Effect of iron ... zinc fortified milk on iron status and functional outcomes in underweight children
Keywords:
Zinc, iron, milk, iron status
Abstract
Background Iron and zinc are essential micronutrients duringschool-age period. Milk could be an alternative medium for
mineral fortification because it is consumed frequently by
children.
Objective To evaluate the effect of iron-zinc fortified milk
supplementation on iron status and functional outcomes in
underweight children.
Methods 44 2 underweight subjects aged 7-10 years attending 10
primary schools in Jakarta and Solo were recruited in the study.
Subjects who had chronic illnesses, severe anemia, thalassemia
or cow's milk allergy were excluded. Blood samples were analyzed
to determine hemoglobin, serum ferritin and serum zinc. Serum
CRP was measured in sub sampled subjects (n= 60). Subjects
were randomizedly allocated to receive iron-zinc fortified milk
(n = 225) and standard milk (n = 217) for six months. The fortified
milk will provide additional6.3 mg iron and 1.5 mg zinc per day (2
feeds). The main outcomes measured were iron status, cognitive
function, growth, physical fitness and morbidity.
Results Study groups were comparable at baseline. The fortified
milk group had better physical fitness score and exercise duration
at baseline. Both milk supplementations reduced the prevalence
of anemia and iron deficiency. Fortified milk improved the speed
processing score (P< 0.0001), height (P<0.0001) and sitting
height (P=O.Ol) significantly.
Conclusion Supplementation of milk reduces the prevalence of
anemia and iron deficiency. Zinc-iron fortified milk gives positive
impact on cognitive performance, growth, and physical fitness.
References
1. Angeles IT, Schultink WJ, Matulessi P, Gross R, Sastroamidjojo
S. Decreased rate of stunting among anemic Indonesian
preschool children through iron supplementation. AmJ Clin
Nutr. 1993;58:339--42.
2. Harahap H, Jahari AB, Husaini MA, Saco-Pollit C, Pollitt.
Effects of an energy and micronutrient supplement on iron
deficiency anemia, physical activity and motor and mental
development in undernourished children in Indonesia.
European Journal of Clinical Nutrition. 2000;54:S114-S119.
3. McCannJC, Ames BN. An overview of evidence for a causal
relation between iron deficiency during development and
deficits in cognitive or behavioral function. Am J Clin N utr.
2007;85:931-945.
4. Brown KH, Peerson J M, Rivera J, Allen L. Effect of
supplemental zinc on the growth and serum concentrations
of prepubertal children: a meta-analysis of randomized
controlled trials. AmJ Clin Nutr. 2002;75:1062-1075.
5. Black MM. The evidence linking zinc deficiency with
children's cognitive and motor functioning. J N utr.
2003; 133: 1473S-1476S.
6. Bentley ME, Caulfield LE, Ram M, Santizo MC, Hurtado E,
Rivera JA, et al. Zinc Supplementation affects the activity
patterns of rural Guatemalan infants. Am J Clin Nutr.
1997; 127:1333-8.
7. Sazawal S, Black RE, Menon V P, Dingra P, Caulfield
LE, Dingra U, Bagati A. Zinc supplementation in
infants born small for gestational age reduces mortality:
a prospective, randomized controlled trial. Pediatrics.
2001; 108:1280-6.
8. Penny ME, Marin RM, Duran A. Randomized controlled
trial of the effect of daily supplementation with zinc or
multiple micronutrients on the morbidity, growth, and
micronutrient status of young Peruvian children. Am J Clin
Nutr. 2004;79:457-65.
9. Lind T, Lonnerdal B, Stenlund H, Gamayanti IL, Ismail
D, Seswandhana R, et a!. A community-based randomized
controlled trial of iron and zinc supplementation in
Indonesian infants: effects on growth and development. Am
J Clin Nutr. 2004;80 :729-6.
10. Lind T, LonnerdalLind T, Lonnerdal B, Stenlund H, Ismail
D, Seswandhana R, et a!. A community-based randomized
controlled trial of iron and zinc supplementation in
Indonesian infants: interactions between iron and zinc. Am
J Clin Nutr. 2003;77:883-90.
11. Wieringa FT, Berger J, Dijkhuizen MA, Hidayat A, Ninh NX,
Utomo B, et al. Combined iron and zinc supplementation
in infants improved iron and zinc status, but Interactions
reduced efficacy in a Multicountry Trial in Southeast. Asia
J Nutr. 2007; 137:466-71.
12. Sandstrom B. Micronutrient interactions: effects on
absorption and bioavailabiliry. Br J Nutr. 2001;85:S181-5.
13. Dijkhuizen MA, Wieringa FT, West CE, Martuti S, Muhilal.
Effects of iron and zinc supplementation in Indonesian
infants on micronutrient status and growth. J Nutr.
2001; 131:2860-5.
14. Friel JK, Serfass RE, Fennessey PV, Miller LV, Andrews
WL, Simmons BS, et a!. Elevated intakes of zinc in infant
formulas do not interfere with iron absorption in premature
infants. Journal of Pediatric Gastroenterology & Nutrition.
1998;27:312-6.
15. Iannotti LL, Tielsch JM, Black MM, Black RE. Iron
supplementation in early childhood: health benefits and
risks. Am J Clinical Nutrition. 2006;84: 1261-76.
16. Oppenheimer SJ. Iron and its relation to immunity and
infectious disease. J Nutr. 2001 ;131:616S-635S.
17. Lestari ED, Hartini TNS, Hakimi M, Surjono A. Nutritional
status and nutrient intake from complementary foods
among breastfed children Purworejo District, Central Java,
Indonesia. Paediatr Indones. 2005;45:31-39.
18. Lestari ED, Moelya AG, Rohana E, Wiboworini B.
Relation of complementary foods and anemia in urban
underprivileged children in Surakarta. Paediatr Indones.
2007;47:196-201.
19. Walker CF, Kordas K, Stoltzfus RJ, Black RE. Interactive
effects of iron and zinc on biochemical and functional. Am
J Clin Nutr. 2005;82:5-12.
20. Villalpando S, Shamah T, Rivera JA, Lara Y, Monterrubio
E. Fortifying milk with ferrous gluconate and zinc oxide in a
public nutrition program reduced the prevalence of anemia
in toddlers. J Nutr. 2006;136:2633-7.
21. Peres-exposito AB, Vilalpando S, Rieviera JA, Griffin IJ,
Abrams SA. Ferrous sulfate is more bioavailable among preschoolers
than other forms of iron in a milk-based weaning
food distributed by PROGRESA, a national program in
Mexico. J Nutr. 2004; 135:64-9.
22. Stephenson LS, Latham MC, et al. Physical fitness, growth,
and appetite of Kenyan school boys with Hookworm,
Trichuris trichiura, Ascaris lumbricoides infections are
improved four months afer a single dose of albendazole. J
Nutr. 1993; 123:1036-46.
23. Hazhihume M, Kunii 0, Sasaki S, Shimdo T, Wakai S,
Mazhitova Z, et al. Anemia and iron deficiency among
school children in Aral Sea Region Kazakhtan. J Trop Pediatr.
2003 ;49: 172-7.
24. Le HT, Brouwer ID, VerhofF!, Nguyen KC, Kok FJ. Anemia
and intestinal parasite infection in school children in rural
Vietnam. Asia Pac J Clin Nutr. 2007; 16:716-23.
25. Sawazal S, Dhingra U, Hiremath G, Kumar J, Dhingra
P, Sarkar A, et al. Effects of fortified milk on morbidity
in young children in north India: community based,
randomized, double masked placebo controlled trial. BMJ.
2007;334:140-5.
26. Perales S, Barberaa R, Lagarda MJ, Farrea R. Fortification
of milk with calcium: Effect on calcium bioavailability
and interactions with iron and zinc. J Agric Food Chern.
2006;54:4901-6.
27. Ponka P, Beaumont C, Richardson DR. Function and
regulation of transferrin and ferritin. Semin Hematol.
1998;35:35-54.
S. Decreased rate of stunting among anemic Indonesian
preschool children through iron supplementation. AmJ Clin
Nutr. 1993;58:339--42.
2. Harahap H, Jahari AB, Husaini MA, Saco-Pollit C, Pollitt.
Effects of an energy and micronutrient supplement on iron
deficiency anemia, physical activity and motor and mental
development in undernourished children in Indonesia.
European Journal of Clinical Nutrition. 2000;54:S114-S119.
3. McCannJC, Ames BN. An overview of evidence for a causal
relation between iron deficiency during development and
deficits in cognitive or behavioral function. Am J Clin N utr.
2007;85:931-945.
4. Brown KH, Peerson J M, Rivera J, Allen L. Effect of
supplemental zinc on the growth and serum concentrations
of prepubertal children: a meta-analysis of randomized
controlled trials. AmJ Clin Nutr. 2002;75:1062-1075.
5. Black MM. The evidence linking zinc deficiency with
children's cognitive and motor functioning. J N utr.
2003; 133: 1473S-1476S.
6. Bentley ME, Caulfield LE, Ram M, Santizo MC, Hurtado E,
Rivera JA, et al. Zinc Supplementation affects the activity
patterns of rural Guatemalan infants. Am J Clin Nutr.
1997; 127:1333-8.
7. Sazawal S, Black RE, Menon V P, Dingra P, Caulfield
LE, Dingra U, Bagati A. Zinc supplementation in
infants born small for gestational age reduces mortality:
a prospective, randomized controlled trial. Pediatrics.
2001; 108:1280-6.
8. Penny ME, Marin RM, Duran A. Randomized controlled
trial of the effect of daily supplementation with zinc or
multiple micronutrients on the morbidity, growth, and
micronutrient status of young Peruvian children. Am J Clin
Nutr. 2004;79:457-65.
