Fortified Milk Reduces Morbidity in Preschool
By Kenna Lowe
Blloomberg School of Public
Consumption of milk fortified with specific
micronutrients — zinc, iron, selenium, copper and
vitamins A, C and E — significantly reduces diarrhea
and acute lower respiratory illness among children in
developing countries, according to researchers from the
Johns Hopkins Bloomberg
School of Public Health and the Center for
Micronutrient Research at Annamalai University in India.
The study was published Nov. 28 on the Web site of the
British Medical Journal.
"Some micronutrients have a crucial role in
generation, maintenance and amplification of immune
responses in the body. Deficiencies in multiple
micronutrients among preschool children are an important
determinant of child health in developing countries," said
Sunil Sazawal, lead author of the study and an associate
professor in the Bloomberg School's
The authors conducted a randomized, controlled trial
among 633 children aged 1 to 4 years in a peri-urban
population in New Delhi, India, from April 2002 to April
2004. An intervention group of 316 children received milk
fortified with additional micronutrients — 7.8 mg
zinc, 9.6 mg iron, 4.2 µg selenium, 0.27 mg copper, 156 mg
vitamin A, 40.2 mg vitamin C and 7.5 mg vitamin E —
while a control group of 317 children received the same
milk without fortification. The study was undertaken in
children over 12 months of age, in whom breast-feeding is
not the primary source of nutrition.
The children who received fortified milk had fewer
episodes of diarrhea and acute lower respiratory illness
(pneumonia); the number of days with severe illness was
reduced by 15 percent, the number of days with high fever
by 7 percent, the incidence of diarrhea by 18 percent and
the incidence of pneumonia by 26 percent.
Robert E. Black, co-author and professor and chair of
the Bloomberg School's Department of International Health,
said, "Together, these results suggest an improved immunity
against common infections in children. There is an urgent
need to develop and implement strategies to reduce the
burden of micronutrient deficiencies in the developing
world," he said. "Our results suggest that micronutrients
can be delivered successfully through fortified milk, which
is also a well-accepted delivery method in these
Co-authors of the study from the Bloomberg School, in
addition to Sazawal and Black, are Usha Dhingra and Girish
Hiremath. Jitendra Kumar, Pratibha Dhingra, Archana Sarkar
and Venugopal P. Menon, with Annamalai University, also
co-authored the study.
The study was supported by Fonterra Brands.
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