Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial

Background: Deficiencies of iron, iodine, and vitamin A are prevalent world wide and can affect the mental development and learning ability of schoolch ildren. Objective: The aim of this study was to determine the effect of micronutrie nt-fortified biscuits on the micronutrient status of primary school childre n. Design: Micronutrient status was assessed in 115 children aged 6-11 y befor e and after consumption of biscuits (fortified with iron, iodine, and beta- carotene) for 43 wk over a 12-mo period and was compared with that in a con trol group (n = 113) who consumed nonfortified biscuits. Cognitive function , growth, and morbidity were assessed as secondary outcomes. Results: There was a significant between-group treatment effect on serum re tinol, serum ferritin, serum iron, transferrin saturation, and urinary iodi ne (P <0.0001) and in hemoglobin and hematocrit (P <0.05). The prevalence o f low serum retinol concentrations (<0.70 mu mol/L) decreased from 39.1% to 12.2%, of low serum ferritin concentrations (<20 mu g/L) from 27.8% to 13. 9%, of anemia (hemoglobin < 120 g/L) from 29.6% to 15.6%, and of low urinar y iodine concentrations (<100 mu g/L) from 97.5% to 5.4%. There was a signi ficant between-group treatment effect (P <0.05) in cognitive function with the digit span forward task (short-term memory). Fewer school days were mis sed in the intervention than in the control group because of respiratory (P = 0.097) and diarrhea-related (P = 0.013) illnesses. The intervention had no effect on morbidity and cognitive function. Conclusions: Fortified biscuits resulted in a significant improvement in th e micronutrient status of primary school children from a poor rural communi ty and also appeared to have a favorable effect on anthropometric status.