Food fortification with multiple micronutrients: impact on health outcomes in general population

摘要: Background Vitamins and minerals are essential for growth maintenance of a healthy body, have role in the functioning almost every organ. Multiple interventions been designed to improve micronutrient deficiency, food fortification is one them. Objectives To assess impact with multiple micronutrients on health outcomes general population, including men, women children. Search methods We searched electronic databases up 29 August 2018, Cochrane Central Register Controlled Trial (CENTRAL), Effective Practice Organisation Care (EPOC) Group Specialised Public Health Register; MEDLINE; Embase, 20 other databases, clinical trial registries. There were no date or language restrictions. checked reference lists included studies relevant systematic reviews additional papers be considered inclusion. Selection criteria randomised controlled trials (RCTs), cluster-RCTs, quasi-randomised trials, before-after (CBA) interrupted time series (ITS) that assessed (MMNs). Primary anaemia, deficiencies, anthropometric measures, morbidity, all-cause mortality cause-specific mortality. Secondary potential adverse outcomes, serum concentration specific micronutrients, haemoglobin levels neurodevelopmental cognitive outcomes. from both high-income low- middle-income countries (LMICs). Data collection analysis Two review authors independently screened, extracted quality-appraised data eligible studies. carried out statistical using Review Manager 5 software. used random-effects meta-analysis combining data, as characteristics study participants differed significantly. set main findings 'Summary findings' tables, GRADE approach. Main results identified 127 through title/abstract screening, 43 (48 papers) 19,585 (17,878 children) review. All except three compared MMN placebo/no intervention. versus iodised salt calcium alone. Thirty-six targeted children; conducted LMICs. Food vehicles staple foods, such rice flour; dairy products, milk yogurt; non-dairy beverages; biscuits; spreads; salt. Fourteen fully commercially funded, 13 had partial-commercial funding, 14 non-commercial funding two did not specify source funding. rated all evidence low very quality due limitations, imprecision, high heterogeneity small sample size. When intervention, may reduce anaemia by 32% (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.56 0.84; 11 studies, 3746 participants; low-quality evidence), iron deficiency 72% (RR 0.28, CI 0.19 0.39; 6 2189 56% 0.44, 0.32 0.60; 3289 evidence); vitamin A 58% 0.42, 0.28 0.62; 1482 B2 64% 0.36, 0.68; 1 study, 296 B6 91% 0.09, 0.02 0.38; 2 301 B12 0.25 0.71; 3 728 weight-for-age z-scores (WAZ) (mean difference (MD) 0.1, 0.17; 8 2889 evidence) weight-for-height/length z-score (WHZ/WLZ) (MD 0.18; 1758 evidence). uncertain about effect zinc 0.84, 0.65 1.08; 1490 height/length-for-age (HAZ/LAZ) 0.01 Most this comparison Subgroup analyses sources (commercial non-commercial) duration intervention demonstrate any effects, although was relatively number possible association between commercial increased estimates has demonstrated wider literature. could conduct subgroup vehicle funding; since there too few each draw meaningful conclusions. we MMNs salt, (R 0.86, 0.37 2.01; 88 0.40, 0.09 1.83; 245 0.98, 0.82 1.17; 0.19, 0.07 0.55; 363 Both Only children fortification. None primary reported study. events, Authors' conclusions The suggests when deficiencies (iron, A, B6). measures (HAZ/LAZ, WAZ WHZ/WLZ). suggest effects fortification, reliable various limited subgroup. remain cautious level field, possibility associated higher estimates, These subject sizes, most quality. hence concrete drawn