Significance
Introduction
Methods
Results
Source | Intervention | Δ Vitamin A status | Δ Iron status, anemia (Δ HB g/l or RR) | Δ Zinc concentration | Anthropometry/growth |
---|---|---|---|---|---|
Multiple micronutrient intervention reviews (n = 9) | |||||
Bhutta et al. (2008) | Multiple micronutrient home fortification | NR | √ | NR | NR |
Multiple micronutrient including Iron fortification | NR | √ | NR | NR | |
Multiple micronutrient including Vit A fortification | √ | NR | NR | NR | |
Multiple micronutrient including zinc fortification | NR | NR | √ | NR | |
Iron fortification | NR | √ | NR | NR | |
Allen et al. (2009) | Multiple micronutrient supplements compared to placebo and iron | √ | √ | √ | √ |
Dewey et al. (2009) | Home fortification of complementary foods | √ | √ | √ | √ |
De-Regil et al. (2011a) | Multiple micronutrient home fortification vs placebo or no intervention | NR | √ | √ | √ |
Home fortification vs iron supplementation | NR | √ | NR | √ | |
Eichler et al. (2012) | Multiple micronutrient fortified milk and cereal vs no fortification | √ | √ | √ | NR |
Single micronutrient (iron) fortified milk and cereal vs no fortification | NR | √ | NR | NR | |
Moran et al. (2012) | MM supplementation and fortification including Zinc | NR | NR | √ | NR |
Das et al. (2013a) | Multiple micronutrient fortification | √ | √ | √ | √ |
Iron fortification | NR | √ | NR | NR | |
Salam et al. (2013) | Multiple micronutrient home fortification | √ | √ | √ | √ |
De-Regil et al. (2017) | MN powders | NR | √ | √ | NR |
Iron intervention reviews (n = 12) | |||||
Okebe et al. (2011) | Iron supplements in malaria endemic areas | NR | √ | NR | √ |
De-Regil et al. (2011b) | Iron supplements intermittent, children under 12 years of age | NR | √ | NR | √ |
Gera et al. (2012) | Iron fortification | NR | √ | √ | √ |
Cembranel et al. (2013) | Iron supplements | NR | √ | NR | NR |
Pasricha et al. (2013) | Iron supplements | √ | √ | √ | √ |
Thompson et al. (2013) | Iron supplements, children 2–5 years of age | NR | √ | NR | √ |
Peña-Rosas et al. (2015a) | Daily iron supplementation during pregnancy | NR | √ | NR | NR |
Peña-Rosas et al. (2015b) | Intermittent supplementation during pregnancy | NR | √ | NR | NR |
Huo et al. (2015) | Iron fortified soy sauce | NR | √ | NR | NR |
Neuberger et al. (2016) | Iron supplementation in malaria endemic areas | NR | √ | NR | NR |
Petry et al. (2016) | Low dose iron supplementation | NR | √ | NR | NR |
Cai et al. (2017) | Iron supplementation | NR | √ | NR | NR |
Zinc intervention reviews (n = 6) | |||||
Brown et al. (2002) | Zinc supplements | NR | NR | √ | √ |
Brown et al. (2009) | Zinc supplements | NR | √ | √ | √ |
Das et al. (2013b) | Zinc fortification | NR | √ | √ | NR |
Nissensohn et al. (2013) | Zinc supplements | NR | NR | √ | NR |
Mayo-Wilson et al. (2014) | Zinc supplements | NR | NR | √ | √ |
Zinc with iron vs zinc supplements | NR | √ | √ | √ | |
Petry et al. (2016) | Zinc supplementation and fortification | NR | NR | √ | NR |
Vitamin A supplementation intervention reviews (n = 6) | |||||
