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

Published:February 20, 2015DOI:https://doi.org/10.1016/j.clnu.2015.02.001

      Summary

      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 aimed 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 randomized, double blind placebo controlled study design was used with normal healthy children from low to middle income families, aged 7–10 years randomly 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. Assessments 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.
      ClinicalTrials.gov IdentifierNCT01415557.
      Clinical Trial RegistryIndia – REF/2012/12/004332.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Nutrition
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smuts C.M.
        • Benadé A.J.
        • Berger J.
        • Hop le T.
        • López de Romaña G.
        • Untoro J.
        • et al.
        • International Research on Infant Supplementation Study Group
        IRIS. I: a FOODlet-based multiple-micronutrient intervention in 6- to 12-month-old infants at high risk of micronutrient malnutrition in four contrasting populations: description of a multicenter field trial.
        Food Nutr Bull. 2003 Sep; 24: S27-S33
        • Hurrell R.F.
        Bioavailability of iron.
        Eur J Clin Nutr. 1997; 51: S4-8
        • Viteri F.E.
        • Gonzalez H.
        Adverse outcomes of poor micronutrient status in childhood and adolescence.
        Nutr Rev. 2002; 60: S77-S83
        • Kapur D.
        • Sharma S.
        • Agarwal K.N.
        Effectiveness of nutrition education, iron supplementation or both on iron status in children.
        Indian Pediatr. 2003; 40 (National Family Health Survey (NFHS-3) 2005–06. Ministry of Health and Family Welfare Government of India): 1131-1144
        • International Institute for Population Sciences (IIPS) and Macro International
        National family health survey (NFHS-3) 2005–06: India. Vol. I. IIPS, Mumbai, India2007
        • Gomber S.
        • Bhawna
        • Madan N.
        • Lal A.
        • Kela K.
        Prevalence & etiology of nutritional anaemia among school children of urban slums.
        Indian J Med Res. 2003; 118: 167-171
        • Kapur D.
        • Sharma S.
        • Agarwal K.N.
        Effectiveness of nutrition education, iron supplementation or both on iron status in children.
        Indian Pediatr. 2003; 40: 1131-1144
        • Thankachan P.
        • Selvam S.
        • Surendran D.
        • Chellan S.
        • Pauline M.
        • Abrams S.A.
        • et al.
        Efficacy of a multi micronutrient-fortified drink in improving iron and micronutrient status among schoolchildren with low iron stores in India: a randomised, double-masked placebo-controlled trial.
        Eur J Clin Nutr. 2013; 67: 36-41https://doi.org/10.1038/ejcn.2012.188
        • Sivakumar B.
        • Vijayaraghavan K.
        • Vazir S.
        • Balakrishna N.
        • Shatrugna V.
        • Sarma K.V.
        • et al.
        Effect of micronutrient supplement on health and nutritional status of schoolchildren: study design.
        Nutrition. 2006; 22: S1-S7
        • National Nutrition Monitoring Bureau
        Diet and nutritional status of population and prevalence of hypertension among adults in rural areas.
        National Institute of Nutrition, Hyderabad, India2006
        • Vinod Kumar M.
        • Rajagopalan S.
        Trial using multiple micronutrient food supplement and its effect on cognition.
        Indian J Pediatr. 2008; 75: 671-678https://doi.org/10.1007/s12098-008-0127-1
        • Muthayya S.
        • Eilander A.
        • Transler C.
        • Thomas T.
        • van der Knaap H.C.
        • Srinivasan K.
        • et al.
        Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (children's health and mental performance influenced by optimal nutrition) study.
        Am J Clin Nutr. 2009; 89: 1766-1775https://doi.org/10.3945/ajcn.2008.26993
        • Vaz M.
        • Pauline M.
        • Unni U.S.
        • Parikh P.
        • Thomas T.
        • Bharathi A.V.
        • et al.
        Micronutrient supplementation improves physical performance measures in Asian Indian school-age children.
        J Nutr. 2011; 141: 2017-2023https://doi.org/10.3945/jn.110.135012
        • Subtamani Y.
        Effect of multiple micronutrient supplementation on growth, whole body endurance, forearm muscle strength, forearm endurance and visual reaction time.
        ([Thesis]) Rajiv Gandhi University of Health Sciences, Bangalore, India2010
        • Panjikkaran S.T.
        • Usha V.
        A path analysis on the nourishment directed haemoglobin status and resulting endurance capacity of adolescent Indian rural girls.
