies that promote compliance through effective delivery of micronutrient interventions are needed Objectives : To assess and compare efficacy of two micronutrient sprinkle supplementation on growth , anemia , and iron deficiency in Cambodian infants . Methods : A total of 204 infants aged 6 months and living in Kompong Chhnang Province , Cambodia were r and omly assigned to receive daily supplements of either iron ( 12.5 mg ) plus folic acid ( 150 & mgr;g ) plus zinc ( 5 mg ) ( MMN , n = 68 ) , or iron ( 12.5 mg ) plus folic acid ( 150 & mgr;g ) alone ( FFA , n = 68 ) , or placebo ( n = 68 ) for a 12 month period in powder form as sprinkles . Anthropometrics was evaluated bimonthly . Biochemical assessment was performed at baseline and at the end of intervention period . Results : At baseline , the overall mean ( SD ) of hemoglobin concentration was 101 g/L. No difference among groups was found for growth pattern . Significant decline was observed for weight-for-age and height-for-age z-scores in any group ( P < 0.0001 ) . The rate of recovery from anemia was significant ( P < 0.001 ) and comparable between MMN ( 54 % ) and FFA ( 53 % ) groups and higher than in the placebo group ( 22 % , P < 0.0001 ) . Through the study period , no significant change in the rate of iron deficiency was found in MMN and FFA groups , whereas it increased in the placebo group ( 31 % , baseline vs. 52 % , end of study ; P < 0.0001 ) . Conclusion : Both MMN and FFA supplements were effective for preventing or treating  anemia in Cambodian infants and stabilizing plasma levels of ferritin . Use of micronutrients in a controlled home setting , as sprinkled daily supplements , may be promising in preventing and treating anemia in developing countries Anemia , micronutrient deficiencies , and growth faltering are still common in Peru . The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure , anemia , and  micronutrient deficiencies  in Peruvian infants . Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind , masked , controlled trial in which they were r and omly assigned to receive either a daily dose of iron ( DI ) , a daily dose of multiple micronutrients ( DMM ) , a weekly dose of multiple micronutrients , or a placebo ( P ) for 6 mo . None of the supplements tested prevented growth faltering or the morbidities common during infancy . Anemia and plasma homocysteine concentrations fell significantly in all groups during the study , but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups , and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups . Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron ( DI and DMM ) . There were no significant differences among groups in mean final values or changes in plasma zinc , retinol , tocopherol , or riboflavin . Although the DMM intervention was the most efficacious for preventing anemia , iron , and zinc deficiencies , 15 % , 20 % , and 50 % of this group still remained anemic , zinc deficient , and iron deficient , respectively , at the end of the study . Further research thus should investigate whether higher doses of iron and zinc , together with infection control measures , are more efficacious Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with anemia ( hemoglobin < 110 g/L ) , 16 % vitamin A deficiency ( plasma retinol < 0.7 micromol/L ) , 47 % zinc deficiency ( plasma zinc < 10.7 micromol/L ) , 2 % underweight , and 11 % stunting . There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study . The DMM was the most effective intervention tested , not only for improving anemia but also for improving iron , zinc , riboflavin , and tocopherol status The control of childhood anaemia in malaria holoendemic areas is a major public health challenge for which an optimal strategy remains to be determined . Malaria prevention may compromise the development of partial immunity . Regular micronutrient supplementation has been suggested as an alternative but its effectiveness remains unsettled . We therefore conducted a r and omised placebo-controlled intervention trial with 207 Tanzanian children aged 5 months to 3 years on the efficacy of supervised supplementation of low-dose micronutrients including iron ( Poly Vi-Sol with iron ) three times per week , with an average attendance of > /= 90 % . The mean haemoglobin ( Hb ) level