The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance. Effect of a Multiple-Micronutrient-Fortified Fruit Powder Beverage on the Nutrition Status, Physical Fitness, and Cognitive Performance of Schoolchildren in the Philippines Multiple micronutrient-fortified rice affects physical performance and plasma vitamin B-12 and homocysteine concentrations of Indian school children. Effect of multivitamin and multimineral supplementation on cognitive function in men and women aged 65 years and over: a randomised controlled trial A preliminary report: effects of zinc and micronutrient repletion on growth and neuropsychological function of urban Chinese children. Nutritional Intervention as a Preventive Approach for Cognitive-Related Outcomes in Cognitively Healthy Older Adults: A Systematic Review. Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings. Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Effect of micronutrient supplement on health and nutritional status of schoolchildren: biochemical status. Decreased parasite load and improved cognitive outcomes caused by deworming and consumption of multi-micronutrient fortified biscuits in rural Vietnamese schoolchildren. Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children's Health and Mental Performance Influenced by Optimal Nutrition) Study. Micronutrient-Fortified Milk and Academic Performance among Chinese Middle School Students: A Cluster-Randomized Controlled Trial Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population. Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention. Antenatal supplementation with micronutrients and biochemical indicators of status and subclinical infection in rural Nepal. Multiple micronutrient supplementation increases the growth of Mexican infants. A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children Micronutrient deficiency in obese subjects undergoing low calorie diet Inconsistent Effects of Iron-Folic Acid and/or Zinc Supplementation on the Cognitive Development of Infants A multimicronutrient-fortified seasoning powder enhances the hemoglobin, zinc, and iodine status of primary school children in North East Thailand: a randomized controlled trial of efficacy. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. An efficacy study on alleviating micronutrient deficiencies through a multiple micronutrient fortified salt in children in South India. Multi-micronutrient-fortified biscuits decreased prevalence of anemia and improved micronutrient status and effectiveness of deworming in rural Vietnamese school children.
Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies . This study aim ed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status , cognition , physical performance and nutritional deficiencies of 7 - 10 years old south Indian children . A r and omized , double blind placebo controlled study design was used with normal healthy children from low to middle income families , aged 7 - 10 years r and omly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink . The drinks were provided 6 days/week for 5 months . Assessment s included anthropometry , blood biochemistry , physical performance and cognition at baseline and endline . The baseline characteristics of the study groups were similar . The changes in body weight and height were similar between the groups at the end of the study . Levels of vitamin B12 , red cell folate and vitamin B2 significantly improved in the intervention group , while vitamin D , selenium and body iron showed no difference . The Hemoglobin ( Hb ) and serum ferritin levels of the control group decreased at endline , while those in the intervention group maintained their levels . The serum transferrin receptor levels increased in both the groups . The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline . Overall improvement in cognitive and physical performance was seen in both the groups at endline , with no significant differences between the groups . The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2 , Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink . It also reduced anemia and the risk of deficiencies of iron , and B12 , in apparently healthy children . Clinical Trials.gov IdentifierNCT01415557 . Clinical Trial RegistryIndia - REF/2012/12/004332 This study aim ed to determine the effect of a multiple-micronutrient-fortified beverage on the micronutrient status , physical fitness , and cognitive performance of schoolchildren . The study was a r and omized , double-blind , placebo-controlled trial of schoolchildren assigned to receive either the fortified or nonfortified beverage with or without anthelmintic therapy .  Data on hemoglobin level , urinary iodine excretion ( UIE ) level , physical fitness , and cognitive performance were collected at baseline and at 16 weeks post-intervention . The fortified beverage significantly improved iron status among the subjects that had hemoglobin levels < 11 g/dl at baseline . The proportion of children who remained moderately to severely anemic was significantly lower among those given the fortified beverage . In the groups that received the fortified product , the median UIE level increased , whereas among those who received the placebo beverage , the median UIE level was reduced significantly . Iron- and /or iodine-deficient subjects who received the fortified beverage showed significant improvements in fitness ( post-exercise reduction of heart rate ) and cognitive performance ( nonverbal mental ability score ) . The study showed that consumption of a multiple-micronutrient-fortified beverage for 16 weeks had significant effects on iron status , iodine status , physical fitness , and cognitive performance among iron- and /or iodine-deficient Filipino schoolchildren .  