{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T22:36:26Z","timestamp":1781908586165,"version":"3.54.5"},"reference-count":42,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T00:00:00Z","timestamp":1682380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mathile Institute For The Advancement of Human Nutrition","award":["TL1 TR003100"],"award-info":[{"award-number":["TL1 TR003100"]}]},{"name":"New York Academy of Sciences","award":["TL1 TR003100"],"award-info":[{"award-number":["TL1 TR003100"]}]},{"name":"University of Maryland","award":["TL1 TR003100"],"award-info":[{"award-number":["TL1 TR003100"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 \u00d7 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6\u201318 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models. At the baseline, the mean age (SD) was 13.0 (4.6) months, including 49% males, 32% who were stunted, 55% who were anemic, and 58% who were iron deficient. At the endline (n = 328\/386, 85% retention), there was no synergistic effect on the fortified beverage and responsive caregiving intervention. Compared to the non-fortified beverage group, socioemotional development improved in the fortified beverage group. There were no intervention effects on other measures of child development, hemoglobin, or ferritin. In a setting with high rates of anemia and iron deficiency, a multiple micronutrient-fortified beverage improved infants\u2019 socioemotional development.<\/jats:p>","DOI":"10.3390\/nu15092062","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T04:27:02Z","timestamp":1682396822000},"page":"2062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Effects of Multiple Micronutrient Fortified Beverage and Responsive Caregiving Interventions on Early Childhood Development, Hemoglobin, and Ferritin among Infants in Rural Guatemala"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7200-9694","authenticated-orcid":false,"given":"Alysse J.","family":"Kowalski","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4694-7569","authenticated-orcid":false,"given":"Victor Alfonso","family":"Mayen","sequence":"additional","affiliation":[{"name":"Asociaci\u00f3n para la Prevenci\u00f3n y Estudio del VIH\/Sida, Retalhuleu 11001, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"de Ponce","sequence":"additional","affiliation":[{"name":"Asociaci\u00f3n para la Prevenci\u00f3n y Estudio del VIH\/Sida, Retalhuleu 11001, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaley B.","family":"Lambden","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Tilton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Villanueva","sequence":"additional","affiliation":[{"name":"The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9489-2219","authenticated-orcid":false,"given":"Ana M.","family":"Palacios","sequence":"additional","affiliation":[{"name":"The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA"},{"name":"Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Reinhart","sequence":"additional","affiliation":[{"name":"The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen M.","family":"Hurley","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6427-4639","authenticated-orcid":false,"given":"Maureen M.","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA"},{"name":"RTI International, Research Triangle Park, NC 27709, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0140-6736(16)31389-7","article-title":"Early childhood development coming of age: Science through the life course","volume":"389","author":"Black","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1542\/peds.2011-2663","article-title":"The lifelong effects of early childhood adversity and toxic stress","volume":"129","author":"Shonkoff","year":"2012","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e916","DOI":"10.1016\/S2214-109X(16)30266-2","article-title":"Risk of poor development in young children in low-income and middle-income countries: An estimation and analysis at the global, regional, and country level","volume":"4","author":"Lu","year":"2016","journal-title":"Lancet Glob. 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