Few studies have evaluated the impact of fortification with
iron-rich foods such as amaranth grain and multi-
micronutrient powder (MNP) containing low doses of highly bioavailable
iron to control
iron deficiency anemia (IDA) in children. We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children. In a 16-wk intervention trial, children (n = 279; 12-59 mo) were randomly assigned to: unrefined maize porridge (control; 4.1 mg of
iron/meal;
phytate:
iron molar ratio 5:1); unrefined maize (30%) and amaranth grain (70%) porridge (amaranth group; 23 mg of
iron/meal;
phytate:
iron molar ratio 3:1); or unrefined maize porridge with MNP (MNP group; 6.6 mg
iron/meal;
phytate:
iron molar ratio 2.6:1; 2.5 mg
iron as
NaFeEDTA). Primary outcomes were
anemia and
iron status with treatment effects estimated relative to control. At baseline, 38% were anemic and 30%
iron deficient. Consumption of MNP reduced the prevalence of
anemia [-46% (95% CI: -67, -12)],
iron deficiency [-70% (95% CI: -89, -16)], and IDA [-75% (95% CI: -92, -20)]. The soluble
transferrin receptor [-10% (95% CI: -16, -4)] concentration was lower, whereas the
hemoglobin (Hb) [2.7 g/L (95% CI: 0.4, 5.1)] and plasma
ferritin [40% (95% CI: 10, 95)] concentrations increased in the MNP group. There was no significant change in Hb or
iron status in the amaranth group. Consumption of maize porridge fortified with low-dose, highly bioavailable
iron MNP can reduce the prevalence of IDA in preschool children. In contrast, fortification with amaranth grain did not improve
iron status despite a large increase in
iron intake, likely due to high ratio of
phytic acid:
iron in the meal.