Multi-micronutrient Fortified Rice Improved Vitamin A Status of Cambodian School Children

Abstract

Objectives: In rice-consuming countries, multi-micronutrient fortified rice (MMFR) is a promising cost-effective strategy to control micronutrient deficiencies. The FORISCA project evaluated the impact of MMFR distributed through the WFP school meal program (SMP) on micronutrient status, health, and cognition of Cambodian schoolchildren. Here, effects on anemia, iron and vitamin A (VA) status are presented. Methods: The FORISCA-UltraRice+NutriRice study was a cluster-randomized, double-blinded, placebo-controlled trial in 9500 schoolchildren. Sixteen schools participating in WFP-SMP were randomly assigned to receive either MMFR including VA (MMFR+VA), MMFR without VA (MMFR-VA), or unfortified rice (placebo) as breakfast distributed 6 days/week for 6 months. Four additional schools not participating in WFP-SMP were randomly selected as control. Twenty-five percent of schoolchildren from grade 1-6 participated in the biochemical study. Hemoglobin (Hb), iron and VA status were measured at baseline, 3 and 6 months. Results: Baseline prevalence of iron deficiency (ID), anemia and (marginal) vitamin A deficiency (VAD) were 51.6%, 15.7% and 8.6% respectively. Hemoglobinopathy (OR 2.5) , VAD (OR 2.1) and total body iron (TBI) were the strongest predictors of anemia (all p<0.01). The intervention had no overall impact on Hb or anemia prevalence. MMFR+VA significantly reduced VAD from 13.5% to 7.1% (p<0.05), whereas VAD increased in the other groups over the intervention (6.1% to 12.7%). Conclusions: Micronutrient deficiencies were prevalent with especially hemoglobinopathy and VAD and to a lesser extent iron status being risk factors for anemia. Fortified rice containing VA significantly improved VA status of schoolchildren. Funded by USDA/FAS, WFP-DSM consortium and IRD.