Anthelmintic therapy improved iron status of anemic children and iodine status of the iron-adequate children at baseline but it had no effect on physical fitness and cognitive performance . The results from the clinical study showed that a multiple-micronutrient-fortified beverage could play an important role in preventing and controlling micronutrient deficiencies Fortifying rice with multiple micronutrients could be a promising strategy for combat micronutrient deficiencies in developing countries . We determined the efficacy of extruded rice grains fortified with multiple micronutrients on the prevalence of anemia , micronutrient status , and  physical and cognitive performance  in 6- to 12-y-old , low-income school children in Bangalore , India . In a r and omized , double-blind , controlled trial , 258 children were assigned to 1 of 3 intervention groups to receive rice-based lunch meals fortified with multiple micronutrients with either low-iron ( 6.25 mg ) or high-iron ( 12.5 mg ) concentrations or identical meals with unfortified rice . The meals were provided 6 d/wk for 6 mo . Anthropometric , biochemical , physical performance , and cognitive assessment s were taken at baseline and endpoint . At baseline , study groups were comparable , with 61 % of the children being anemic . However , only < 10 % were deficient in iron , vitamin A , and zinc . After 6 mo , plasma vitamin B-12 and homocysteine concentrations ( both P < 0.001 ) as well as physical performance ( P < 0.05 ) significantly improved in the intervention arms . No between-group differences were observed in hemoglobin concentration , anemia , and deficiencies of other micronutrients or cognitive function after 6 mo , but paired analyses revealed a small reduction in anemia prevalence in children in the low-iron group . The fortified rice was efficacious in improving vitamin B-12 status and physical performance in Indian school children Background Observational studies have frequently reported an association between cognitive function and nutrition in later life but r and omised trials of B vitamins and antioxidant supplements have mostly found no beneficial effect . We examined the effect of daily supplementation with 11 vitamins and 5 minerals on cognitive function in older adults to assess the possibility that this could help to prevent cognitive decline . Methods The study was carried out as part of a r and omised double blind placebo controlled trial of micronutrient supplementation based in six primary care health centres in North East Scotl and . 910 men and women aged 65 years and over living in the community were recruited and r and omised : 456 to active treatment and 454 to placebo . The active treatment consisted of a single tablet containing eleven vitamins and five minerals in amounts ranging from 50–210 % of the UK Reference Nutrient Intake or matching placebo tablet taken daily for 12 months . Digit span forward and verbal fluency tests , which assess immediate memory and executive functioning respectively , were conducted at the start and end of the intervention period . Risk of micronutrient deficiency at baseline was assessed by a simple risk question naire . Results For digit span forward there was no evidence of an effect of supplements in all participants or in sub-groups defined by age or risk of deficiency . For verbal fluency there was no evidence of a beneficial effect in the whole study population but there was weak evidence for a beneficial effect of supplementation in the two pre-specified subgroups : in those aged 75 years and over ( n 290 ; mean difference between supplemented and placebo groups 2.8 ( 95 % CI -0.6 , 6.2 ) units ) and in those at increased risk of micronutrient deficiency assessed by the risk question naire ( n 260 ; mean difference between supplemented and placebo groups 2.5 ( 95 % CI -1.0 , 6.1 ) units ) . Conclusion The results provide no evidence for a beneficial effect of daily multivitamin and multimineral supplements on these domains of cognitive function in community-living people over 65 years . However , the possibility of beneficial effects in older people and those at greater risk of nutritional deficiency deserves further attention OBJECTIVE Zinc is essential for growth and cognition of experimental animals . Past research found zinc repletion improved growth of stunted Chinese children . Therefore we measured effects of zinc repletion on growth and neuropsychological functions of children . DESIGN Double-blind r and omized controlled treatment trial . SETTING Elementary schools in low income districts of Chongqing , Qingdao and Shanghai . SUBJECTS Three hundred-seventy-two 6 to 9 year old first grade rs . INTERVENTIONS Treatments were 20 mg zinc , 20 mg zinc with micronutrients , or micronutrients alone . The micronutrient