{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T01:46:10Z","timestamp":1780623970221,"version":"3.54.1"},"reference-count":58,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UN-WFP Pakistan"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Cost-effective interventions are needed to address undernutrition, particularly micronutrient deficiencies, which are common in children under the age of five in low- and middle-income countries. A community-based, non-randomized clinical trial was undertaken in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019, to evaluate the effect of locally produced micronutrient powder (local name: Vita-Mixe) on plasma micronutrient status, hemoglobin level, and anthropometric outcomes. Children aged 24\u201348 months old were recruited and allocated to the intervention and control arm of the study. The enrolled children in the intervention arm received one micronutrient powder (MNP) sachet for consumption on alternate days for 12 months. To assess the impact of the intervention on plasma levels of zinc, vitamin D, vitamin A, and hemoglobin level, blood samples were taken at baseline and after one year following the intervention. The analysis was conducted using Enzyme-Linked Immunosorbent Assay (ELISA), atomic absorption spectrometry, and an automated hematology analyzer. For the impact on growth parameters, the anthropometric assessment was performed using WHO standard guidelines. A 24 h dietary recall interview was used to assess the nutrient intake adequacy. Results showed that in the intervention arm, children had on average a 7.52 ng\/mL (95% CI 5.11\u20139.92, p-value &lt; 0.001) increase in the plasma level of vitamin A, 4.80 ng\/mL (95% CI 1.63\u20137.95, p-value &lt; 0.002) increase in vitamin D levels and 33.85 \u00b5g\/dL (95% CI 24.40\u201343.30, p-value &lt; 0.001) increase in the plasma zinc level, as well as a 2.0g\/dL (95% CI 1.64\u20132.40, p-value &lt; 0.001) increase in hemoglobin level. Statistically significant improvement was observed in the weight-for-height z-score (WHZ) (from \u22121.0 \u00b1 0.88 to \u22120.40 \u00b1 1.01, p &lt; 0.001) and weight-for-age z-score (WAZ) (from \u22121.40 \u00b1 0.50 to \u22121.05 \u00b1 0.49, p &lt; 0.001) in the intervention group compared to the control group. No statistically significant change was observed in the height-for-age z-score (HAZ) in the intervention group (p = 0.93). In conclusion, micronutrient powder supplementation is a cost-effective intervention to improve the micronutrient status, hemoglobin level, and growth parameters in under-five children, which can be scaled up in the existing health system to address the alarming rates of undernutrition in Pakistan and other developing countries.<\/jats:p>","DOI":"10.3390\/nu15071690","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T01:37:02Z","timestamp":1680226622000},"page":"1690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long-Term Impact of Multiple Micronutrient Supplementation on Micronutrient Status, Hemoglobin Level, and Growth in Children 24 to 59 Months of Age: A Non-Randomized Community-Based Trial from Pakistan"],"prefix":"10.3390","volume":"15","author":[{"given":"Aslam","family":"Khan","sequence":"first","affiliation":[{"name":"Institute of Basic Medical Science, Khyber Medical University, Peshawar 25120, Pakistan"},{"name":"Institute of Public Health Sciences, Khyber Medical University, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia","family":"Ul-Haq","sequence":"additional","affiliation":[{"name":"Institute of Public Health Sciences, Khyber Medical University, Peshawar 25120, Pakistan"},{"name":"Institute of Health & Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1677-5535","authenticated-orcid":false,"given":"Sadia","family":"Fatima","sequence":"additional","affiliation":[{"name":"Institute of Basic Medical Science, Khyber Medical University, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Institute of Basic Medical Science, Khyber Medical University, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6478-1238","authenticated-orcid":false,"given":"Hussah M.","family":"Alobaid","sequence":"additional","affiliation":[{"name":"Department of Zoology, College of Science, King Saud University, Riyadh 11362, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheraz","family":"Fazid","sequence":"additional","affiliation":[{"name":"Institute of Public Health Sciences, Khyber Medical University, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawshad","family":"Muhammad","sequence":"additional","affiliation":[{"name":"Institute of Basic Medical Science, Khyber Medical University, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Garzon","sequence":"additional","affiliation":[{"name":"World Food Programme, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasir","family":"Ihtesham","sequence":"additional","affiliation":[{"name":"World Food Programme, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ijaz","family":"Habib","sequence":"additional","affiliation":[{"name":"World Food Programme, Peshawar 25000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahamadou","family":"Tanimoune","sequence":"additional","affiliation":[{"name":"World Food Programme, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Institute of Basic Medical Science, Khyber Medical University, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7199-0118","authenticated-orcid":false,"given":"Muhammad","family":"Arshad","sequence":"additional","affiliation":[{"name":"Jhang Campus, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sher Zaman","family":"Safi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom 42610, Malaysia"},{"name":"Interdisciplinary Research Center in Biomedical Materials, COMSATS University Islamabad Lahore Campus, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"k2238","DOI":"10.1136\/bmj.k2238","article-title":"Hunger and malnutrition in the 21st century","volume":"361","author":"Webb","year":"2018","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Boah, M., Azupogo, F., Amporfro, D.A., and Abada, L.A. 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