Mayo-Wilson et al. (2011) | Vitamin A supplements | √ | NR | NR | NR |
Oliveira et al. (2016) | Vitamin A supplements in postpartum women | √ | NR | NR | NR |
Haider et al. (2017) | Vitamin A supplements | √ | NR | NR | NR |
Imdad et al. (2016) | Vitamin A supplements | √ | NR | NR | NR |
Imdad et al. (2017) | Vitamin A supplements | √ | NR | NR | NR |
Da-Cunha et al. (2018) | Vitamin A | √ | NR | NR | NR |
Other intervention strategies (n = 8) | |||||
Gulani et al. (2007) | Anthelminthic drug treatment | NR | √ | NR | NR |
Hall et al. (2008) | Anthelminthic drug treatment, children 1–19 years | √ | √ | NR | √ |
De Gier et al. (2014) | Anthelminthic drug treatment | √ | √ | NR | NR |
Athuman et al. (2015) | Intermittent preventive malaria treatment | NR | √ | NR | NR |
Hutton and Hassan (2007) | Late vs early cord clamping | NR | √ | NR | NR |
McDonald et al. (2013) | Early vs late cord clamping | NR | √ | NR | NR |
Qasem et al. (2015) | Introduction of first complementary feeing (4 vs 6 months) | NR | √ | NR | NR |
Dong et al. (2017) | Red palm oil | √ | NR | NR | NR |
Source | Intervention | Δ Vitamin A status | Δ Mean difference serum ferritin | Δ Mean difference HB (g/l) | RR Anemia | Δ Zinc concentration |
---|---|---|---|---|---|---|
Multiple micronutrient intervention reviews | ||||||
Bhutta et al. (2008) | Multiple micronutrient home fortification | NR | NR |
3.75 (0.46, 7.97)
|
0.54 (0.42, 0.72)
| NR |
MMN including Iron fortification | NR | NR |
3.39 (0.90, 5.89)
|
0.89 (0.27, 3.53)
| NR | |
MMN including Vit. A fortification | 0.02 (− 0.05, 0.09) | NR | NR | NR | NR | |
MMN including zinc fortification | NR | NR | NR | NR | 0.60 (− 0.18, 1.37) | |
Allen et al. (2009) | Multi-micronutrient supplements compared to either placebo or to iron only |
0.33 (0.05, 0.61)
| NR |
0.39 (0.25, 0.53)
| NR |
0.23 (0.18, 0.43)
|
Multi-micronutrient fortification compared to either placebo or to iron only | NR | NR | 0.60 (0.32, 0.88) | NR | NR | |
Dewey et al. (2009) | Home fortification vs iron drops |
NR
| − 0.17 (− 0.92, 0.58) | − 0.91 (− 11.96, 10.14) | 1.04 (0.76, 1.41) | NR |
Home fortification and supplements | 0.06 (− 0.16, 0.28) |
0.36 (0.18, 0.54)
| 5.06 (2.29, 7.83) |
0.54 (0.46, 0.64)
|
0.13 (0.05, 0.31)
| |
De-Regil et al. (2011a) | Home fortification vs placebo or no intervention | NR | 20.38 µg/l (6.27, 34.49) (2 studies) | 5.87 (3.25, 8.49) |
0.69 (0.60, 0.78)
| 0.20 (− 0.95, 0.55) (1 study) |
Home fortification vs iron supplementation | NR | NR | − 2.36 (− 10.30, 5.59) |
0.89 (0.58, 1.39)
| NR | |
Eichler et al. (2012) | Multiple micronutrient fortified milk and cereal vs no fortification |
3.7 µg/dl (1.3, 6.1)
| NR | 0.87 (0.57, 1.16) |
0.43 (0.26,0.71)
| 0.4 µ/dl (− 1.7, 2.6) |
Single micronutrient (iron) fortified milk and cereal vs no fortification | NR | NR | 0.20 (− 0.05, 0.45) |
0.76 (0.45, 1.28)
| NR | |
Moran et al. (2012) | MM supplementation and fortification including zinc | NR | NR | NR |
NR
|
0.12 (0.04, 0.20)
|
Das et al. (2013b) | Iron fortification infants | NR |
0.63 (0.25, 0.98)
|
0.81 (0.31, 1.31)
|
0.42 (0.24, 0.72)
