Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial.
Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial.
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DOI：
10.3390/nu8010029
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发表时间：
2016-01-07
期刊：
影响因子：
5.9
通讯作者：
Wieringa FT
中科院分区：
文献类型：
--
作者：
Perignon M;Fiorentino M;Kuong K;Dijkhuizen MA;Burja K;Parker M;Chamnan C;Berger J;Wieringa FT
在柬埔寨，微量营养素缺乏仍然是一个严重的公共卫生问题。我们的目标是评估通过世界粮食计划署学校膳食计划 (WFP-SMP) 分发的多微量营养素强化大米 (MMFR) 配方对柬埔寨学童的血红蛋白浓度以及铁和维生素 A (VA) 状况的影响。 FORISCA-UltraRice+NutriRice 研究是一项双盲、整群随机、安慰剂对照试验。参与粮食计划署 SMP 的 16 所学校被随机分配接受挤压强化大米（UltraRice Original、UltraRice New (URN) 或 NutriRice）或未强化大米（安慰剂），每周 6 天，持续六个月。随机选择另外四所未参加粮食计划署 SMP 的学校作为对照。共有 2440 名学童（6-16 岁）参与了生化研究。在基线以及三个月和六个月时测量血红蛋白、铁状态（使用炎症调整的铁蛋白和转铁蛋白受体浓度评估）和VA状态（使用炎症调整的视黄醇结合蛋白浓度评估）。贫血、铁储备耗尽、组织缺铁、边缘 VA 状态和 VA 缺乏的基线患病率分别为 15.6%、1.4%、51.0%、7.9% 和 0.7%。贫血的最强危险因素是血红蛋白病、VA 缺乏和铁储备耗尽（所有 p < 0.01）。六个月后，与安慰剂组相比，接受 NutriRice 和 URN 治疗的儿童出现低 VA 状态的风险分别降低了 4 倍和 5 倍。与安慰剂组相比，URN 组三个月后血红蛋白显着增加 (+0.8 g/L)；然而，除了没有炎症的儿童外，六个月后这种差异不再显着。含有VA的MMFR有效改善了学童的VA状况。对血红蛋白和铁状态的影响有限，部分原因是亚临床炎症。应进一步研究 MMFR 与解决贫血和炎症的非营养方法相结合。
In Cambodia, micronutrient deficiencies remain a critical public health problem. Our objective was to evaluate the impact of multi-micronutrient fortified rice (MMFR) formulations, distributed through a World Food Program school-meals program (WFP-SMP), on the hemoglobin concentrations and iron and vitamin A (VA) status of Cambodian schoolchildren. The FORISCA-UltraRice+NutriRice study was a double-blind, cluster-randomized, placebo-controlled trial. Sixteen schools participating in WFP-SMP were randomly assigned to receive extrusion-fortified rice (UltraRice Original, UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. Four additional schools not participating in WFP-SMP were randomly selected as controls. A total of 2440 schoolchildren (6–16 years old) participated in the biochemical study. Hemoglobin, iron status, estimated using inflammation-adjusted ferritin and transferrin receptors concentrations, and VA status, assessed using inflammation-adjusted retinol-binding protein concentration, were measured at the baseline, as well as at three and six months. Baseline prevalence of anemia, depleted iron stores, tissue iron deficiency, marginal VA status and VA deficiency were 15.6%, 1.4%, 51.0%, 7.9%, and 0.7%, respectively. The strongest risk factors for anemia were hemoglobinopathy, VA deficiency, and depleted iron stores (all p < 0.01). After six months, children receiving NutriRice and URN had 4 and 5 times less risk of low VA status, respectively, in comparison to the placebo group. Hemoglobin significantly increased (+0.8 g/L) after three months for the URN group in comparison to the placebo group; however, this difference was no longer significant after six months, except for children without inflammation. MMFR containing VA effectively improved the VA status of schoolchildren. The impact on hemoglobin and iron status was limited, partly by sub-clinical inflammation. MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated.