Bill & Melinda Gates Foundation

Getting Good Nutrition Safely to Young Children: Do We Have What It Takes?

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April 25, 2013

Millions of children, living in poverty, in the developing world don’t get enough nutritious food to eat. In fact, more than one-third of the almost 7 million children who die every year, do so from nutrition-related causes. When they survive, they are at risk for stunted growth which affects their ability to thrive and grow into a healthy, productive adult.  What do we do? Lack of zinc in children’s diet is an important factor in undernourishment and the community is working hard to identify new ways to address this issue.

A recent study looked at the effects of providing zinc to children from 6 to 18 months old via micronutrient powders. Zinc has been shown to be effective at reducing illness and improving growth of children, particularly in low-income countries, but until now there has been no consensus as to how to get additional zinc to those children.

This study looked at a potential delivery mechanism by adding zinc to micronutrient powder supplements, an intervention approved by the World Health Organization for children at-risk of micronutrient deficiencies. This study included three groups of children: one receiving micronutrient powder supplements with zinc, another receiving micronutrient powder supplements without zinc, and a control group without any supplement.

 As we continue to support implementation of micronutrient programs, we need to learn more about their safety through systematic monitoring as well as their health benefits.

The results for the groups getting the micronutrient powder supplement were as to be expected—lower prevalence of stunting at 18 months of age, slightly more weight gain, and 80% lower odds of iron deficiency anemia, all good indications of better health.

The unexpected outcome of this trial is that there was a greater cumulative number of days with diarrhea and an increased incidence of bloody diarrhea from 6 to 18 months of age in the two groups that received the supplement, regardless of whether or not it had zinc.

To provide some perspective, the increased risk of diarrhea amounted to about one additional episode of bloody diarrhea per year for every 12 to 13 children treated. These groups also had an increased incidence of chest in-drawing as reported by the mothers, a sign associated with acute lower respiratory tract infections. 

Several studies have shown positive effects of micronutrient powders on reducing anemia and iron deficiency anemia among children under two. These have provided little information, however, on safety and only involved short periods of supplementation of two to three months.

Some previous studies, however, have indicated that iron supplementation may increase the risk of diarrhea slightly, by 11 percent.  Micronutrient powders include iron, which is encapsulated to prevent discoloration and other chemical changes.  Delivery of iron through powders and foods has been considered to be safe.

The researchers acknowledge that the health benefits reported from micronutrient powder studies must be weighed against the risks. In addition, alternative strategies for achieving these health benefits such as use of fortified foods, fortified lipid spreads, and strategies to improve maternal micronutrient deficiencies and improve iron stores at birth should be considered in areas where diarrhea and other infections are common.

While the results of this research were not expected, we would be wise to pay attention to them. As we continue to support implementation of micronutrient programs, we need to learn more about their safety through systematic monitoring as well as their health benefits.

And we’ll keep looking for success, possibly in several forms, for micronutrients to ensure all children get the nutrients they need to grow up healthy and strong.

 
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