increased by 8 g/l more in children on supplement ( 95 % CI 3 - 12 ) during the 5-month study . All age groups benefited from the intervention including severely anaemic subjects . The mean erythrocyte cell volume ( MCV ) increased but Hb in children > /= 24 months improved independently of MCV and no relation was found with hookworm infection . The data therefore suggest that micronutrients other than iron also contributed to Hb improvement . In the supplement group of children who had received sulfadoxine-pyrimethamine ( SP ) treatment , the mean Hb level increased synergistically by 22 g/l ( 95 % CI 13 - 30 ) compared to 7 g/l ( 95 % CI 3 - 10 ) in those without such treatment . Supplementation did not affect malaria incidence . In conclusion , micronutrient supplementation  improves childhood anaemia in malaria holoendemic areas and this effect is synergistically enhanced by temporary clearance of parasitaemia OBJECTIVE We evaluated the effect of a micronutrient-fortified beverage on growth and morbidity in apparently healthy schoolchildren . METHODS This was a double-blind , placebo-controlled , matched-pair , cluster , r and omized study in semi-urban middle-income residential schoolchildren aged 6 to 16 y.  Anthropometrics ( height and weight ) , clinical symptoms of deficiency , and morbidity data were collected at baseline in the supplemented group ( n = 446 in 10 grade s ) and the placebo group ( n = 423 in 10 grade s ) and after 14 mo of supplementation ( n = 355 in the supplement group and n = 340 in the placebo group from nine pairs ) . RESULTS After 14 mo of supplementation , there was a significant increase in mean increments of height and weight z scores of -0.04 and 0.02 , respectively , in the supplemented group compared with -0.14 and -0.09 in the placebo group . Velocity of weight ( 3.56 versus 3.00 ) was significantly ( P < 0.01 ) higher with supplementation . Although there were no differences in the incidence of common childhood diseases such as fever , cough and cold , diarrhea , and ear infections elicited for a reference period of 1 mo at every quarterly follow-up examination , the mean duration of illness ( calculated per person per year ) was significantly shorter ( 5.0 d ) in the supplemented group than in the placebo group ( 7.4 d ) . CONCLUSIONS The micronutrient-fortified beverage was beneficial in promoting growth and decreasing duration of common illnesses among middle-class residential schoolchildren who had adequate energy and protein intakes Multiple micronutrient deficiencies are highly prevalent in Indonesia , but the interventions are still focused on single micronutrients . This study aim ed to investigate the efficacy of multiple micronutrient supplements for improving micronutrient status , anemia , growth , and morbidity of Indonesian infants . In this double-blind , placebo-controlled trial , 284 infants aged 6 - 12 mo were r and omly allocated to 4 treatment groups for 23 wk ; 260 ( 92 % ) infants completed the study . Group 1 ( DMM ) received one adequate intake of multiple micronutrient supplements daily ( n = 66 ) ; group 2 ( WMM ) received 2 adequate intakes of multiple micronutrient on 1d plus 6 d of placebo ( n = 60 ) ; group 3 ( DI ) received 10 mg of iron supplement daily ( n = 69 ) ; group 4 received a placebo supplement daily ( n = 65 ) . Blood sample s were collected at baseline and at posttreatment to assess anemia and micronutrient status . Anthropometric measurements were taken monthly , and morbidity was recorded daily . At baseline , 58.1 % of infants were anemic , 34.2 % were iron deficient , 21.3 % were vitamin A deficient , and 11 % were zinc deficient . The DMM and DI supplements both corrected iron deficiency , but DMM supplements were more efficacious in improving hemoglobin levels of anemic infants than the other supplements . However , anemia still persisted in one-third of DMM infants posttreatment . The DMM supplement was more efficacious than WMM or DI supplementation in improving infant status of other micronutrients , including zinc , tocopherol , and riboflavin , whereas DI exacerbated zinc deficiency . There were no significant differences in growth and morbidity among treatment groups , and growth faltering was not prevented Poor nutrient intake during pregnancy can adversely affect both infant and maternal health . The aim was to investigate the efficacy of multiple-micronutrient supplementation during pregnancy in a socially deprived population in the developed world . We conducted a r and omised , double-blind , placebo-controlled trial of multiple-micronutrient supplementation including 20 mg Fe and 400 microg folic acid , from the first trimester of pregnancy in 402 mothers , in East London , UK .  