        J Dairy Foods Home Sci. 2010; 29: 010
        • WHO Multicentre Growth Reference Study Group
        WHO child growth standards based on length/height, weight and age.
        Acta Paediatr Suppl. 2006; 450: 76-85
        • Harrison G.G.
        • Buskirk E.R.
        • Carter J.E.L.
        • Johnston F.E.
        • Lohman T.G.
        • Pollock M.L.
        • et al.
        Skinfold thickness and measurement technique.
        in: Lohman T.G. Roche A.F. Martorell R. Anthropometric standardization reference manual. Human Kinetics Book, Illinios1988: 55-71
        • Dror Y.
        • Stern F.
        • Komarnitsky M.
        Optimal and stable conditions for the determination of erythrocyte glutathione reductase activation coefficient to evaluate riboflavin status.
        Int J Vitam Nutr Res. 1994; 64: 257-262
        • Cook J.D.
        • Flowers C.H.
        • Skikne B.S.
        The quantitative assessment of body iron.
        Blood. 2003; 101: 3359-3364
        • Bharathi A.V.
        • Kurpad A.V.
        • Thomas T.
        • Yusuf S.
        • Saraswathi G.
        • Vaz M.
        Development of food frequency questionnaires and a nutrient database for the prospective urban and rural epidemiological (PURE) pilot study in South India: methodological issues.
        Asia Pac J Clin Nutr. 2008; 17: 178-185
        • Ohtake P.J.
        Field tests of aerobic capacity for children and older adults.
        Cardiopulm Phys Ther J. 2005; 16: 5-12
      1. Foran Bill High-performance sports conditioning. 0-7360-0163-8 Human Kinetics Publisher, 2001
        • D'Elia L.F.
        • Satz P.
        • Uchiyama C.L.
        • White T.
        Color trails test: Professional Manual.
        Psychological Assessment Resources, Inc, Odessa (Florida)1996
        • Kar B.R.
        • Rao S.L.
        • Chandramouli B.A.
        Cognitive development in children with chronic protein energy malnutrition.
        Behav Brain Funct. 2008; 4: 31https://doi.org/10.1186/1744-9081-4-31
        • Malda M.
        • Van de Vijver F.J.R.
        • Srinivasan K.
        • Transler C.
        • Sukumar P.
        • Rao K.
        Adapting a cognitive test for a different culture: an illustration of qualitative procedures.
        Psychol Sci Q. 2008; 50: 451-468
        • Malda M.
        • Van de Vijver F.J.R.
        • Srinivasan K.
        • Transler C.
        • Sukumar P.
        Travelling with cognitive tests: testing the validity of a KABC-II adaptation in India.
        Assessment. 2010; 17: 107-115
        • Porteus S.D.
        The porteus maze test Manual.
        1st ed. George G. Harrap& Co. Ltd, High Holborn, London1952
        • Indian Council of Medical Research (ICMR)
        utrient requirement and recommended dietary allowances for Indians: a report of the expert group of the Indian council of medical research.
        National Institute of Nutrition, Hyderabad, India2010
        • Muthayya S.
        • Thankachan P.
        • Zimmermann M.B.
        • Andersson M.
        • Eilander A.
        • Misquith D.
        • et al.
        Low anemia prevalence in school-aged children in Bangalore, South India: possible effect of school health initiatives.
        Eur J Clin Nutr. 2007 Jul; 61: 865-869
        • Thankachan P.
        • Rah J.H.
        • Thomas T.
        • Selvam S.
        • Amalrajan V.
        • Srinivasan K.
        • et al.
        Multiple micronutrient-fortified rice affects physical performance and plasma vitamin B-12 and homocysteine concentrations of indian school children.
        J Nutr. 2012; 142: 846-852https://doi.org/10.3945/jn.111.149021
        • Khor G.L.
        • Misra S.
        Micronutrient interventions on cognitive performance of children aged 5-15 years in developing countries.
        Asia Pac J Clin Nutr. 2012; 21: 476-486
      2. Bamji M.S. Krishnaswamy K. Brahmam G.N. Textbook of human nutrition. 3rd ed. Oxford and IBH Publishing Company, New Delhi, India2010
        • Gracia-Marco L.
        • Valtueña J.
        • Ortega F.B.
        • Pérez-López F.R.
        • Vicente-Rodríguez G.
        • Breidenassel C.
        • et al.
        Iron and vitamin status biomarkers and its association with physical fitness in adolescents: the HELENA study.
