Iron Absorption from Intrinsically Labeled Microencapsulated Ferrous Fumarate (Sprinkles) in Anemic and Non-anemic Infants

S. Zlotkin, C. Schauer, S. Newton, S. Owusu-Agyei, M. Tondeur: Departments of Paediatrics, Nutritional Sciences, and Centre for International Health, University of Toronto; The Hospital for Sick Children, Research Institute, Canada, Kintampo Health Research Centre, Ghana.

Microencapsulated ferrous fumarate (Sprinkles) is a new supplement for ‘home-fortification’. The contents of a sachet can be added to any complementary food without changing the colour or taste. We believe this intervention may decrease the burden of iron deficiency anemia (IDA) in the developing world. However, the most appropriate dose of iron (Fe) to include is not known since its bioavailability has not been studied. Aim: To determine the absorption of 2 doses of Sprinkles when added to a complementary food provided to anemic and non-anemic infants. Methods: In a prospective triple-masked, randomized trial, 39 anemic (hemoglobin (Hb) <100 g/L) …

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Pakistan (Waseem Sharrief-Completed)

It has been estimated that diarrheal illnesses account for 12,600 deaths each day in children in Asia, Africa, and
Latin America while pre-school children spend 35 to 70 days per year with diarrhea. Although, oral rehydration therapy has
reduced diarrhea-related mortality by 50%, its affect has plateaud. To further decrease this burden malnutrition and immunity
needs to be targeted. Sprinkles Supplefer Plus is unique in that micronutrients such as iron, zinc, Vitamin A and C, together
with a probiotic can be formulated into the sachet to prevent common micronutrient deficiencies as well as diarrhea.

We investigated the effect of zinc and a heat-killed strain of probiotic L. acidophilus provided as micronutrient Sprinkles on
diarrhea morbidity in infants. This community-based, double-blind, placebo-controlled trial took place in an urban slum of Karachi,
Pakistan. 75 infants at high-risk for diarrhea-related-mortality identified as: (a) age between 6 to12 months; and (b) …

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Vitamin A:

Function

The main role of vitamin A is in vision. However, it also plays a role in growth, reproduction and in the immune system.

Physiology

Vitamin A may exist in its pre-formed state; carotene or as retinol in the diet. Carotene is converted to vitamin A
in the intestine, liver and kidney. Vitamin A and its precursors are absorbed with fat in the intestine. It is then stored in the liver and transported around the body attached to retinol binding protein, a transporter.

Food Sources

Vitamin A is found mainly in foods of animal origin including milk products, margarines, butter, egg yolk, liver
and fish liver oils. Carotenes are found in dark green leafy vegetables, deep yellow vegetables, tomatoes and yellow fruit.

Deficiency

First signs of vitamin A deficiency include night blindness leading to bitot’s spots and later xerophthalmia. One important additional effect of Vitamin A deficiency is …

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SUMMARY

Dr. Ziauddin
Hyder used to coordinate the ‘Public Health Nutrition Research Unit’ at BRAC
for over 10 years. BRAC, one of the largest indigenous NGOs in the world, works
on poverty alleviation, empowerment of women, education, environment, nutrition
and public health issues (www.brac.net). He also worked with the Food and
Agriculture Organization of the United Nations to implement the Food Insecurity
and Vulnerability Information and Mapping Systems (FIVIMS) in the South and
South-East Asian Region (www.fivims.net).   By training he is a Medical Doctor with
Masters in Food and Nutrition Planning and PhD in Epidemiology and Public
Health.  His main areas of work started
in research and program development in areas related to food security and applied
nutrition and then gradually moved into issues of micronutrient deficiencies in
women and children.  He is now working at
the Hospital for Sick Children in Toronto to scale up the micronutrient Sprinkles intervention…

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MATHEMATICAL MODELLING TO PREDICT POPULATION-BASED RESPONSE TO MICRONURTIENT INTERVENTIONS

W.Sharieff, S.Zlotkin, C.Schauer, M.Tondeur: Department of Health Policy, Management and Evaluation, University of Toronto; Departments of Paediatrics and Nutritional Sciences, University of Toronto; The Centre for International Health, University of Toronto; The Hospital for Sick Children, Research Institute, Canada;