| NR |
(pre) School children | NR |
1.37 (0.01,2.78)
|
0.46 (0.24, 0.67)
|
0.60 (0.43, 0.84)
| NR | |
Multiple micronutrient fortification infants | 0.04 (− 0.22, 0.30) |
0.43 (0.17, 0.68)
|
1.05 (0.48, 1.63)
|
0.59 (0.50, 0.70)
| 0.04 (− 0.10, 0.17) | |
(pre) School children | − 0.21 (− 0.34, − 0.07) | 0.06 (− 0.17, 0.29) |
0.45 (0.12, 0.79)
|
0.45 (0.22, 0.89)
|
0.17 (0.04, 0.30)
| |
Salam et al. (2013) | Multiple micronutrient home fortification | 1.66 (− 1.60, 4.92) | 1.78 (− 0.31, 3.88) |
0.98 (0.55, 1.40)
|
0.66 (0.57, 0.77)
| − 0.22 (− 0.52, 0.09) |
De-Regil et al. (2017) | MN powders | NR | 0.42 (− 4.36, 5.19) |
3.37 (0.94, 5.80)
|
0.66 (0.49, 0.88)
| NR |
Source | Intervention | Δ Vitamin A status | Δ Mean difference serum ferritin | Δ Mean difference HB g/l | RR Anemia | Δ Zinc concentration |
---|---|---|---|---|---|---|
Iron intervention reviews | ||||||
Bhutta et al. (2008) | Iron fortification | NR | NR |
6.05 (3.53, 8.57)
|
0.30 (0.17, 0.51)
| NR |
Okebe et al. (2011) | Iron supplements (malaria endemic areas) | NR | NR | 0.87 (0.64, 1.09 g/L) |
0.55 (0.43, 0.71)
| NR |
De-Regil et al. (2011b) | Iron supplements, intermittent | NR |
Intermittent vs placebo
14.17 (3.53, 24.81)
|
Intermittent vs placebo
5.20 (2.51, 7.88)
|
Intermittent vs placebo
0.51 (0.37, 0.72)
| NR |
Intermittent vs daily − 4.19 (− 9.42, 1.05) | Intermittent vs daily − 0.60 (− 1.54, 0.35) |
Intermittent vs daily
1.23 (1.04, 1.47)
| ||||
Eichler et al. (2012) | Iron fortified milk & cereal | NR | NR | 0.20 (− 0.05, 0.45) | 0.76 (0.45, 1.28) | NR |
Gera et al. (2012) | Iron fortification vs placebo | NR |
1.36 (1.12, 1.52)
|
0.46 (0.42, 0.50)
| NR | 0.05 (− 0.33, 0.43) |
Cembranel et al. (2013) | Iron supplementation | NR | NR |
0.44 (0.22, 0.66)
|
0.77 (0.54, 0.91)
| NR |
Das et al. (2013b) | Iron fortification infants | NR |
0.63 (0.25, 0.98)
|
0.81 (0.31, 1.31)
|
0.42 (0.24, 0.72)
| NR |
(pre) School children | NR |
1.37 (0.01, 2.78)
|
0.46 (0.24, 0.67)
|
0.60 (0.43, 0.84)
| NR | |
Pasricha et al. (2013) | Iron supplementation | − 0.07 (− 0.15, 0.01) |
21.42 (17.25, 25.58)
|
7.22 (4.87, 9.57)
|
0.61 (0.50, 0.74)
| − 0.70 (− 1.37, − 0.03) |
Iron + zinc vs zinc | NR | NR | NR | − 1.77 (− 3.01, − 0.52) | ||
Thompson et al. (2013) | Iron supplements | NR | 11.64 µg/l
(6.02, 17.25)
|
6.97 (4.21, 9.72)
| NR | NR |
Peña-Rosas et al. (2015a) | Daily iron supplementation during pregnancy | NR |
Infant HB first 6 months 11
(4.37, 17.63) (1 study)
|
Infant HB first 6 months
− 1.25 (− 8.10, 5.59) (1 study) | NR | NR |
Peña-Rosas et al. (2015b) | Intermittent supplementation during pregnancy | NR |
Infant HB first 6 months
0.09 (0.05, 0.13) (1 study)
|
Infant HB first 6 months
− 0.50 (− 2.44, 1.44) (1 study) | NR | NR |
Huo et al. (2015) | Iron fortified soy sauce | NR | NR | 8.81 (5.96, 11.67) | 0.27 (0.20, 0.36) | NR |
Neuberger et al. (2016) | Iron supplementation vs placebo/no treatment in malaria endemic areas | NR | NR | 0.67 (0.42–0.92) | 0.63 (0.49, 0.82) | NR |
Iron + folic acid suppl. vs placebo/no treatment in malaria endemic areas | NR | NR | NR | 0.49 (0.25, 0.99) | NR | |
