Effect of iron-, iodine-, and β-carotene–fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial

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Abstract
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 β-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 (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 morbidity and cognitive function. Conclusions: Fortified biscuits resulted 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 anthropometric status.