Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age

• Published in: Cochrane database of systematic reviews 2017-11, Vol.11 (11), p.CD009666
• Main Authors: De-Regil, Luz Maria, Jefferds, Maria Elena D, Peña-Rosas, Juan Pablo
• Format: Article
• Language: English
• Subjects: Anemia, Iron-Deficiency - blood; Anemia, Iron-Deficiency - prevention & control; Anemia, Iron-Deficiency - therapy; Child; Child health; Child, Preschool; DEVELOPMENTAL PROBLEMS; Developmental, psychosocial & learning problems; Dietary Supplements; Edetic Acid - administration & dosage; Ferric Compounds - administration & dosage; Ferrous Compounds - administration & dosage; Food, Fortified - adverse effects; Humans; Iron - administration & dosage; Micronutrients - administration & dosage; Micronutrients - adverse effects; Point-of-Care Systems; Powders; Trace Elements - administration & dosage; Vitamins - administration & dosage
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD009666.pub2

Approximately 600 million children of preschool and school age are anaemic worldwide. It is estimated that at least half of the cases are due to iron deficiency. Point-of-use fortification of foods with micronutrient powders (MNP) has been proposed as a feasible intervention to prevent and treat anaemia. It refers to the addition of iron alone or in combination with other vitamins and minerals in powder form, to energy-containing foods (excluding beverages) at home or in any other place where meals are to be consumed. MNPs can be added to foods either during or after cooking or immediately before consumption without the explicit purpose of improving the flavour or colour. To assess the effects of point-of-use fortification of foods with iron-containing MNP alone, or in combination with other vitamins and minerals on nutrition, health and development among children at preschool (24 to 59 months) and school (five to 12 years) age, compared with no intervention, a placebo or iron-containing supplements. In December 2016, we searched the following databases: CENTRAL, MEDLINE, Embase, BIOSIS, Science Citation Index, Social Science Citation Index, CINAHL, LILACS, IBECS, Popline and SciELO. We also searched two trials registers in April 2017, and contacted relevant organisations to identify ongoing and unpublished trials. Randomised controlled trials (RCTs) and quasi-RCTs trials with either individual or cluster randomisation. Participants were children aged between 24 months and 12 years at the time of intervention. For trials with children outside this age range, we included studies where we were able to disaggregate the data for children aged 24 months to 12 years, or when more than half of the participants were within the requisite age range. We included trials with apparently healthy children; however, we included studies carried out in settings where anaemia and iron deficiency are prevalent, and thus participants may have had these conditions at baseline. Two review authors independently assessed the eligibility of trials against the inclusion criteria, extracted data from included trials, assessed the risk of bias of the included trials and graded the quality of the evidence. We included 13 studies involving 5810 participants from Latin America, Africa and Asia. We excluded 38 studies and identified six ongoing/unpublished trials. All trials compared the provision of MNP for point-of-use fortification with no intervention or placebo. No trials compared th