Iron supplementation + anti malarial treatment vs antimalarial treatment in malaria endemic areas | NR | NR | NR | End of treatment (n = 2): 0.44 (0.28, 0.70) End of follow-up (n = 1) 0.37 (0.26, 0.54) | NR | |
Petry et al. (2016) | Low dose iron | NR |
17.3 (13.5, 21.2)
| NR |
0.59 (0.49, 0.70)
| NR |
Cai et al. (2017) | Iron supplementation in exclusively breastfed infants | NR | 17.26 (− 40.96, 75.47) | 1.78 (− 1.00, 4.57) | NR | NR |
Source | Intervention | Δ Vitamin A status | Δ Mean difference serum ferritin | Δ Mean difference HB g/l | RR Anemia | Δ Zinc concentration | |
---|---|---|---|---|---|---|---|
Zinc intervention reviews | |||||||
Brown et al. (2002) | Zinc supplements | NR | NR | NR | NR |
0.82 (0.50, 1.14)
| |
Brown et al. (2009) | Zinc supplements | NR | 0.05 (− 0.15, 0.25) | 0.02 (− 0.13, 0.17) | NR |
0.60 (0.44, 0.77)
| |
Moran et al. (2012) | Zn suppl. & fortification | NR | NR | NR | NR |
0.12 (0.04, 0.20)
| |
Das et al. (2013b) | Zinc fortification | NR | NR | − 0.11 (− 0.52, 0.31) | NR | 0.50 (− 0.12, 1.11) | |
Mayo-Wilson et al. (2014) | Zinc supplements | NR | NR | − 0.05 (− 0.10, 0.00) | 1.00 (0.95, 1.06) | ||
Zinc with iron vs zinc | NR | NR |
− 0.23 (− 0.34, − 0.12)
|
0.78 (0.67, 0.92)
| |||
Petry et al. (2016) | Daily zinc | NR | NR | NR | NR | NR |
2.0 (1.2, 2.9)
|
Zinc supplementation | NR | NR | NR | NR | NR |
2.4 (1.5, 3.4)
| |
Zinc fortification | NR | NR | NR | NR | NR | 0.3 (− 0.1, 0.8) | |
Vitamin A intervention reviews | |||||||
Mayo-Wilson et al. (2011) | Vitamin A supplementation in children |
0.31 g/l (0.26, 0.36)
| NR | NR | NR | NR | |
Oliveira et al. (2016) | Vitamin a in post partum women | 3–3.5 months post-partum infants: 0.02 (− 0.03 to 0.07) | NR | NR | NR | NR | |
At 6–6.5 months post-partum infants: 0.06 (− 0.02 to 0.14) | |||||||
Haider et al. (2017) | Neonatal vitamin A supplementation |
RR VAD (6 weeks) 0.94 (0.75, 1.19)
| NR | NR | 0.97 (0.87, 1.07) | NR | |
RR VAD (4 months) 1.02 (0.64, 1.62)
| |||||||
Imdad et al. (2016) | Vitamin A supplements |
RR VAD 0.86 (0.70, 1.06)
| NR | NR | NR | NR | |
Imdad et al. (2017) | Vitamin A |
RR VAD at longest follow-up 0.71 (0.65, 0.78)
| NR | NR | NR | NR | |
Da-Cunha et al. (2018) | Vitamin A |
NR
|
5.26 (1.21, 9.30)
|
5.64 (4.11, 7.17)
|
0.74 (0.66, 0.82)
|
Source | Intervention | Δ Vitamin A status | Δ Mean difference serum ferritin | Δ Mean difference HB g/l | RR anemia | Δ Zinc concentration |
---|---|---|---|---|---|---|
Anthelminthic treatment | ||||||
Gulani et al. (2007) | Anthelminthic treatment | NR | NR |
1.71 (0.70, 2.73)
| NR | NR |
Hall et al. (2008) | Anthelminthic treatment | % DR/R = 0.17 (− 0.60, 0.93) | NR | − 0.93 (− 2.97, 1.10) | NR | NR |
De Gier et al. (2014) | Anthelminthic treatment | 0.04 (− 0.06, 0.14) |
0.16 (0.09, 0.22)
| NR | NR | NR |
Malaria treatment | ||||||
Athuman et al. (2015) | Intermittent preventive malaria treatment | NR | NR |
At 12 weeks: 0.32 (0.19, 0.45)
|
At 12 weeks: 0.97 (0.88, 1.07)
| |
Complementary feeding | ||||||
Qasem et al. (2015) | Introduction of complementary feeding at 4 months | NR |
