Efficacy of a vitamin A–fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren

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Abstract
Background: Wheat flour is a possible food vehicle for vitamin A fortification. Objective: This study assessed the efficacy of consumption of a vitamin A–fortified wheat-flour bun (pandesal) on the vitamin A status of school-age children. Design: This was a double-masked clinical trial conducted in 396 and 439 children aged 6–13 y attending 4 rural schools in the Philippines. The children were randomly assigned to a vitamin A–fortified (experimental) or nonfortified (control) group. A 60-g vitamin A–fortified pandesal (containing ≈133 μg retinol equivalents) or a nonfortified pandesal was consumed by the children 5 d/wk for 30 wk. Vitamin A status, hemoglobin concentration, anthropometric status, morbidity, and dietary intake were assessed at baseline and 30 wk later. A modified relative dose response (MRDR) was assessed in a subsample of 20% of the children (≈75/group) with the lowest initial serum retinol concentration at the 30-wk follow-up. Results: Baseline serum retinol significantly modified the effect of the intervention. The fortified group, whose initial serum retinol concentrations were below the median, had a 0.07 ± 0.03-μmol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group (P = 0.02). Improved vitamin A status was also evident in the MRDR subsample. End-of-study differences in the MRDR showed that vitamin A– fortified pandesal intake decreased the percentage of children with inadequate liver vitamin A stores by 50% (15.3% compared with 28.6%; P = 0.05). Conclusions: Daily consumption of vitamin A–fortified pandesal significantly improved the vitamin A status of Filipino school-age children with marginal-to-low initial serum retinol concentrations.