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Home-Fortification with Iron and Zinc Sprinkles or Iron Sprinkles Alone Successfully Treats Anemia in Infants and Young Children

Stanley Zlotkin^*,,**,,2, Paul Arthur, Claudia Schauer^*,**,, Kojo Yeboah Antwi, George Yeung^*,**, and Ana Piekarz^*,**,

Departments of ^* Paediatrics and Nutritional Sciences, University of Toronto, Toronto, Canada; ^** Division of Gastroenterology and Nutrition, The Hospital for Sick Children, Toronto, Canada; Programs in Metabolism and Integrative Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada; Kintampo Health Research Centre, Health Research Unit, Ministry of Health, Ghana

²To whom correspondence should be addressed. E-mail: Stanley.zlotkin{at}sickkids.ca.

Although iron deficiency is the most common single-nutrient deficiency in infants and children, other deficiencies may develop concurrently, including zinc deficiency. In previous studies, we used home-fortification with "Sprinkles," single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods, to successfully treat anemia. This mode of micronutrient delivery is amenable to the delivery of other micronutrients. However, the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions. Thus, we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants, compared with Sprinkles formulated with iron alone. We studied 304 anemic infants (mean age 10.3 ± 2.5 mo; hemoglobin 87.4 ± 8.4 g/L) in rural Ghana. A combined supplementation group (FeZn) received daily Sprinkles containing 80 mg iron and 10 mg zinc; a comparison group (Fe) received Sprinkles (80 mg iron) without zinc for 2 mo. The rate of recovery from anemia was higher in the Fe group compared with the FeZn group (74.8 vs. 62.9%; P = 0.048). The plasma zinc concentration decreased significantly in both groups (P < 0.05). A significant decline in the height for age Z-score was observed in the FeZn group (P = 0.0011), but there was no change in the Fe group. These results suggest that in a controlled setting, home-fortification using micronutrient Sprinkles with iron, or iron and zinc, was very successful in treating anemia; however, this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population.

KEY WORDS: • iron deficiency • anemia • zinc • infants and young children • sprinkles

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