        J Appl Physiol. 2012; 113: 566-573
        • Bamji M.S.
        • Lakshmi A.V.
        Less recognised micronutrient deficiencies in India.
        NFI Bull. 1998; 19: 5-8
        • Van der Beek E.J.
        • van Dokkum W.
        • Wedel M.
        • Schrijver J.
        • van den Berg H.
        Thiamin, riboflavin and vitamin B6: impact of restricted intake on physical performance in man.
        J Am Coll Nutr. 1994; 13: 629-640
        • Suchdev P.S.
        • Ruth L.J.
        • Woodruff B.A.
        • Mbakaya C.
        • Mandava U.
        • Flores – Ayala R.
        • et al.
        Selling sprinkles micronutrient powder reduces anemia, iron deficiency, and vitamin A deficiency in young children in Western Kenya: a cluster-randomized controlled trial.
        Am J Clin Nutr. 2012; 95: 1223-1230
        • Bilenko N.
        • Belmaker I.
        • Vardi H.
        • Fraser D.
        A cluster randomised controlled clinical trial to assess the efficacy of multiple micronutrient supplementations (iron, vitamins A, C, folic acid and zinc) to improve the nutritional and health indicators in Jewish and Bedouin infants in southern Israel.
        J Epidemiol Community Health. 2011; 65: A325-A326https://doi.org/10.1136/jech.2011.142976l.4
        • Aaron G.J.
        • Kariger P.
        • Aliyu R.
        • Flach M.
        • Iya D.
        • Obadiah M.
        • et al.
        A multi-micronutrient beverage enhances the vitamin A and zinc status of Nigerian primary school children.
        J Nutr. 2011; 141: 1565-1572https://doi.org/10.3945/jn.110.136770
        • Goyle A.
        • Prakash S.
        Effect of supplementation of micronutrient fortified biscuits on serum total proteins and vitamin A levels of adolescent girls (10–16 years) of Jaipur city, India.
        Nepal Med Coll J. 2011; 13: 233-237
        • Grima N.A.
        • Pase M.P.
        • Macpherson H.
        • Pipingas A.
        The effects of multivitamins on cognitive performance: a systematic review and meta-analysis.
        J Alzheimers Dis. 2012; 29: 561-569https://doi.org/10.3233/JAD-2011-111751
        • Eilander A.
        • Gera T.
        • Sachdev H.S.
        • Transler C.
        • Van der Knaap H.C.
        • Kok F.J.
        • et al.
        Multiple micronutrient supplementation for improving cognitive performance in children: systematic review of randomized controlled trials.
        Am J Clin Nutr. 2010; 91: 115-130https://doi.org/10.3945/ajcn.2009.28376
        • Sazawal S.
        • Dhingra U.
        • Dhingra P.
        • Hiremath G.
        • Sarkar A.
        • Dutta A.
        • et al.
        Micronutrient fortified milk improves iron status, anemia and growth among children 1–4 years: a double masked, randomized, controlled trial.
        PLoS One. 2010 Aug 13; 5: e12167https://doi.org/10.1371/journal.pone.0012167
        • Hoppe C.
        • Udam T.R.
        • Lauritzen L.
        • Molgaard C.
        • Juul A.
        • Michaelsen K.F.
        Animal protein intake, serum insulin-like growth factor I, and growth in healthy 2.5-y-old Danish children.
        Am J Clin Nutr. 2004; 80: 447-452
        • Hoppe C.
        • Molgaard C.
        • Michaelsen K.F.
        Cow's milk and linear growth in industrialized and developing countries.
        Annu Rev Nutr. 2006; 26: 131-173
        • Broome C.S.
        • McArdle F.
        • Kyle J.A.
        • Andrews F.
        • Lowe N.M.
        • Hart C.A.
        • et al.
        An increase in selenium intake improves immune function and poliovirus handling in adults with marginal selenium status.
        Am J Clin Nutr. 2004; 80: 154-162
        • Institute of Medicine, Food and Nutrition Board
        Dietary reference Intakes: Vitamin C, vitamin e, selenium, and carotenoids.
        National Academy Press, Washington, DC2000
        • Safaralizadeh R.
        • Kardar G.A.
        • Pourpak Z.
        • Moin M.
        • Zare A.
        • Teimourian S.
        Serum concentration of Selenium in healthy individuals living in Tehran.
        Nutr J. 2005; 4: 32https://doi.org/10.1186/1475-2891-4-32