{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:12:26Z","timestamp":1790863946910,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T00:00:00Z","timestamp":1624406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["408786\/2017-5"],"award-info":[{"award-number":["408786\/2017-5"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005285","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de Goi\u00e1s","doi-asserted-by":"publisher","award":["201710267001247"],"award-info":[{"award-number":["201710267001247"]}],"id":[{"id":"10.13039\/501100005285","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.<\/jats:p>","DOI":"10.3390\/nu13072160","type":"journal-article","created":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T11:28:41Z","timestamp":1624447721000},"page":"2160","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial"],"prefix":"10.3390","volume":"13","author":[{"given":"Malaine Morais Alves","family":"Machado","sequence":"first","affiliation":[{"name":"Graduate Program in Health Sciences of the Federal University of Goi\u00e1s, Faculty of Medicine, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirella de Paiva","family":"Lopes","sequence":"additional","affiliation":[{"name":"Faculty of Nutrition, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel Machado","family":"Schincaglia","sequence":"additional","affiliation":[{"name":"Research Laboratory in Clinical and Sports Nutrition, Faculty of Nutrition, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9370-9139","authenticated-orcid":false,"given":"Paulo S\u00e9rgio Sucasas","family":"da Costa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre Siqueira Guedes","family":"Coelho","sequence":"additional","affiliation":[{"name":"Graduate Program in Nutrition and Health of the Federal University of Goi\u00e1s, Faculty of Nutrition Goi\u00e2nia, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0631-8629","authenticated-orcid":false,"given":"Maria Claret Costa Monteiro","family":"Hadler","sequence":"additional","affiliation":[{"name":"Graduate Program in Health Sciences of the Federal University of Goi\u00e1s, Faculty of Medicine, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"},{"name":"Faculty of Nutrition, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"},{"name":"Graduate Program in Nutrition and Health of the Federal University of Goi\u00e1s, Faculty of Nutrition Goi\u00e2nia, Federal University of Goi\u00e1s, Goi\u00e2nia 74605-050, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1016\/S2214-109X(13)70001-9","article-title":"Behalf of Nutrition Impact Model Study Group Anaemia. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995\u20132011: A systematic analysis of population-representative data","volume":"1","author":"Stevens","year":"2013","journal-title":"Lancet Glob. Health"},{"key":"ref_2","first-page":"1","article-title":"Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age","volume":"11","author":"Jefferds","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_3","unstructured":"World Health Organizaton (2021, February 04). World Health Data Platform. Prevalence of Anaemia in Children under 5 Years (%) [internet]. Geneva., Available online: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/prevalence-of-anaemia-in-children-under-5-years-(-)."},{"key":"ref_4","unstructured":"Minist\u00e9rio da Sa\u00fade (Brasil) (2015). NutriSUS. Guia de evid\u00eancias: Estrat\u00e9gia de Fortifica\u00e7\u00e3o da Alimenta\u00e7\u00e3o Infantil com Micronutrientes (Vitaminas e Minerais) em p\u00f3, Minist\u00e9rio da Sa\u00fade, Minist\u00e9rio da Educa\u00e7\u00e3o."},{"key":"ref_5","unstructured":"World Health Organization (2014). Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition, WHO."},{"key":"ref_6","first-page":"1","article-title":"Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age","volume":"9","author":"Suchdev","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tam, E., Keats, E.C., Rind, F., Das, J.K., and Bhutta, Z.A. (2020). Micronutrient supplementation and fortification interventions on health and development outcomes among children under-five in low- and middle-income countries: A systematic review and meta-analysis. Nutrients, 12.","DOI":"10.3390\/nu12020289"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Suchdev, P.S., Jefferds, M.E.D., Ota, E., Lopes, K.S., and De-Regil, L.M. (2020). Home Fortification of Foods with Multiple Micronutrient Powders for Health and Nutrition in Children under Two Years of Age (Review), World Health Organization.","DOI":"10.1002\/14651858.CD008959.pub3"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/j.1740-8709.2006.00060.x","article-title":"Multi-micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: A randomized clinical trial","volume":"2","author":"Christofides","year":"2006","journal-title":"Matern. Child Nutr."