Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-31T13:46:39.508Z Has data issue: false hasContentIssue false
  • English
  • Français

Short-term daily or weekly administration of micronutrient Sprinkles™ has high compliance and does not cause iron overload in Chinese schoolchildren: a cluster-randomised trial

Published online by Cambridge University Press:  02 January 2007

Waseem Sharieff ,
Shi-an Yin ,
Michelle Wu ,
Qingjun Yang ,
Claudia Schauer ,
George Tomlinson  and
Stanley Zlotkin
Waseem Sharieff
Affiliation:
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Research Institute of The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
Shi-an Yin
Affiliation:
National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
Michelle Wu
Affiliation:
Research Institute of The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
Qingjun Yang
Affiliation:
National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
Claudia Schauer
Affiliation:
Research Institute of The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
George Tomlinson
Affiliation:
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada Department of Medicine and The University Health Network, University of Toronto, Toronto, Ontario, Canada
Stanley Zlotkin*
Affiliation:
Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada Departments of Paediatrics and of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada Research Institute of The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives

To examine consumption rates and serum ferritin (SF) concentrations (as a marker of safety) among schoolchildren (3–6 years) provided with daily and weekly micronutrients.

Design and methods

Micronutrients were provided for one school term (13 weeks) to a kindergarten in northern China as single-dose SprinklesTM sachets containing 30 mg of iron as encapsulated ferrous fumarate, 5 mg zinc gluconate, 50 mg vitamin C, 300 μg vitamin A, 7.5 μg vitamin D3 and 150 μg folic acid. Sixteen classrooms were randomly assigned to: (1) daily supplements for 5 days a week (daily group); (2) weekly supplements (weekly group); or (3) no supplements (control group). Consumption of sachets was monitored for each child and SF concentrations were measured at the end of study. Random effects general linear models and graphs were used to compare the groups.

Results

A total of 415 children from 16 classrooms entered the study. At the end of the study, mean consumption rates per child were 86% (daily group; standard deviation (SD) 12%) and 87% (weekly group; SD 16%). Median SF concentrations were 71 μg l−1 (range 27–292 μg l−1; daily group), 55 μg l−1 (range 11–299 μg l−1; weekly group) and 54 μg l−1 (range 7–327 μg l−1; control group); the overall difference was not significant (P = 0.06). However, the daily group was significantly different from the control (P = 0.02); daily and weekly groups had higher SF at lower percentiles and similar SF at higher percentiles compared with the control group.

Conclusion

The high consumption rates and appropriate SF concentrations in the supplemented groups suggest that a short-term school programme with Sprinkles is an efficient and safe way to provide micronutrients (including iron).

Keywords

MicronutrientsChildrenAnaemiaIron deficiencyCluster-randomised trialSafetySprinklesChina
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 3 , May 2006 , pp. 336 - 344
Copyright
Copyright © The Authors 2006