mixture was based on guidelines of the US NAS/NRC . Treatments were assigned to classrooms of 40 or more children each , and administered by teachers 6 days per week for 10 weeks . MEASURES OF OUTCOME Changes in knee height and neuropsychological functions . RESULTS Zinc alone had the least effect on growth while zinc with micronutrients had the largest effect ; micronutrients alone had an intermediate effect . Zinc-containing treatments improved neuropsychological functions , but micronutrients alone had little effect . CONCLUSIONS The findings confirm the essentiality of zinc for growth of children , and show , for the first time , the essentiality of zinc for neuropsychological functions of children . In addition , the need for repletion of other potentially limiting nutrients in studies examining the effects of specific nutrients on growth and neuropsychological functions was confirmed The link diet-cognitive function/dementia has been largely investigated in observational studies ; however , there was a lack of evidence from r and omized clinical trials ( RCTs ) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults . In the present article , we systematic ally review ed RCTs published in the last four years ( 2014 - 2017 ) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation ( i.e. , dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches ) as well as possible underlying mechanisms of nutritional prevention . From the 35 included RCTs , there was moderate evidence that intervention through dietary pattern changes , medical food/nutraceutical supplementation , and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers . There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect on cognitive function . For fatty acid supplementation , mainly long-chain polyunsaturated fatty acids , there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains , magnetic resonance imaging ( MRI ) findings , and /or cognitive-related biomarkers also in selected subgroups of older subjects , although some results were conflicting . There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and /or MRI findings . Finally , there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions , dementia incidence , or cognitive-related biomarkers in cognitively healthy older subjects A previous longitudinal three-country study in Egypt , Kenya and Mexico found significant positive associations between intake of animal source foods ( ASF ) and growth , cognitive development and physical activity . To test for a causal relationship , a controlled school feeding intervention study was design ed to test the hypotheses that ASF would improve micronutrient status , growth and cognitive function in Kenyan primary school children . Twelve rural Kenyan schools with 554 children were r and omized to four feeding interventions using a local vegetable stew as the vehicle . The groups were design ated as Meat , Milk , Energy and Control , who received no feedings . Feeding was carried out on school days for seven terms during 21 mo . Preintervention baseline measures included nutritional status , home food intake , anthropometry , biochemical measures of micronutrient status , malaria , intestinal parasites , health status and cognitive and behavioral measures . The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30 % of children and widespread inadequate intakes and /or biochemical evidence of micronutrient deficiencies , particularly of iron , zinc , vitamins A and B-12 , riboflavin and calcium . Little or no ASF were eaten and fat intake was low . Malaria was present in 31 % of children , and hookworm , amebiasis and giardia were widely prevalent . The outcomes measured were rates of change or increase during the intervention in cognitive function , growth , physical activity and behavior and micronutrient status . Hierarchical linear r and om effects modeling was used for analysis of outcomes BACKGROUND Deficiencies of iron , iodine , and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren . OBJECTIVE The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children . DESIGN Micronutrient status was assessed in 115 children aged 6 - 11 y before 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 control 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 retinol , serum ferritin , serum iron , transferrin saturation , and urinary iodine ( P < 0.0001 ) and in hemoglobin and hematocrit ( P < 0.05 ) . The prevalence of low serum retinol concentrations ( < 0.70 micromol/L ) decreased from 39.1 % to 12.2 % , of low serum ferritin concentrations ( < 20 microg/L ) from 27.8 % to 13.9 % , of anemia ( hemoglobin < 120 g/L ) from 29.6 % to 15.6 % , and of low urinary iodine concentrations ( < 100 microg/L ) from 97.5 % to 5.4 % . There was a significant between-group treatment effect ( P < 0.05 ) in cognitive function with the digit span forward task ( short-term memory ) . Fewer school days were missed 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 anthropometric status [ corrected ] . CONCLUSIONS Fortified biscuits result ed in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [ corrected ] OBJECTIVE We assessed the effect of a daily intake of a micronutrient-fortified beverage for 14 mo on indicators of biochemical status