},{"key":"ref_10","first-page":"91","article-title":"Low dose \u2019Sprinkles\u2019\u2014An innovative approach to treat iron deficiency anemia in infants and young children","volume":"44","author":"Hirve","year":"2007","journal-title":"Indian Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e12572","DOI":"10.1111\/mcn.12572","article-title":"Acceptability of multiple micronutrient powders and iron syrup in Bihar, India","volume":"14","author":"Young","year":"2018","journal-title":"Matern. Child Nutr."},{"key":"ref_12","first-page":"361","article-title":"Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia","volume":"21","author":"Inayati","year":"2012","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1475-2891-10-129","article-title":"Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People\u2019s Democratic Republic: A randomised trial","volume":"10","author":"Kounnavong","year":"2011","journal-title":"Nutr. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1177\/156482651003100307","article-title":"Daily use of Sprinkles micronutrient powder for 2 months reduces anemia among children 6 to 36 months of age in the Kyrgyz Republic: A cluster-randomized trial","volume":"31","author":"Lundeen","year":"2010","journal-title":"Food Nutr. Bull."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.3945\/jn.112.157578","article-title":"Maize porridge enriched with a micronutrient powder containing low-dose iron as NaFeEDTA but not amaranth grain flour reduces anemia and iron deficiency in Kenyan preschool children","volume":"142","author":"Moretti","year":"2012","journal-title":"J. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1186\/s12889-017-4755-0","article-title":"The effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: A cluster randomized trial","volume":"17","author":"Luo","year":"2017","journal-title":"BMC Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1017\/S1368980017003858","article-title":"The WHO recommendation of home fortification of foods with multiple-micronutrient powders in children under 2 years of age and its effectiveness on anaemia and weight: A pragmatic cluster-randomized controlled trial","volume":"21","author":"Dramaix","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e12820","DOI":"10.1111\/mcn.12820","article-title":"Micronutrient powder supplements combined with nutrition education marginally improve growth amongst children aged 6\u201323 months in rural Burkina Faso: A cluster randomized controlled trial","volume":"15","author":"Lanou","year":"2019","journal-title":"Matern. Child Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1017\/S000711451800140X","article-title":"Effectiveness of a home fortification programme with multiple micronutrients on infant and young child development: A cluster-randomised trial in rural Bihar, India","volume":"120","author":"Larson","year":"2018","journal-title":"Br. J. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e12831","DOI":"10.1111\/mcn.12831","article-title":"Adherence and acceptability of community-based distribution of micronutrient powders in Southern Mali","volume":"15","author":"Roschnik","year":"2019","journal-title":"Matern. Child Nutr."},{"key":"ref_21","unstructured":"Minist\u00e9rio da Sa\u00fade (Brasil) (2015). NutriSUS. Manual Operacional: Estrat\u00e9gia de Fortifica\u00e7\u00e3o da Alimenta\u00e7\u00e3o Infantil com Micronutrientes (Vitaminas e Minerais) em p\u00f3, Minist\u00e9rio da Sa\u00fade, Minist\u00e9rio da Educa\u00e7\u00e3o."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Cardoso, M.A., Augusto, R.A., Bortolini, G.A., Oliveira, C.S., Tietzman, D.C., Sequeira, L.A., Hadler, M.C., do Rosario, G., Peixoto, M., and Muniz, P.T. (2016). Effect of providing multiple micronutrients in powder through primary healthcare on anemia in young brazilian children: A multicentre pragmatic controlled trial. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156194"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S259","DOI":"10.1590\/S0102-311X2008001400011","article-title":"Treament and prevention of anemia with ferrous sulfate plus folic acid in children attending daycare centers in Goi\u00e2nia, Goi\u00e1s State, Brazil: A randomized controlled trial","volume":"24","author":"Hadler","year":"2008","journal-title":"Cad. Sa\u00fade P\u00fablic"},{"key":"ref_24","unstructured":"HF-TAG\u2014Home Fortification Technical Advisory Group (2013). Manual on Micronutrient Powder (MNPs) Composition, Home Fortification Technical Advisory Group."},{"key":"ref_25","unstructured":"Associa\u00e7\u00e3o Brasileira de Empresas de Pesquisas (ABEP) (2015). Crit\u00e9rio de classifica\u00e7\u00e3o econ\u00f4mica Brasil, Associa\u00e7\u00e3o Brasileira de Empresas de Pesquisa (ABEP)."},{"key":"ref_26","unstructured":"World Health Organization (2011). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity, WHO."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1038\/s41430-018-0368-7","article-title":"Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher","volume":"73","author":"Lundeen","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_28","unstructured":"World Health Organization (2020). Guideline on Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations, World Health Organization."