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International Research on Infant Supplementation: Randomized Controlled Trials of Micronutrient Supplementation During Infancy

Efficacy of a Foodlet-Based Multiple Micronutrient Supplement for Preventing Growth Faltering, Anemia, and Micronutrient Deficiency of Infants: The Four Country IRIS Trial Pooled Data Analysis^1,2

Cornelius M. Smuts³, Carl J. Lombard, A. J. Spinnler Benadé, Muhammad A. Dhansay, Jacques Berger^*, Le Thi Hop, Guillermo López de Romaña^**, Juliawati Untoro, Elvina Karyadi, Jürgen Erhardt and Rainer Gross : International Research on Infant Supplementation (IRIS) Study Group

Medical Research Council, Parow, South Africa; ^* Institute of Research for Development, Hanoi, Vietnam; National Institute of Nutrition in Hanoi, Vietnam; ^** Instituto de Investigación Nutricional, Universidad Agraria La Molina, Lima, Peru; SEAMED-TROPMED Regional Center for Community Nutrition at the University of Indonesia, Jakarta, Indonesia; Institute of Biological Chemistry and Nutrition at the University of Hohenheim, Stuttgart, Germany; and UNICEF, New York City, New York

³To whom correspondence should be addressed. E-mail: marius.smuts{at}mrc.ac.za.

Diets of infants across the world are commonly deficient in multiple micronutrients during the period of growth faltering and dietary transition from milk to solid foods. A randomized placebo controlled trial was carried out in Indonesia, Peru, South Africa, and Vietnam, using a common protocol to investigate whether improving status for multiple micronutrients prevented growth faltering and anemia during infancy. The results of the pooled data analysis of the 4 countries for growth, anemia, and micronutrient status are reported. A total of 1134 infants were randomized to 4 treatment groups, with 283 receiving a daily placebo (P), 283 receiving a weekly multiple micronutrient supplement (WMM), 280 received a daily multiple micronutrient (DMM) supplement, and 288 received daily iron (DI) supplements. The DMM group had a significantly greater weight gain, growing at an average rate of 207 g/mo compared with 192 g/mo for the WMM group, and 186 g/mo for the DI and P groups. There were no differences in height gain. DMM was also the most effective treatment for controlling anemia and iron deficiency, besides improving zinc, retinol, tocopherol, and riboflavin status. DI supplementation alone increased zinc deficiency. The prevalence of multiple micronutrient deficiencies at baseline was high, with anemia affecting the majority, and was not fully controlled even after 6 mo of supplementation. These positive results indicate the need for larger effectiveness trials to examine how to deliver supplements at the program scale and to estimate cost benefits. Consideration should also be given to increasing the dosages of micronutrients being delivered in the foodlets.

KEY WORDS: • iron • zinc • multiple micronutrient supplements • anemia • infant’s growth

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