Impact Of Milk Based Micronutrient Supplementation On Zinc, Iron, and Vitamin A Deficiencies In School Children In Quito ‐ Ecuador
Authors: Guevara Daniela , Reyes Samira , Anarumba Daysi , López Mariuxi , Cevallos Sonia , Montenegro Eva , Flores Nancy , Fornasini Marco , Baldeon Manuel E. 
Published: November 2023

Currently, the most common micronutrient deficiencies in Ecuador are: Zn, vitamin A, and Fe deficits in all age groups. These deficiencies have been associated with short stature, immune‐defects, sight deficiency, anemia, and diminished cognitive performance. Several micronutrient supplementation programs have been implemented with limited impact. These programs have had poor acceptability by the consumer due to poor palatability of the supplements, the forms of supplementation such as pills, snacks, and additives for meals that could interfere with the absorption of micronutrients. An ideal vehicle of micronutrient supplementation would be a common food that would provide a good source of micro‐ and macronutrients. The appropriate combination of micro‐ and macronutrients would provide a complete nutritional meal that could be better metabolized. The objective of the present study was to test the usefulness of cow milk as a vehicle for Zn, vitamin A, and Fe supplementation. Three hundred twenty eight children aged 6 – 10 were included in a double blind controlled study, 173 children received daily 480 mL of whole milk (300 Kcals; Zn = 1.96 mg, Fe = 0.14 mg, vit A = 136 ug; G1) and 155 children fortified milk (Zn = 7.16 mg, Fe = 4.56 mg, vit A = 360 ug; G2) for 23 weeks. All children received daily 2 glasses of milk one in the morning and one in the afternoon. Participants had a complete nutritional evaluation before and after milk supplementation that included a clinical evaluation, anthropometry, and laboratory analysis. The IRB of Universidad de las Américas approved the study. Both groups G1 and G2 were comparable for age, weight and height at the beginning of the study; in addition, a similar number of boys and girls were distributed in the 2 groups. Both types of milk were well accepted by the participating children. Data showed that serum concentrations of Zn, vitamin A, and Fe significantly increased within both treatment groups, Table 1. The increase in serum concentrations of the indicated micronutrients in deficient children was significantly greater than in non‐deficient ones, Table 2. The number of children with Zinc deficiency decreased from 24 to 0; vitamin A from 32 to 5; and increased for Fe deficiency from 121 to 155 in G1. In G2 the number of children with Zinc deficiency decreased from 20 to 2; vitamin A from 19 to 3; and Fe from 137 to 106. There were not significant differences in serum concentrations of Zn, vitamin A, and Fe between groups after 23 weeks of supplementation. These data indicated that fortified and non‐fortified milk are excellent options to increase serum Zn, vitamin A, and Fe concentration in school children. Whole milk supplementation provides an excellent strategy for the reduction the most common micronutrient deficiencies in Ecuador. Further studies need to establish the ideal concentration of micronutrients in milk fortification.

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Universidad de las AméricasNestlé ‐ Ecuador

Changes in serum concentrations of Zn, vitamin A, and Fe in school children supplemented with milk or fortified‐milk for 23 weeks.

Milk (G1)
Fortified Milk (G2)

Serum concentrations
Basal
Final
Δ (post‐basal)
P value
Basal
Final
Δ (post‐basal)
P value

Zn (μg/dl)
82,30 (± 17,24)
90,38 (± 17,02)
8,08
0,000
80,12(±15,18)
88,31 (±13,84)
8,19
0,000

Vitamin A (μg/ml)
0,2919 (±0,078)
0,2801 (±0,067)
−0,012
0,059
0,2712(±0,06)
0,2753(±0,062)
0,004
0,583

Fe (μg/dl)
88,63 (±37,25)
98,23(±33,67)
9,6
0,002
91,613(±36,22)
94,59(±28,58)
3
0,352

Changes in serum concentrations of Zn, vitamin A, and Fe in school children with micronutrient deficiencies supplemented with milk or fortified‐milk for 23 weeks.

Milk (G1)
Fortified Milk (G2)

Serum concentrations
Basal
Final
Δ (post‐basal)
P value
Basal
Final
Δ (post‐basal)
P value

Zn (μg/dl)
53,30(±7,9)
89,1(±21,5)
35,8
0,000
59,1(±5,1)
87,2(±12,5)
28
0,000

Vitamin A (μg/ml)
0,163 (±0,02)
0,249(±0,04)
0,086
0,000
0,161 (±0,022)
0,25(±0,08)
0,089
0,000

Fe (μg/dl)
74,2 (±25,6)
94,48(±34,4)
28,3
0,000
77,5(±25,4)
91,8(±28,5)
14,3
0,000