},{"key":"ref_29","unstructured":"Ag\u00eancia Nacional de Vigil\u00e2ncia Sanit\u00e1ria\u2014ANVISA (2002). Aprova\u00e7\u00e3o do Regulamento T\u00e9cnico para a Fortifica\u00e7\u00e3o das Farinhas de Trigo e das Farinhas de Milho com Ferro e \u00c1cido F\u00f3lico, RDC N\u00ba 344, de 13 de dezembro de 2002."},{"key":"ref_30","unstructured":"Minist\u00e9rio da Sa\u00fade (Brasil) (2000). Instituir o Componente I do Programa de Humaniza\u00e7\u00e3o no Pr\u00e9-natal e Nascimento\u2014Incentivo \u00e0 Assist\u00eancia Pr\u00e9-natal no \u00e2mbito do Sistema \u00danico de Sa\u00fade, Minist\u00e9rio da Sa\u00fade. Portaria n\u00ba 570, de 1\u00ba de junho de 2000."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1590\/S0103-21002012000300022","article-title":"Iniciativa Hospital Amigo da Crian\u00e7a: Uma pol\u00edtica de promo\u00e7\u00e3o, prote\u00e7\u00e3o e apoio ao aleitamento materno","volume":"25","author":"Figueredo","year":"2012","journal-title":"Acta Paul. Enferm."},{"key":"ref_32","unstructured":"Minist\u00e9rio da Sa\u00fade (Brasil) (2013). Programa Nacional de Suplementa\u00e7\u00e3o de Ferro: Manual de condutas gerais, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade, Departamento de Aten\u00e7\u00e3o B\u00e1sica, Minist\u00e9rio da Sa\u00fade."},{"key":"ref_33","unstructured":"Minist\u00e9rio da Sa\u00fade (Brasil) (2013). Manual de condutas gerais do Programa Nacional de Suplementa\u00e7\u00e3o de Vitamina A, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade, Departamento de Aten\u00e7\u00e3o B\u00e1sica, Minist\u00e9rio da Sa\u00fade."},{"key":"ref_34","unstructured":"Minist\u00e9rio da Sa\u00fade (Brasil) (2017). Bases para a discuss\u00e3o da Pol\u00edtica Nacional de Promo\u00e7\u00e3o, Prote\u00e7\u00e3o e Apoio ao Aleitamento Materno, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade, Departamento de A\u00e7\u00f5es Program\u00e1ticas Estrat\u00e9gicas, Minist\u00e9rio da Sa\u00fade."},{"key":"ref_35","unstructured":"WHO\u2014World Health Organization (2013). O clampeamento tardio do cord\u00e3o umbilical reduz a anemia infantil, WHO."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/01.mpg.0000189363.07040.4b","article-title":"Double-blind, placebo-controlled trial comparing effects of supplementation with two different combinations of micronutrients delivered as sprinkles on growth, anemia, and iron deficiency in cambodian infants","volume":"42","author":"Giovannini","year":"2006","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1093\/jn\/137.4.1023","article-title":"Micronutrient sprinkles reduce anemia among 9- to 24-mo-old children when delivered through an integrated health and nutrition program in rural Haiti","volume":"137","author":"Menon","year":"2007","journal-title":"J. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/ajcn\/86.2.412","article-title":"Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: Effects on growth and motor development","volume":"86","author":"Lartey","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/156482650702800204","article-title":"Effect of daily versus once-weekly home fortification with micronutrient sprinkles on hemoglobin and iron status among young children in rural Bangladesh","volume":"28","author":"Hyder","year":"2007","journal-title":"Food Nutr. Bull."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/nyas.14090","article-title":"Use and interpretation of hemoglobin concentrations for assessing anemia status in individuals and populations: Results from a WHO technical meeting","volume":"1450","author":"Pasricha","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/8979456","article-title":"Efficacy of Different Doses of Multiple Micronutrient Powder on Haemoglobin Concentration in Children Aged 6\u201359 Months in Arusha District","volume":"3","author":"Kejo","year":"2019","journal-title":"Scientifica"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e427","DOI":"10.1542\/peds.2009-2097","article-title":"Iron deficiency anemia and cognitive function in infancy","volume":"126","author":"Carter","year":"2010","journal-title":"Pediatrics"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Tang, M., Frank, D.N., Hendricks, A.E., Ir, D., Esamai, F., Liechty, E., Hambidge, K.M., and Krebs, N.F. (2017). Iron in micronutrient powder promotes an unfavorable gut microbiota in Kenyan infants. Nutrients, 9.","DOI":"10.3390\/nu9070776"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/7\/2160\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:22:19Z","timestamp":1760163739000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/7\/2160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,23]]},"references-count":43,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["nu13072160"],"URL":"https:\/\/doi.org\/10.3390\/nu13072160","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,23]]}}}