One of the major criticisms of evidence-based medicine is that evidence obtained from one setting is inappropriately applied to other settings. To show that a given intervention would work in variable populations, clinical trials are repeated in several different settings. However, time and resources would be saved if the impact of a given intervention could be modeled to predict outcomes in variable settings. Methods We simulated a one year 4-cell clinical trial beginning with infants 6-24 months of age and longitudinally following them for one year. A fictitious infant population (N= 1,000,000) was created using Hemoglobin estimates taken from actual recent …

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Abstracts:

1) Presented at the 17th International Congress of Nutrition, August 27-31, 2001, Vienna, Austria:

RANDOMIZED CONTROLLED TRIAL OF MICROENCAPSULATED FERROUS FUMARATE ‘SPRINKLES’ AND FERROUS SULFATE DROPS, FOR TREATMENT AND PREVENTION OF ANEMIA IN GHANAIAN INFANTS S Zlotkin, P Arthur, K Y Antwi, G Yeung. Depts of Paediatr and Nutr Sci, University of Toronto, Div of Gastroent & Nutr, Hospital for Sick Children, Toronto, Canada and Kintampo Health Res. Centre, Ghana.> >Background. The standard treatment of anemia in infants is ferrous sulfate (DROPS)
given 3-times daily. Adherence to long-term use of DROPS is often poor. Thus we developed a novel delivery system with microencapsulated ferrous fumarate and
ascorbic acid (SPRINKLES) that can be sprinkled onto complimentary foods. Aim. To compare the use of SPRINKLES (± vitamin A) vs DROPS in the treatment and prevention of anemia in infants. Methods. A randomized controlled trial in 2 consecutive phases: (i) Treatment Phase: …

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Daily vs. Weekly Study

Among the first Sprinkles activities conducted at BRAC as part of Sprinkles program development was a
study that compared the efficacy of daily versus weekly use of Sprinkles among children 12-24 months of age in Kalinganj.
The intervention lasted 8 weeks and took place from September to December 2003 with the goal of identifying a suitable
dose-frequency of Sprinkles for infants in Bangladesh and assessing the compliance and acceptability of intervention through
focus group discussions (FGDs). In a subgroup of children (n=150) with initial hemoglobin <100 g/L, hemoglobin increased by 21 g/L
and 16 g/L (p=0.199) and anemia (defined as Hb <100 g/L) decreased by 85% and 62% (p=0.034) in the daily and weekly groups,
respectively (unpublished). Although the daily administration of Sprinkles (12mg Fe) seemed to have a better impact on anemia,
significant improvement of hemoglobin concentrations and reduction in anemia was also observed in …

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Mongolia

Evaluation of the Distribution of Micronutrient Sprinkles in over 10,000 Mongolian Infants Using a Non-Governmental Organization (NGO) Model.

Economic instability and severe winters have resulted in food shortages across Mongolia. As a result, micronutrient deficiencies are common among children. In a cross sectional survey conducted by World Vision, the prevalence of anemia (Hb<115 g/L) and vitamin D deficiency rickets (causing irreversible bone malformation) was found to be 42% and 33%, respectively, among Mongolian infants 6-36 months of age.

Sprinkles are unique in that other micronutrients in addition to iron, such as vitamin A, vitamin D, folic acid and zinc, can be included in the formulation for large-scale distribution to children at risk of multiple micronutrient deficiencies.

In the summer of 2001, Sprinkles were implemented for the first time into program by World Vision Mongolia. The objective of the program is to significantly reduce the prevalence of anemia and rickets …

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Foege W. Keynote address: Issues in overcoming iron deficiency. The journal of nutrition 2002; 132:790S-93S.

Gibson R. Principles of Nutritional Assessment. 1990: Oxford University Press; New York, U.S.A.

Heinz Handbook of Nutrition. (Editor: D. Yeung). 1995: Heinz Corporate Research Center; H.J. Heinz Company, U.S.A.

Nestel P. & Alnwick D. Iron/Multi-Micronutrient supplements for young children. (monograph). Summary and conclusions of a consultation held at UNICEF, Copenhagen, Denmark, August 19-20 1996. UNICEF.…

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