Micronutrient and Inflammation Status Following One Year of Complementary Food Supplementation in 18-Month-Old Rural Bangladeshi Children: A Randomized Controlled Trial

Background:Four fortified complementary food supplements (CFSs) in a randomized controlled trial (RCT) were found to improve childhood linear growth in rural Bangladesh. We hypothesized children receiving these supplements would have improved micronutrient status.Methods:In the RCT, we assessed hemoglobin and serum ferritin, retinol, zinc, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) at endline (18 mo) in a subsample of children (n= 752). The impact of supplementation on mean concentrations and the prevalence of nutrient deficiency and inflammation were evaluated using adjusted generalized estimating equation (GEE) linear and log-binomial regression models.Results:In the control arm at age 18 months, 13% of children were anemic (hemoglobin < 110 g/L), and 6% were iron (inflammation-adjusted ferritin < 12 mu g/L), 8% vitamin A (inflammation-adjusted retinol < 0.70 mu mol/L), and 5% zinc (zinc < 9.9 mu mol/L) deficient. The prevalence of inflammation by CRP (>5 mg/L) and AGP (>1 g/L) was 23% and 66%, respectively, in the control group. AGP trended lower in CFS groups (p= 0.04), while CRP did not. Mean ferritin (p< 0.001) and retinol (p= 0.007) were higher in all supplemented groups relative to control, whereas hemoglobin improved with two of the four CFSs (p= 0.001), and zinc was equal or lower in supplemented groups relative to control (p= 0.017).Conclusions:CFSs improved iron status and vitamin A concentrations and lowered inflammation in a context of low underlying nutrient deficiency but high inflammation.