of important micronutrients in schoolchildren . METHODS A double-blind , placebo-controlled , matched-pair , cluster , r and omization study design was used . Biochemical indicators of micronutrient status were evaluated at baseline and at the end of 14 mo on a sub sample in nine matched pairs . Prevalence ( percentage ) of sub clinical deficiency , mean , and mean increments of each indicator were compared between supplemented and placebo groups . RESULTS Extent of inadequacy at baseline was more or less 100 % for folic acid , 65 % for vitamins B2 and B6 , and 55 % for vitamins C and A. Prevalence of anemia among subjects was 55 % , with inadequacy of vitamin B12 being 40 % and that of vitamin D being 30 % . No subject had inadequacy of iodine based on urinary iodine . Supplementation of a micronutrient-enriched beverage for 14 mo significantly improved the status of many of the nutrients . The effect was significant with respect to vitamins A , B2 , and B12 , folic acid , vitamin D , parathyroid hormone , and thyroid-stimulating hormone in children who received the supplement compared with those who received only placebo .  Hemoglobin status improved only in children who had anemia in the supplemented group . CONCLUSIONS Prevalence of multiple sub clinical micronutrient deficiencies are high in middle-income Indian school children . Daily consumption of a micronutrient-enriched beverage had positive effects that were confined to those nutrients that were inadequate at baseline Micronutrient deficiencies are associated with impaired growth and cognitive  function  . A school-based fortification program might benefit schoolchildren but a high prevalence of parasite infestation might affect effectiveness . A r and omized , double-blind , placebo-controlled 2 × 2 factorial trial was conducted to assess the efficacy of multi-micronutrient fortified biscuits with or without de-worming on growth , cognitive function , and parasite load in Vietnamese schoolchildren . Schoolchildren ( n = 510 ) , 6 - 8 years of age were r and omly allocated to receive albendazole or placebo at baseline and four months of multi-micronutrient fortified biscuits ( FB ) or non-fortified biscuits .  Children receiving FB for four months scored higher on two cognitive tests : Raven 's Colored Progressive Matrices and the Digit Span Forward test . Children receiving albendazole plus FB had the lowest parasite load after four months . In children receiving FB , mid-upper arm circumference was slightly improved ( + 0.082 cm ) but there were no differences in other indexes of anthropometry . Combining multi-micronutrient fortified biscuits with de-worming is an effective strategy BACKGROUND Fortification with multiple micronutrients has been shown to improve growth and cognitive performance among children in developing countries , but it is unknown whether higher concentrations are more effective than lower concentrations . OBJECTIVE We compared the effect of 2 different concentrations of a combination of micronutrients and n-3 ( omega-3 ) fatty acids on indicators of growth and cognitive performance in low-income , marginally nourished schoolchildren in Bangalore , India . DESIGN In a 2-by-2 factorial , double-blind , r and omized controlled trial , 598 children aged 6 - 10 y were individually allocated to 1 of 4 intervention groups to receive foods fortified with either 100 % or 15 % of the Recommended Dietary Allowance of micronutrients in combination with either 900 mg alpha-linolenic acid plus 100 mg docosahexaenoic acid or 140 mg alpha-linolenic acid for 12 mo . Anthropometric and biochemical assessment s were performed at baseline and 12 mo . Cognitive performance was measured at baseline and at 6 and 12 mo . RESULTS The high micronutrient treatment significantly improved linear growth at 12 mo ( 0.19 cm ; 0.01 , 0.36 ) and short-term memory at 6 mo ( 0.11 SD ; 0.01 , 0.20 ) and was less beneficial on fluid reasoning at 6 ( -0.10 SD ; -0.17 , -0.03 ) and 12 ( -0.12 SD ; -0.20 , -0.04 ) mo than was the low micronutrient treatment , whereas no differences were observed on weight , retrieval ability , cognitive speediness , and overall cognitive performance . No significant differences were found between the n-3 treatments . CONCLUSIONS The high micronutrient treatment was more beneficial for linear growth than was the low micronutrient treatment . However , with some small differential effects , higher micronutrient concentrations were as effective as lower concentrations on cognitive performance . This trial was registered at clinical trials.gov as NCT00467909 Many children suffer from nutritional deficiencies that may negatively affect their academic performance  . This cluster-r and omized controlled trial aim ed to test the effects of micronutrient-fortified milk in Chinese students . Participants received either micronutrient-fortified ( n = 177 ) or unfortified ( n = 183 ) milk for six months . Academic performance , motivation , and learning strategies were estimated by end-of-term tests and the Motivated Strategies for Learning Question naire . Blood sample s were analyzed for micronutrients . In total , 296 students ( 82.2 % ) completed this study . Compared with the control group , students in the intervention group reported higher scores