Date Published: January 23, 2019
Publisher: Public Library of Science
Author(s): Klaus Eichler, Sascha Hess, Claudia Twerenbold, Magalie Sabatier, Flurina Meier, Simon Wieser, Seth Adu-Afarwuah.
Micronutrient (MN) deficiencies cause a considerable burden of disease for children in many countries. Dairy products or cereals are an important food component during adolescence. Fortification of dairy products or cereals with MN may be an effective strategy to overcome MN deficiencies, but their specific impact on health in this age group is poorly documented.
We performed a systematic review and meta-analysis (registration number CRD42016039554) to assess the impact of MN fortified dairy products and cereal food on the health of children and adolescents (aged 5–15 years) compared with non-fortified food. We reviewed randomised controlled trials (RCT) using electronic databases (MEDLINE, EMBASE, Cochrane library; latest search: January 2018), reference list screening and citation searches. Three pairs of reviewers assessed 2048 studies for eligibility and extracted data. We assessed the risk of bias and applied GRADE to rate quality of evidence.
We included 24 RCT (often multi MN fortification) with 30 pair-wise comparisons mainly from low- and middle income countries. A very small and non-significant increase of haemoglobin values emerged (0.09 g/dl [95%-CI: -0.01 to 0.18]; 13 RCT with iron fortification; very low quality of evidence). No significant difference was found on anaemia risk (risk ratio 0.87 [95%-CI: 0.76 to 1.01]; 12 RCT; very low quality), but a significant difference in iron deficiency anaemia favouring fortified food was found (risk ratio 0.38 [95%-CI: 0.18 to 0.81]; 5 RCT; very low quality). Similar effects were seen for fortified dairy products and cereals and different fortification strategies (mono- vs. dual- vs. multi-MN). Follow-up periods were often short and the impact on anthropometric measures was weak (low quality of evidence) Very low quality of evidence emerged for the improvement of cognitive performance, functional measures and morbidity.
Fortification of dairy products and cereal food had only marginal health effects in our sample population from 5–15 years. Further evidence is needed to better understand the health impact of fortified dairy products and cereals in this age group.
The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 26 May 2016 (registration number CRD42016039554).
Micronutrient (MN) deficiencies cause a considerable burden of disease for children in many countries with impaired physical and cognitive development, as well as increased morbidity and mortality .
Our systematic review took into account critical methodological issues of current guidelines for performing [18, 19] and reporting of systematic reviews (PRISMA checklist: S1 Table) [20, 21]. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 26 May 2016 (registration number CRD42016039554; http://www.crd.york.ac.uk/prospero/; study protocol: S1 SP).
In our systematic review, we assessed the effects of fortified milk and cereal food with different MNs on direct health measures in 9,367 children and adolescents in the age group 5–15 years, based on data from 24 included studies. Fortification led to a very small and non-significant increase in haemoglobin values in this age group that may not be clinically relevant (very low quality of evidence).
Fortification of dairy products and cereal food had only marginal health effects in our sample population of children and adolescents from 5–15 years. Further evidence is needed from experimental studies, cohort studies with a longer follow up period and evaluations of large-scale implementation programmes to better understand the health impact of fortified dairy products and cereal food on functional and cognitive development, as well as on morbidity, in this age group.