References

1Cai, M, Yan, W. Study on iron nutritional status in adolescence. Biomedical and Environmental Sciences 1990; 3(1): 113–9.Google Scholar
2Ge, K, Zhai, F, Yan, H. The Dietary and Nutritional Status of Chinese Population. 1992 National Nutrition Survey, Volume 1. Beijing: People's Medical Publishing House, 1996; 43–51.Google Scholar
3He, Y, Wang, H, Hu, Z, Lin, Y. Study on nutritional anemia in students of 7 nationalities in Xinjiang autonomous. Xinjiang Hygiene Prevention 1994; 12: 1–6.Google Scholar
4Li, R, Chen, X, Yan, H, Deurenberg, P, Garby, L, Hautvast, J. Functional consequences of iron supplementation in iron-deficient female cotton mill workers in Beijing, China. American Journal of Clinical Nutrition 1994; 59(4): 908–13.CrossRefGoogle ScholarPubMed
5Zhang, Q. Iron nutritional status of young female workers in Shanghai First Silk Factory. Chinese Journal of Preventive Medicine 1987; 21(2): 87–9.Google ScholarPubMed
6Li, A, Cheng, M. Anaemia and thalassaemia in healthy adolescents from southern Chinese families. Journal of Paediatrics and Child Health 1990; 26(6): 339–42.CrossRefGoogle ScholarPubMed
7Zhao, X. Nutritional situation of Beijing residents. Southeast Asian Journal of Tropical Medicine and Public Health 1992; 23(Suppl. 3): 65–8.Google ScholarPubMed
8Du, S, Zhai, F, Wang, Y, Popkin, B. Current methods for estimating dietary iron bioavailability do not work in China. Journal of Nutrition 2000; 130(2): 193–8.CrossRefGoogle Scholar
9Schumann, K. Safety aspects of iron in food. Annals of Nutrition & Metabolism 2001; 45(3): 91–101.CrossRefGoogle ScholarPubMed
10Majumdar, I, Paul, P, Talib, V, Ranga, S. The effect of iron therapy on the growth of iron-replete and iron-deplete children. Journal of Tropical Pediatrics 2003; 49(2): 84–8.CrossRefGoogle Scholar
11Liu, X, Liu, P. The effectiveness of weekly iron supplementation regimen in improving the iron status of Chinese children and pregnant women. Biomedical and Environmental Sciences 1996; 9(2–3): 341–7.Google ScholarPubMed
12Beaton, G, McCabe, G. Efficacy of Intermittent Iron Supplementation in the Control of Iron Deficiency Anaemia in Developing Countries: An Analysis of Experience. Ottawa: The Micronutrient Initiative, 1999.Google Scholar
13 Supplefer Sprinkles: A Humanitarian Project to Reduce Global Childhood Anemia [online]. Available at http://www.supplefer.com. Accessed 10 12 2004Google Scholar
14Zlotkin, S, Arthur, P, Antwi, K, Yeung, G. Treatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods. American Journal of Clinical Nutrition 2001; 74(6): 791–5.CrossRefGoogle ScholarPubMed
15Lipschitz, D, Cook, J, Finch, C. A clinical evaluation of serum ferritin as an index of iron stores. New England Journal of Medicine 1974; 290(22): 1213–6.CrossRefGoogle ScholarPubMed
16Blaustein, D, Schwenk, M, Chattopadhyay, J, Singh, H, Daoui, R, Gadh, R, et al. The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease. Kidney International. Supplement 2003; (87): S72–7.CrossRefGoogle Scholar
17Cohen, A, Galanello, R, Piga, A, De Sanctis, V, Tricta, F. Safety and effectiveness of long-term therapy with the oral iron chelator deferiprone. Blood 2003; 102(5): 1583–7.CrossRefGoogle ScholarPubMed
18Peng, C, Chow, K, Chen, J, Chiang, Y, Lin, T, Tsai, C. Safety monitoring of cardiac and hepatic systems in β-thalassemia patients with chelating treatment in Taiwan. European Journal of Haematology 2003; 70(6): 392–7.CrossRefGoogle ScholarPubMed
19 A SAS Program for the CDC Growth Charts [online]. Available at http://www.cdc.gov/nccdphp/dnpa/growthcharts/sas.htm. Accessed 25 05 2004.Google Scholar
20Stoltzfus, R. Defining iron-deficiency anemia in public health terms: a time for reflection. Journal of Nutrition 2001; 131(Suppl. 2): 565S–7S.CrossRefGoogle ScholarPubMed
21Knutson, M, Walter, P, Ames, B, Viteri, F. Both iron deficiency and daily iron supplements increase lipid peroxidation in rats. Journal of Nutrition 2000; 130(3): 621–8.CrossRefGoogle ScholarPubMed
22Ekstrom, E, Hyder, S, Chowdhury, A, Chowdhury, S, Lonnerdal, B, Habicht, J, et al. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. American Journal of Clinical Nutrition 2002; 76(6): 1392–400.CrossRefGoogle ScholarPubMed
23Hallberg, L, Hulten, L, Gramatkovski, E. Iron absorption from the whole diet in men: how effective is the regulation of iron absorption? American Journal of Clinical Nutrition 1997; 66(2): 347–56.CrossRefGoogle ScholarPubMed
24Munro, H, Linder, M. Ferritin: structure, biosynthesis, and role in iron metabolism. Physiological Reviews 1978; 58(2): 317–96.CrossRefGoogle ScholarPubMed
25Worwood, M. Serum ferritin. In: Jacobs, A, Worwood, M, eds. Iron in Biochemistry and Medicine II. London: Academic Press, 204–44.Google Scholar
26Halliday, J, Powell, L. Serum ferritin and isoferritins in clinical medicine. In: Brown, EB, ed. Progress in Hematology XI. New York: Grune & Stratton, 1979; 229–66.Google Scholar
27Birgegard, G, Hogman, C, Killander, A, Levander, H, Simonsson, B, Wide, L. Serum ferritin and erythrocyte 2,3-DPG during quantitated phlebotomy and iron treatment. Scandinavian Journal of Haematology 1977; 19(4): 327–33.CrossRefGoogle Scholar
28Milman, N. Serum ferritin in Danes: studies of iron status from infancy to old age, during blood donation and pregnancy. International Journal of Hematology 1996; 63(2): 103–35.CrossRefGoogle ScholarPubMed
29Siimes, M, Addiego, J Jr, Dallman, P. Ferritin in serum: diagnosis of iron deficiency and iron overload in infants and children. Blood 1974; 43(4): 581–90.CrossRefGoogle ScholarPubMed
30Tandon, BN. Nutritional interventions through primary health care: impact of the ICDS projects in India. Bulletin of the World Health Organization 1989; 67(1): 77–80.Google ScholarPubMed