in several academic subjects ( p < 0.05 ) , including language s , mathematics , ethics , and physical performance at the end of follow-up . Students in the intervention group showed greater self-efficacy and use of cognitive strategies in learning , and reported less test anxiety ( p < 0.001 ) . Moreover , vitamin B2 deficiency ( odds ratio ( OR ) = 0.18 , 95 % confidence interval ( CI ) : 0.11~0.30 ) and iron deficiency ( OR = 0.34 , 95 % CI : 0.14~0.81 ) were less likely in the students of the intervention group , whereas vitamin D , vitamin B12 , and selenium deficiencies were not significantly different . “ Cognitive strategy ” had a partial mediating effect on the test scores of English ( 95 % CI : 1.26~3.79 ) and Chinese ( 95 % CI : 0.53~2.21 ) . Our findings suggest that micronutrient-fortified milk may improve students ’ academic performance , motivation , and learning strategies Poor nutrient intake during pregnancy can adversely affect both infant and maternal health . The aim was to investigate the efficacy of multiple-micronutrient supplementation during pregnancy in a socially deprived population in the developed world . We conducted a r and omised , double-blind , placebo-controlled trial of multiple-micronutrient supplementation including 20 mg Fe and 400 microg folic acid , from the first trimester of pregnancy in 402 mothers , in East London , UK .  Nutrient status was measured at recruitment , and at 26 and 34 weeks of gestation . Infants were weighed at birth . At recruitment the prevalence of anaemia was 13 % , vitamin D insufficiency 72 % , thiamin deficiency 12 % and folate deficiency 5 % , with no differences between groups . Only 39 % of women completed the study ; rates of non-compliance were similar in both groups . Intention-to-treat analysis showed that participants receiving treatment had higher mean Hb at 26 weeks of gestation ( 110 ( sd 10 ) v.108 ( sd 10 ) g/l ; P = 0.041 ) and 34 weeks of gestation ( 113 ( sd 12 ) v.109 ( sd 10 ) g/l ; P = 0.003 ) and packed cell volume concentrations at 26 weeks of gestation ( 0.330 ( sd 0.025 ) v. 0.323 ( sd 0.026 ) l/l ; P = 0.011 ) and 34 weeks of gestation ( 0.338 ( sd 0.029 ) v. 0.330 ( sd 0.028 ) l/l ; P = 0.014 ) compared with controls . Analysis of compliant women showed supplemented women had higher median concentrations of serum ferritin , erythrocyte folate and 25-hydroxyvitamin D later in gestation than controls . In the compliant subset ( n 149 ) , placebo mothers had more small-for-gestational age ( SGA ) infants ( eight SGA v. thirteen ; P = 0.042 ) than treatment mothers . Baseline micronutrient deficiencies were common ; the multiple-micronutrient supplement was well-tolerated and improved nutrient status .  Multiple-micronutrient supplements from early pregnancy may be beneficial and larger studies are required to assess impact on birth outcomes and infant development Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition . In the present study , we investigated the effects of micronutrients and sugar , alone and in combination , in a beverage on growth and cognition in schoolchildren . In a 2 × 2 factorial design , children ( n 414 , 6 - 11 years ) were r and omly allocated to consume beverages containing ( 1 ) micronutrients with sugar , ( 2 ) micronutrients with a non-nutritive sweetener , ( 3 ) no micronutrients with sugar or ( 4 ) no micronutrients with a non-nutritive sweetener for 8.5 months . Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II ( KABC-II ) subtests and the Hopkins Verbal Learning Test ( HVLT ) . Micronutrients decreased the OR for Fe deficiency at the endpoint ( OR 0.19 ; 95 % CI 0.07 , 0.53 ) . Micronutrients  increased KABC Atlantis ( intervention effect : 0.76 ; 95 % CI 0.10 , 1.42 ) and HVLT Discrimination Index ( 1.00 ; 95 % CI 0.01 , 2.00 ) scores . Sugar  increased KABC Atlantis ( 0.71 ; 95 % CI 0.05 , 1.37 ) and Rover ( 0.72 ; 95 % CI 0.08 , 1.35 ) scores and HVLT Recall 3 ( 0.94 ; 95 % CI 0.15 , 1.72 ) . Significant micronutrient × sugar interaction effects on the Atlantis , Number recall , Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone . Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls ( micronutrients - 0.08 ; 95 % CI - 0.15 , - 0.01 ; sugar - 0.07 ; 95 % CI - 0.14 , - 0.002 ) , but in combination , this effect was attenuated . The beverages with micronutrients or added sugar alone had a beneficial effect on cognition , which was attenuated when provided in combination BACKGROUND Previously we showed that women in rural Nepal experience multiple micronutrient deficiencies in early pregnancy . OBJECTIVE This study examined the effects of daily antenatal micronutrient supplementation on changes in the biochemical status of several micronutrients during pregnancy . DESIGN In Nepal , we conducted a r and omized controlled trial in which 4 combinations of micronutrients ( folic acid , folic acid + iron , folic acid + iron + zinc , and a multiple micronutrient supplement containing folic acid , iron , zinc , and 11 other nutrients ) plus vitamin A , or vitamin A alone as a control , were given daily during pregnancy . In a sub sample of subjects ( n = 740 ) , blood was collected both before supplementation and at approximately 32 wk of gestation . RESULTS In the control group , serum concentrations of zinc , riboflavin , and vitamins B-12 and B-6 decreased , whereas those of copper and alpha-tocopherol increased , from the first to the third trimester . Concentrations of serum folate , 25-hydroxyvitamin D , and undercarboxylated prothrombin remained unchanged . Supplementation with folic acid alone or folic acid + iron decreased folate deficiency . However , the addition of zinc failed to increase serum folate , which suggests a negative inhibition ; multiple micronutrient supplementation increased serum folate .  