Dataset Information

Integrated Nutrition Program Improves Anemia and Hemoglobin Concentrations in 6- to 12-Month-Old Infants From Rural El Salvador

ABSTRACT: Abstract

Objectives

To assess the effectiveness of a nutrition intervention with a multi-micronutrient fortified corn-soy blend (MMC) (ChapuditosTM) vs. standard of care (SOC) in anemia and hemoglobin (Hb) in 6 to 12-mo-old infants from four rural municipalities in La Libertad, El Salvador.

Methods

A two-arm, clustered randomized evaluation was implemented between September 2015 and November 2017. A total of n = 384 infants met eligibility criteria: ages 6 to ≤ 12 mo, permanent resident of study locations, no genetic, health conditions or disability, parental consent, having attended 2 consecutive well-child visits. Clinicaltrials.gov registration NCT02567981. A total of n = 195 received SOC: 3 lb of corn-soy blend with dry milk with 18 micronutrients including 1.8 mg of zinc and 3.6 mg of iron per serving, equivalent to 30 daily servings; + 100,000 IU of vitamin A every 6 mo, and 12.5 mg of elemental iron per day via ferrous sulphate. A total of n = 189 received “MMC”: 3 lb of corn-soy blend with 21 micronutrients and high concentrations of chelated zinc (9 mg) and iron (12 mg) per serving, equivalent to 72 daily servings. Capillary blood was drawn at baseline (Bl) and 3 mo. Linear and generalized linear mixed models with binary outcomes were used to assess Bl – 3 mo changes in Hb and anemia, respectively. Models were adjusted by age, sex, Bl outcomes, and cluster. Both nutrition interventions were provided at the scheduled well-child visits.

Results

Preliminary analyses showed that Hb tended to improve from Bl to 3 mo in both groups [Bl-MMC = 10.47g/dL; 95% CI (10.32–10.61), Bl-SOC = 10.26 g/dL; 95% CI (10.12–10.40); 3 mo MMC = 10.88g/dL; 95% CI (10.72–11.04); 3 mo-SOC = 10.43g/dL; 95% CI (10.28–10.60)]. Changes in Hb were significant for the MMC vs. SOC group, [mean difference = 0.41g/dL, P ≤ 0.001; and 0.180g/dL, P = 0.228, respectively]. The odds of anemia were 63% lower in the MMC group, relative to SOC, [OR: 0.37, 95% CI (0.17–0.82)].

Conclusions

A multi-micronutrient cereal with 21 micronutrients and elevated concentrations of chelated zinc and iron may be an effective alternative to current practices in alleviating anemia and improving Hb in this population. Consolidating different multiple-micronutrient delivery methods into one product may simplify provision and adherence, resulting in improved anemia and Hb status.

Funding Sources

This study was funded by the Mathile Institute for the Advancement of Human Nutrition.

SUBMITTER: Palacios A

PROVIDER: S-EPMC8181429 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundMetabolic programming of glucose homeostasis in the first 1,000 days of life may impact lifelong metabolic and cardiovascular health. Continuous glucose monitoring (CGM) devices may help measure the impact of dietary intake on glucose rhythms and metabolism in infants during the complementary feeding period.ObjectivesDemonstrate the feasibility of CGM to measure and quantify glucose variability in response to infant feeding and to evaluate associations between macronutrient meal composition and glucose variability.MethodsThe "FreeStyle Libre Pro®" device interstitial glucose meter was applied to the anterior thigh of 10 healthy 6-12-month-old infants. Parents recorded food intake, time of feeding, and used daily dairies to record sleep time and duration. Descriptive statistics were employed for food intake, sleep and key glycemic parameters over three full days. Mixed linear models were used to assess glycemic changes.ResultsMid-day, afternoon, and evening feeds contained >30 g carbohydrate and induced higher 2-h iAUC (3.42, 3.41, and 3.50 mmol/L*h respectively) compared to early and mid-morning feedings with ≤25 g carbohydrates (iAUC 2.72 and 2.81 mmol/L*h, p < 0.05). Early morning and evening milk feedings contained approximately 9 g of fat and induced a longer time to reach maximal glucose value (Tmax; 75 and 68 min, respectively) compared to lower fat feedings (2.9-5.9 g; Tmax range: 34-60 min; p < 0.05). Incremental glucose value at time of food intake (C0) increased significantly from 0.24 ± 0.39 mM in early morning to 1.07 ± 0.57 mM in the evening (p < 0.05). Over the day, 70% of glucose values remained within the normal range (3.5-5.5 mmol/L), 10% were between 5.5-10 mmol/L, and 20% were < 3.5 mmol/L.ConclusionOur data support the feasibility of using CGM to measure glucose in 6-12-month-old infants. The observation of possible diurnal glucose variability and typical glucose values may have implications for future studies investigating metabolic adaptation to nutritional intake in early life.