5 (1.54, 8.46)
Only 1 study
|
19.90 (0.74, 37.06) Only 1 study
| NR | NR |
Cord clamping | ||||||
Hutton et al. (2007) | Late vs early cord clamping | NR |
17.89 (16.58, 13.21)
Only 2 studies | NR |
0.53 (0.40, 0.70)
Only 2 studies
| NR |
McDonald et al. (2013) | Early vs late cord clamping newborn | NR | NR |
− 2.17 (− 4.06, − 0.28)
| NR | NR |
Infant 24–48 h | NR | NR |
− 1.49 (− 1.78, − 1.21)
| NR | NR | |
Infant 3–6 months | NR | NR | − 0.15 (− 0.48, 0.19) |
2.65 (1.04, 6.73)
| NR | |
Red palm oil | ||||||
Dong et al. (2017) | Red palm oil |
0.09 (0.06, 0.12)
| NR | NR | NR | NR |
RR, VAD 0.55 (0.37, 0.82)
|
Effect of Multimicronutrient (MM) Supplementation and Fortification on Micronutrient Status
Effect of Iron Supplementation and Fortification on Micronutrient Status
Effect of Zinc Supplementation and Fortification on Micronutrient Status
Effect of Vitamin A Supplementation on Micronutrient Status
Effect of Other Interventions on Micronutrient Status
Source | Intervention | Weight for height | Height for age | Δ Mean MUAC | Δ Mean skin fold |
---|---|---|---|---|---|
Multiple micronutrient intervention reviews | |||||
Allen et al. (2009) | Multimicronutrient supplementation | NR | NR | NR | NR |
Dewey et al. (2009) | Home fortification | − 0.01 (− 0.21, 0.19) | 0.02 (− 0.11, 0.15) | ||
Home fortification + energy | 0.12 (− 0.19, 0.43) |
0.41 (0.16, 0.69)
| |||
De-Regil et al. (2011a) | Home fortification vs placebo/no intervention | 0.04 (− 0.44, 0.52) | 0.04 (− 0.15, 0.23) | NR | NR |
Eichler et al. (2012) | Iron supplementation in children 2–5 years of age | NR | NR | NR | NR |
Das et al. (2013b) | Multimicronutrient fortification infants | 0.08 (− 0.06, 0.21) |
0.26 (0.12, 0.40)
| NR | NR |
(pre) School children | − 0.39 (− 1.06, 0.28) | − 0.01 (− 0.21, 0.20) | NR | NR | |
Salam et al. (2013) | Home fortification | 0.04 (− 0.16, 0.21) | 0.04 (− 0.16, 0.22) | NR | NR |
Iron intervention reviews | |||||
Okebe et al. (2011) | Iron supplements for children in malaria endemic areas | NR | NR | NR | NR |
De-Regill et al. (2011b) | Intermittent iron supplements | NR | Versus placebo 0.03 (− 0.04, 0.10) (3 studies) | NR | NR |
Versus daily iron supplements − 0.26 (− 0.80, 0.28) (3 studies) | |||||
Gera et al. (2012) | Iron fortification vs placebo | NR | 0.05 (− 0.17,0.26) | NR | NR |
Pasricha et al. (2013) | Iron supplementation | 0.03 (− 0.06, 0.12) | 0.01 (− 0.04, 0.06) | NR | NR |
Thompson et al. (2013) | Iron supplements in children 2–5 years of age | NR | NR | NR | NR |
Zinc intervention reviews | |||||
Brown et al. (2002) | Zinc supplements | − 0.02 (− 0.1, 0.10) |
0.35 (0.19, 0.51)
| NR | NR |
Brown et al. (2009) | Zinc supplements |
0.06 (0.00, 0.12)
|
0.17 (0.08, 0.26)
| NR | NR |
Mayo-Wilson et al. (2014) | Zinc supplementation |
0.05 (0.01, 0.10)
|
NR
|
NR
|
NR
|
Zinc + iron supplements | − 0.06 (− 0.07, 0.19) |
NR
|
NR
|
NR
| |
Anthelminthic treatment reviews | |||||
Hall et al. (2008) | Anthelminthic treatment |
0.38 (0.30, 0.45)
|
0.09 (0.06, 0.11)
|
0.30 (0.23, 0.37)
|
0.11 (0.03, 0.18)
|