Folic acid + iron + zinc failed to improve zinc status but reduced sub clinical infection .  Multiple micronutrient supplementation decreased the prevalence of serum riboflavin , vitamin B-6 , vitamin B-12 , folate , and vitamin D deficiencies but had no effect on infection . CONCLUSIONS In rural Nepal , antenatal supplementation with multiple micronutrients can ameliorate , to some extent , the burden of deficiency . The implication s of such biochemical improvements in the absence of functional and health benefits remain unclear BACKGROUND The role of single micronutrient deficiencies in the etiology of growth retardation has recently gained attention . However , because multiple micronutrient deficiencies are common in children in developing countries , it is possible that more than one micronutrient may limit growth and , hence , the correction of a single deficiency may not be enough to improve growth substantially . OBJECTIVE The objective was to evaluate the effect of multiple micronutrient supplementation on the growth of children aged 8 - 14 mo whose diets were poor in several micronutrients . DESIGN Children were r and omly assigned to 1 of 2 groups . One group received a multiple micronutrient supplement containing the recommended dietary allowance ( RDA ) or 1.5 times the RDA of vitamins A , D , E , K , C , B-1 , B-6 , B-12 , riboflavin , niacin , biotin , folic acid , and pantothenic acid , and iron , zinc , iodine , copper , manganese , and selenium . The other group received a placebo . Supplements were administered 6 d/wk for an average of 12.2 mo . Body length was measured at baseline and monthly thereafter until the end of supplementation . RESULTS Supplemented infants initially aged < 12 mo had significantly greater length gains than did the placebo group , with a difference of 8.2 mm ( length-for-age z score : 0.3 ) at the end of supplementation . In contrast , differences in length gains between the supplemented and placebo groups initially aged > or = 12 mo were not significant . CONCLUSIONS Micronutrient deficiencies limited the growth of the Mexican infants studied . Improving micronutrient intakes should be a component of interventions to promote growth in infants living in setting s where micronutrient intakes are inadequate Summary Single interventions for helminthic infections and micronutrient deficiencies are effective , but it is not clear whether combined interventions will provide equal , additive or synergistic effects to improve children 's health . The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children . A double-blind , r and omized , placebo-controlled trial in 11 rural South African primary schools r and omly allocated 579 children aged between 8 and 10 years into six study groups , half of whom received antihelminthic treatment at baseline . The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits , either unfortified or fortified with vitamin A and iron or with vitamin A only , given daily for 16 weeks . The outcome measures were anthropometric , micronutrient and parasite status , and scholastic and cognitive test scores . There was a significant treatment effect of vitamin A on serum retinol ( p < 0.01 ) , and the suggestion of an additive effect between vitamin A fortification and de-worming . Fortified biscuits improved micronutrient status in rural primary school children ; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection . The burden of micronutrient deficiency ( anaemia , iron and vitamin A ) and stunting in this study population was low and , coupled with the restricted duration of the intervention ( 16 weeks ) , might have limited the impact of the interventions Background The prevalence of micronutrient deficiencies is higher in obese individuals compared to normal-weight people , probably because of inadequate eating habits but also due to increased dem and s among overweight persons , which are underestimated by dietary reference intakes ( DRI ) intended for the general population . We therefore evaluated the dietary micronutrient intake in obese individuals compared to a reference population and DRI recommendations . Furthermore , we determined the micronutrient status in obese subjects undergoing a st and ardized DRI-covering low-calorie formula diet  to analyze if the DRI meet the micronutrient requirements of obese individuals . Methods In 104 subjects baseline micronutrient intake was determined by dietary record collection .  