Fortification of school meals

Abstract

Multiple micronutrient deficiencies exist in the poor in developing countries with the women and children being the most vulnerable. In children, one way to address this problem is through fortification of school meals. Two school meal fortification studies are discussed here, one using ferrous glycine phosphate and ribo fl avin as the fortificants and another study using a multiple micronutrient food fortificant. • Fortification of school meals using ferrous glycine phosphate and ribofl avin as fortificants: The study had a pre- and posttest design, with experimental and control groups. The experimental school had 65 children and the control school had 71 children, all of whom consumed a noon meal at the school daily. • The children in the experimental school received a powder containing ferrous glycine phosphate and ribo fl avin, which was added to the meal during cooking every day for 6 months. The dosage was 28 mg of elemental iron and 1 mg of ribo fl avin per child per day. The children attended school for 5 days each week from Monday to Friday, except for holidays; they received the fortificants on 100 days during the 6-month period. There was no intervention in the control school. Hemoglobin was measured by the cynamethemoglobin method at baseline and endline. • Binary logistic regression showed a significant (p < 0.001) time × group interaction for anemia. The prevalence of anemia in the experimental school was 69.0 % at baseline and 32.8 % after 100 days of intervention over 6 months, a statistically significant change (p < 0.001). The prevalence of anemia in the control school was 91.5 % at baseline and increased to 97.2 % at endline; the increase was not statistically significant. The prevalence of angular stomatitis was reduced from 21 % at baseline to 0 % at endline in the experimental school, whereas it was 23 % at baseline and 20 % at endline in the control school. • Fortification of school meals using a multiple micronutrient food fortificant: A pre- and posttest design was used to study children 5-15 years of age with an experimental and a control group. The experimental group (n = 211) consisted of children from two residential schools and the control group (n = 202) consisted of children from three residential schools. The experimental group received a multiple micronutrient fortificant containing vitamin A, vitamin B2, vitamin B6, vitamin B 12, folic acid, niacin, calcium pantothenate, vitamin C, vitamin E, iron, lysine, and calcium which was added to all the meals cooked for them daily for 9 months. There was no nutritional intervention in the control group. Biochemical • measurements (hemoglobin, serum vitamin A, serum vitamin E, serum vitamin B12, and serum folic acid) were measured at baseline, after 4 months, and at the endpoint (after 9 months). The heights and weights of the children were also measured at baseline and endpoint. Serum vitamins A and E were measured in a subsample of 50 % and vitamin B12 and serum folic acid measured in a subsample of 25 % of the children. The mean gain in all biochemical measurements was significantly higher (p < 0.05) in the experimental group than in the control group at the end of the study.