Efficacy of a vitamin A-fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren

Background: Wheat flour is a possible food vehicle for vitamin A fortificat ion. Objective: This study assessed the efficacy of consumption of a vitamin A-f ortified wheat-flour bun (pandesal) on the vitamin A status of school-age c hildren. Design: This was a double-masked clinical trial conducted in 396 and 439 ch ildren aged 6-13 y attending 4 rural schools in the Philippines. The childr en were randomly assigned to a vitamin A-fortified (experimental) or nonfor tified (control) group. A 60-g vitamin A-fortified pandesal (containing app roximate to 133 mu g retinol equivalents) or a nonfortified pandesal was co nsumed by the children 5 d/wk for 30 wk. Vitamin A status, hemoglobin conce ntration, anthropometric status, morbidity, and dietary intake were assesse d at baseline and 30 wk later. A modified relative dose response (MRDR) was assessed in a subsample of 20% of the children (approximate to 75/group) w ith the lowest initial serum retinol concentration at the 30-wk follow-up. Results: Baseline serum retinol significantly modified the effect of the in tervention. The fortified group, whose initial serum retinol concentrations were below the median, had a 0.07 +/- 0.03-mu mol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group (P = 0.02) . Improved vitamin A status was also evident in the MRDR subsample. End-of- study differences in the MRDR showed that vitamin A-fortified pandesal inta ke decreased the percentage of children with inadequate liver vitamin A sto res by 50% (15.3% compared with 28.6%; P = 0.05). Conclusions: Daily consumption of vitamin A-fortified pandesal significantl y improved the vitamin A status of Filipino school-age children with margin al-to-low initial serum retinol concentrations.