A r and omly assigned subgroup of subjects ( n = 32 ) underwent a st and ardized DRI-covering low-calorie formula diet over a period of three months . Pre- and post-interventional intracellular micronutrient status in buccal mucosa cells ( BMC ) was analyzed , as well as additional micronutrient serum concentrations in 14 of the subjects . Results Prior to dietetic intervention , nutrition was calorie-rich and micronutrient-poor . Baseline deficiencies in serum concentrations were observed for 25-hydroxyvitamin-D , vitamin C , selenium , iron , as well as ß-carotene , vitamin C , and lycopene in BMC . After a three-month period of formula diet even more subjects had reduced micronutrient levels of vitamin C ( serum , BMC ) , zinc , and lycopene . There was a significant negative correlation between lipophilic serum vitamin concentrations and body fat , as well as between iron and C-reactive protein . Conclusions The present pilot study shows that micronutrient deficiency occurring in obese individuals is not corrected by protein-rich formula diet containing vitamins and minerals according to DRI . In contrast , micronutrient levels remain low or become even lower , which might be explained by insufficient intake , increased dem and and unbalanced dispersal of lipophilic compounds in the body . Trial registration The study was registered at Clinical Trials.gov ( NCT01344525 ) . The study protocol comprises only a part of the approved trial protocol Despite concerns over the neurocognitive effects of micronutrient deficiencies in infancy , few studies have examined the effects of micronutrient supplementation on specific cognitive indicators . This study investigated , in 2002 , the effects of iron-folic acid and /or zinc supplementation on the results of Fagan Test of Infant Intelligence ( FTII ) and the A-not-B Task of executive functioning among 367 Nepali infants living in Sarlahi district . Infants were enrolled in a cluster-r and omized , placebo-controlled clinical trial of daily supplementation with 5 mg of zinc , 6.25 mg of iron with 25 µg of folic acid , or zinc-iron-folic acid , or placebo . These were tested on both the tasks using five indicators of information processing : preference for novelty ( FTII ) , fixation duration ( FTII ) , accelerated performance ( ≥85 % correct ; A-not-B ) , deteriorated performance ( < 75 % correct and > 1 error on repeat-following-correct trails ; A-not-B ) , and the A-not-B error ( A-not-B ) . At 39 and 52 weeks , 247 and 333 infants respectively attempted the cognitive tests ; 213 made an attempt to solve both the tests . The likelihood of females completing the A-not-B Task was lower compared to males when cluster r and omization was controlled [ odds ratio=0.67 ; 95 % confidence interval 0.46 - 0.97 ; p<0.05 ] . All of the five cognitive outcomes were modelled in linear and logistic regression . The results were not consistent across either the testing sessions or the information-processing indicators . Neither the combined nor the individual micronutrient supplements improved the performance on the FTII or the A-not-B Task ( p>0.05 ) . These findings suggest that broader interventions ( both in terms of scope and duration ) are needed for infants who face many biological and social stressors Anemia and co-existing deficiencies of zinc , iron , iodine , and vitamin A occur among children in many developing countries including NE Thail and , probably contributing to impairments in growth , immune competence , and cognition . Sustainable strategies are urgently required to combat these deficiencies . We assessed the efficacy of a micronutrient-fortified seasoning powder served with a school lunch on reducing anemia and improving the micronutrient status of rural NE Thai children . Children ( n = 569 ) aged 5.5 - 13.4y from 10 schools were r and omly assigned to receive a seasoning powder either unfortified or fortified with zinc ( 5 mg ) , iron ( 5 mg ) , vitamin A ( 270 microg ) , and iodine ( 50 microg ) ( per serving ) and incorporated into a school lunch prepared central ly and delivered 5 d/wk for 31 wk . Teachers monitored school lunch consumption . Baseline and final micronutrient status , hemoglobinopathies , and infection or inflammation were assessed from blood and urine sample s. For the primary outcome , anemia ( based on hemoglobin ) , no intervention effect was apparent ( odds ratio : 1.02 95 % CI : 0.69 , 1.51 ) after adjustment for design strata . The odds of zinc ( based on serum zinc ) and urinary iodine deficiency in the fortified group were 0.63 ( 0.42 , 0.94 ) and 0.52 ( 0.38 , 0.71 ) times those in the unfortified group , respectively . Fortification had no effect on serum retinol ( 0.61 : 0.25,1.51 ) , ferritin ( 1.12 : 0.43 , 2.96 ) , or mean red cell volume ( 1.16 : 0.82 , 1.64 ) . Therefore , a micronutrient-fortified seasoning powder is a promising vehicle for improving zinc , iodine , and hemoglobin status , and its potential for incorporation into lunch programs in day care centers and schools in NE Thail and warrants investigation Although iron deficiency is the most common single-nutrient deficiency in infants and children , other deficiencies may develop concurrently , including zinc deficiency . In previous studies , we used home-fortification with " Sprinkles , " single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods , to successfully treat anemia . This mode of micronutrient delivery is amenable to the delivery of other micronutrients . However , the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions . Thus , we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants , compared with Sprinkles formulated with iron alone . We studied 304 anemic infants ( mean age 10.3 + /- 2.5 mo ; hemoglobin 87.4 + /- 8.4 g/L ) in rural Ghana . A combined supplementation group ( FeZn ) received daily Sprinkles containing 80 mg iron and 10 mg zinc ; a comparison group ( Fe ) received Sprinkles ( 80 mg iron ) without zinc for 2 mo . The rate of recovery from anemia was higher in the Fe group compared with the FeZn group ( 74.8 vs. 62.9 % ; P = 0.048 ) . The plasma zinc concentration decreased significantly in both groups ( P < 0.05 ) . A significant decline in the height for age Z-score was observed in the FeZn group ( P = 0.0011 ) , but there was no change in the Fe group . These results suggest that in a controlled setting , home-fortification using micronutrient Sprinkles with iron , or iron and zinc , was very successful in treating anemia ; however , this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population BACKGROUND Multiple micronutrient deficiencies are prevalent in India . OBJECTIVE The study aims to establish the efficacy of multi-micronutrient fortified salt in addressing multiple micronutrient deficiencies among children compared to nutrition education and no intervention in Tamilnadu . METHODS The study employed a community based r and omized controlled trial design ed to study the impact of multiple micronutrient salt ( micronutrient group ) in comparison with nutrition education ( education group ) and no intervention ( control group ) on haemoglobin , serum ferritin , soluble transferrin receptor , body iron stores , serum retinol and urinary iodine outcomes over a period of 8 months . The fortified salt contained iron , iodine , vitamin A , vitamin B12 and folic acid . All the children were dewormed at baseline and at the end of the study just before the biochemical measurements . RESULTS There was a significant improvement in most biochemical parameters studied in the micronutrient group when compared with the control group whereas this was not seen between the education and control . Over 8 months , in the micronutrient group , hemoglobin increased by 0.52 g/dL , retinol by 8.56 μg/dL , ferritin by 10.8 μg/L , body iron stores by 1.27 mg and the decrease in the prevalence of retinol deficiency was from 51.6 % to 28.1 % , anaemia from 46.0 % to 32.6 % , iron deficiency from 66.9 % to 51.3 % and iron deficiency anaemia from 35.2 % to 31.0 % , while the prevalence of all these deficiencies increased or the changes were not significant in the other two groups . CONCLUSIONS Multiple micronutrient fortified salt was able to improve iron and vitamin A status , whereas this was not seen in the nutrition education group Concurrent micronutrient deficiencies are prevalent among Vietnamese school children . A school-based program providing food fortified with multiple micronutrients could be a cost-effective and sustainable strategy to improve health and cognitive function of  school children . However , the efficacy of such an intervention may be compromised by the high prevalence of parasitic infestation . To evaluate the efficacy of school-based intervention using multi-micronutrient-fortified biscuits with or without deworming on anemia and micronutrient status in Vietnamese schoolchildren , a r and omized , double-blind , placebo-controlled trial was conducted among 510 primary schoolchildren , aged 6 - 8 y , in rural Vietnam .  Albendazole ( Alb ) ( 400 mg ) or placebo was given at baseline . Nonfortified or multi-micronutrient-fortified biscuits including iron ( 6 mg ) , zinc ( 5.6 mg ) , iodine ( 35 microg ) , and vitamin A ( 300 microg retinol equivalents ) were given 5 d/wk for 4 mo . Multi-micronutrient fortification significantly improved the concentrations of hemoglobin ( + 1.87 g/L ; 95 % CI : 0.78 , 2.96 ) , plasma ferritin ( + 7.5 microg/L ; 95 % CI : 2.8 , 12.6 ) , body iron ( + 0.56 mg/kg body weight ; 95 % CI : 0.29 , 0.84 ) , plasma zinc ( + 0.61 micromol/L ; 95 % CI : 0.26 , 0.95 ) , plasma retinol ( + 0.041 micromol/L ; 95 % CI : 0.001 , 0.08 ) , and urinary iodine ( + 22.49 micromol/L ; 95 % CI : 7.68 , 37.31 ) . Fortification reduced the risk of anemia and deficiencies of zinc and iodine by > 40 % . Parasitic infestation did not affect fortification efficacy , whereas fortification significantly enhanced deworming efficacy , with the lowest reinfection rates in children receiving both micronutrients and Alb . Multi-micronutrient fortification of biscuits is an effective strategy to improve the micronutrient status of Vietnamese schoolchildren and enhances effectiveness of deworming
The effects of micronutrient interventions on other domains were inconsistent .
Improvement in fluid intelligence among micronutrient-deficient children was consistently reported .
BACKGROUND & AIMS Micronutrients are essential for brain development with deficiencies in specific nutrients linked to impaired cognitive function .
Interventions are shown to be beneficial to children 's mental development , particularly in subjects who were micronutrient-deficient at baseline but results on healthy subjects remain inconsistent .
This systematic review evaluated the effect of micronutrient inventions on different cognitive domains .