Sprinkling a vitamin- and mineral-packed powder onto young kids' food may help prevent anaemia in countries where many people don't get enough iron, according to a new report.
Kids with the extra nutrients, including iron, zinc and vitamin A, were about 30% less likely to be anaemic and 50% less likely to be iron deficient, researchers found.
Their work sums up data from past studies of anaemia and iron deficiency in babies and toddlers who received the vitamin boost compared with those who didn't.
For other aspects of nutrition or kids' development, there's still not enough data to say if the supplements have an impact, according to the researchers, whose findings are published in The Cochrane Library.
"Anaemia and iron deficiency probably are the most widespread nutritional deficiencies in the world," said study author Luz Maria de Regil, from the World Health Organization in Geneva.
Half of all young kids are affected by an iron, zinc or vitamin A deficiency, she told Reuters Health, most of them in poor countries. The studies that she and her colleagues reviewed all took place in Asia, Africa, and the Caribbean.
By the time babies are six months old, they are starting to run low on the iron reserves they were born with, researchers say.
Breast feeding period
The WHO recommends exclusive breast feeding up to six months and continued breast feeding until kids are at least two years old. During that in-between period, parents typically start to incorporate semi-solid food into babies' diets – possibly offering an opportunity for the addition of extra sources of vitamins and minerals.
Health programmes have relied on iron drops or syrups to prevent anaemia in young kids, de Regil said. However, she added, "supplements can be perceived by the mom... as something like a drug.
Micronutrient powders are sprinkled into the food so that they don't change the flavour – (parents) think that they are improving the diet without giving a medication."
In addition, iron drops "really do taste awful", said Purnima Menon, from the International Food Policy Research Institute, based in New Delhi. "A really substantial advantage of this is that you can feed it really easily."
De Regil and her colleagues found six studies that compared the nutrient powders to nothing extra or a nutrient-free placebo powder in kids between 2 and 23 months old.
Of more than 3,000 youngsters, those who got the extra vitamins and minerals for a few months at a time, usually daily, were less likely to be anaemic or iron deficient at the end of the fortification period.
In two studies that compared the nutrient powders with iron drops or syrups, the researchers found no difference in anaemia rates, but cautioned against drawing too much from the less-robust findings.
And there wasn't enough data for them to say whether the extra nutrients, including iron and zinc, made any difference in kids' general health and well-being – but previous studies have suggested the minerals are important for growth and brain development.
The researchers also couldn't definitively address the worry that giving extra iron to kids in high-malaria areas may increase their risk of infection (the parasite needs iron to grow).
Guidelines on nutrient supplementation
"There is a huge controversy," de Regil said. "A possible side effect of iron supplements given very frequently is to increase the risk of malaria in some places." In 2008, malaria caused close to one million deaths, mostly in African kids, according to the WHO.
Regarding the nutrient powder, de Regil said that "it's still a concern, but we didn't find evidence that in (high-malaria) settings it doesn't work or it is harmful".
Based on the current findings, the WHO has updated its guidelines on nutrient supplementation in young children, which now state, "Home fortification of foods with multiple micronutrient powders is recommended to improve iron status and reduce anaemia among infants and children 6 - 23 months of age". The authors note that the nutrient powder packets are convenient and could also be used in schools or refugee camps, for example. They are currently looking at their effect in older, school-age kids.
Menon said that the nutrient powders typically run at about R14.00 for a 2-month supply, and that more research is needed to figure out the best way to provide them to parents in low-income countries, including whether powder packets should be given out for free by the government.
For now, the new review suggests that the powder "is a promising innovation to address childhood anaemia", said Menon, who did not participate in the study. "Any innovations that take us closer to solving the problem are more than welcome."
(Reuters Health, Genevra Pittman, September 2011)