Nutrient status was measured at recruitment , and at 26 and 34 weeks of gestation . Infants were weighed at birth . At recruitment the prevalence of anaemia was 13 % , vitamin D insufficiency 72 % , thiamin deficiency 12 % and folate deficiency 5 % , with no differences between groups . Only 39 % of women completed the study ; rates of non-compliance were similar in both groups . Intention-to-treat analysis showed that participants receiving treatment had higher mean Hb at 26 weeks of gestation ( 110 ( sd 10 ) v.108 ( sd 10 ) g/l ; P = 0.041 ) and 34 weeks of gestation ( 113 ( sd 12 ) v.109 ( sd 10 ) g/l ; P = 0.003 ) and packed cell volume concentrations at 26 weeks of gestation ( 0.330 ( sd 0.025 ) v. 0.323 ( sd 0.026 ) l/l ; P = 0.011 ) and 34 weeks of gestation ( 0.338 ( sd 0.029 ) v. 0.330 ( sd 0.028 ) l/l ; P = 0.014 ) compared with controls . Analysis of compliant women showed supplemented women had higher median concentrations of serum ferritin , erythrocyte folate and 25-hydroxyvitamin D later in gestation than controls . In the compliant subset ( n 149 ) , placebo mothers had more small-for-gestational age ( SGA ) infants ( eight SGA v. thirteen ; P = 0.042 ) than treatment mothers . Baseline micronutrient deficiencies were common ; the multiple-micronutrient supplement was well-tolerated and improved nutrient status .  Multiple-micronutrient supplements from early pregnancy may be beneficial and larger studies are required to assess impact on birth outcomes and infant development A r and omized , double-blind , placebo-controlled trial was performed to assess the efficacy of different micronutrient supplementation regimes for improving micronutrient status , preventing anemia , and growth faltering of Vietnamese infants . A population -based sample of 306 infants aged 6 - 12 mo , split in 4 treatment groups , received daily multiple micronutrient ( DMM ) , daily placebo ( P ) , weekly multiple micronutrient ( WMM ) , or daily iron ( DI ) supplements for 6 mo , 7 d/wk , under supervision . Weight and length were measured monthly , and anemia and plasma levels of ferritin , zinc , riboflavin , retinol , tocopherol , and homocysteine were determined before and after the supplementation . Z-scores for length-for-age and weight-for-age worsened significantly in all groups , but the length-for-age Z-score decreased significantly less in the DMM group ( -0.32 + /- 0.05 ) than in the P and WMM groups ( -0.49 + /- 0.05 and -0.51 + /- 0.05 , respectively , P = 0.001 ) . Hemoglobin levels increased significantly more in the DMM group [ mean ( 95%CI ) : 16.4 g/L ( 12.4 - 20.4 ) ] than in the P group [ 8.6 g/L ( 5.0 - 12.2 ) , P = 0.04 ) , with intermediate nonsignificant increases in the WMM [ 15.0 g/L ( 11.5 - 18.5 ) ] and the DI [ 12.9 g/L ( 8.4 - 17.3 ) ] groups . Ferritin changes were significantly greater in DMM ( 12.1 microg/L ) and DI ( 9.5 microg/L ) than in P ( -14.7 microg/L ) and WMM groups ( -9.7 microg/L ) . Of the other micronutrients , only tocopherol showed a significantly greater level in the DMM group compared with P. Anemia still affected a quarter and zinc deficiency affected a third of infants although there was no iron deficiency after 6 mo of supplementation with DMM , suggesting that multiple factors are causing anemia and that the dose of zinc is too small
Synthesized evidence indicates that addition of multiple micronutrients to Fe supplementation may only marginally improve Hb response compared with Fe supplementation alone .
However , addition of ' other micronutrients ' may have a negative effect .
Routine addition of unselected multiple micronutrients to Fe therefore appears unjustified for nutritional anaemia control programmes
OBJECTIVES To study the effect of combining multiple ( two or more ) micronutrients with Fe supplementation on Hb response , when compared with placebo and with Fe supplementation , in children .