9. Lind T, Lonnerdal B, Stenlund H, Gamayanti IL, Ismail
D, Seswandhana R, et a!. A community-based randomized
controlled trial of iron and zinc supplementation in
Indonesian infants: effects on growth and development. Am
J Clin Nutr. 2004;80 :729-6.
10. Lind T, LonnerdalLind T, Lonnerdal B, Stenlund H, Ismail
D, Seswandhana R, et a!. A community-based randomized
controlled trial of iron and zinc supplementation in
Indonesian infants: interactions between iron and zinc. Am
J Clin Nutr. 2003;77:883-90.
11. Wieringa FT, Berger J, Dijkhuizen MA, Hidayat A, Ninh NX,
Utomo B, et al. Combined iron and zinc supplementation
in infants improved iron and zinc status, but Interactions
reduced efficacy in a Multicountry Trial in Southeast. Asia
J Nutr. 2007; 137:466-71.
12. Sandstrom B. Micronutrient interactions: effects on
absorption and bioavailabiliry. Br J Nutr. 2001;85:S181-5.
13. Dijkhuizen MA, Wieringa FT, West CE, Martuti S, Muhilal.
Effects of iron and zinc supplementation in Indonesian
infants on micronutrient status and growth. J Nutr.
2001; 131:2860-5.
14. Friel JK, Serfass RE, Fennessey PV, Miller LV, Andrews
WL, Simmons BS, et a!. Elevated intakes of zinc in infant
formulas do not interfere with iron absorption in premature
infants. Journal of Pediatric Gastroenterology & Nutrition.
1998;27:312-6.
15. Iannotti LL, Tielsch JM, Black MM, Black RE. Iron
supplementation in early childhood: health benefits and
risks. Am J Clinical Nutrition. 2006;84: 1261-76.
16. Oppenheimer SJ. Iron and its relation to immunity and
infectious disease. J Nutr. 2001 ;131:616S-635S.
17. Lestari ED, Hartini TNS, Hakimi M, Surjono A. Nutritional
status and nutrient intake from complementary foods
among breastfed children Purworejo District, Central Java,
Indonesia. Paediatr Indones. 2005;45:31-39.
18. Lestari ED, Moelya AG, Rohana E, Wiboworini B.
Relation of complementary foods and anemia in urban
underprivileged children in Surakarta. Paediatr Indones.
2007;47:196-201.
19. Walker CF, Kordas K, Stoltzfus RJ, Black RE. Interactive
effects of iron and zinc on biochemical and functional. Am
J Clin Nutr. 2005;82:5-12.
20. Villalpando S, Shamah T, Rivera JA, Lara Y, Monterrubio
E. Fortifying milk with ferrous gluconate and zinc oxide in a
public nutrition program reduced the prevalence of anemia
in toddlers. J Nutr. 2006;136:2633-7.
21. Peres-exposito AB, Vilalpando S, Rieviera JA, Griffin IJ,
Abrams SA. Ferrous sulfate is more bioavailable among preschoolers
than other forms of iron in a milk-based weaning
food distributed by PROGRESA, a national program in
Mexico. J Nutr. 2004; 135:64-9.
22. Stephenson LS, Latham MC, et al. Physical fitness, growth,
and appetite of Kenyan school boys with Hookworm,
Trichuris trichiura, Ascaris lumbricoides infections are
improved four months afer a single dose of albendazole. J
Nutr. 1993; 123:1036-46.
23. Hazhihume M, Kunii 0, Sasaki S, Shimdo T, Wakai S,
Mazhitova Z, et al. Anemia and iron deficiency among
school children in Aral Sea Region Kazakhtan. J Trop Pediatr.
2003 ;49: 172-7.
24. Le HT, Brouwer ID, VerhofF!, Nguyen KC, Kok FJ. Anemia
and intestinal parasite infection in school children in rural
Vietnam. Asia Pac J Clin Nutr. 2007; 16:716-23.
25. Sawazal S, Dhingra U, Hiremath G, Kumar J, Dhingra
P, Sarkar A, et al. Effects of fortified milk on morbidity
in young children in north India: community based,
randomized, double masked placebo controlled trial. BMJ.
2007;334:140-5.
26. Perales S, Barberaa R, Lagarda MJ, Farrea R. Fortification
of milk with calcium: Effect on calcium bioavailability
and interactions with iron and zinc. J Agric Food Chern.
2006;54:4901-6.
27. Ponka P, Beaumont C, Richardson DR. Function and
regulation of transferrin and ferritin. Semin Hematol.
1998;35:35-54.
Published
2009-07-01
How to Cite
1.
Lestari E, Bardosono S, Lestarina L, Salimo H. Effect of iron . zinc fortified milk on iron status and functional outcomes in underweight children. PI [Internet]. 1Jul.2009 [cited 22Nov.2024];49(3):139-48. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/542
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Received 2016-09-10
Accepted 2016-09-10
Published 2009-07-01
Accepted 2016-09-10
Published 2009-07-01
