Effect of long-term intermittent supplementation with multiple micronutrients compared with iron-and-folic acid supplementation on Hb and micronutrient status of non-anaemic adolescent schoolgirls in rural Bangladesh

Br J Nutr. 2012 Oct 28;108(8):1484-93. doi: 10.1017/S0007114511006908. Epub 2012 Jan 16.

Abstract

The present study examined whether long-term supplementation with once- and twice-weekly multiple micronutrients (MMN-1 and MMN-2) can improve Hb and micronutrient status more than twice-weekly Fe-folic acid (IFA-2) supplementation in non-anaemic adolescent girls in Bangladesh. An equal number of 324 rural schoolgirls aged 11-17 years were given MMN-1 or MMN-2 or IFA-2 supplements for 52 weeks in a randomised, double-blind trial. Blood samples were collected at baseline, and at 26 and 52 weeks of supplementation. The girls receiving IFA-2 supplements were more likely to be anaemic than the girls receiving MMN-2 supplements for 26 weeks (OR 5·1, 95% CI 1·3, 19·5; P = 0·018). All three supplements reduced Fe deficiency effectively. Both the MMN-1 and MMN-2 groups showed significantly greater improvements in vitamins A, B(2) and C status than the girls in the IFA-2 group, as might be expected. Receiving a MMN-1 supplement was found to be less effective than MMN-2 supplement in improving Fe, vitamins A, B(2) and folic acid status. Receiving micronutrient supplements beyond 26 weeks showed little additional benefit in improving micronutrient status. In conclusion, given twice-weekly for 26 weeks, MMN supplements can improve micronutrient status effectively with no significant increase in Hb concentration compared with IFA supplements in non-anaemic Bangladeshi adolescent girls. However, it significantly reduces the risk of anaemia. Before any recommendations can be made, further research, including into cost-effectiveness, is needed to see whether MMN supplementation has any additional longer-term health benefits over that of IFA supplementation in this population.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anemia
  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / prevention & control*
  • Bangladesh
  • Child
  • Dietary Supplements*
  • Double-Blind Method
  • Female
  • Folic Acid / blood
  • Folic Acid / pharmacology
  • Folic Acid / therapeutic use*
  • Hemoglobins / metabolism*
  • Humans
  • Iron / blood
  • Iron / pharmacology
  • Iron / therapeutic use*
  • Iron Deficiencies
  • Micronutrients / blood
  • Micronutrients / pharmacology
  • Micronutrients / therapeutic use*
  • Nutritional Status / drug effects*
  • Reference Values
  • Time Factors
  • Vitamins / blood

Substances

  • Hemoglobins
  • Micronutrients
  • Vitamins
  • Folic Acid
  • Iron