Effectiveness of Iron-Fortified Milk on Iron Status and Anemia in Young Children in Mexico

Introduction. Iron deficiency anemia is the most common nutritional deficiency worldwide (1-3).Children less than 5 years are the most affected(4). Almost 24% of Mexican children 1-4 years of age are anemic and 52% iron deficient (5). The peak prevalence of anemia (38%) occurs in children 12-23 months of age (6). The prevalence is higher in low socioeconomic households (29 %) but remains high even in the highest quintile (17%). Anemia and iron deficiency in infants and young children are associated with adverse effects on neurodevelopment (7-12).

During several decades, the Mexican government has sold whole milk at subsidized prices to low income households with children 1-11 y of age through a federal program (Liconsa). In 2000 a decision was made to fortify the subsidized milk with iron, vitamin C and other micronutrients to contribute to the reduction of IDA and other micronutrient deficiencies. At that time, 4.2 million children 1-11 y old from low income families were beneficiaries of the program. There are very few examples of large scale public health interventions using iron fortified whole milk.

The effectiveness of interventions such as food fortification for reducing anemia and iron deficiency is often questioned (14) and little information is available on the effectiveness of these strategies implemented through large scale programs. Reliable evidence of the effectiveness of these strategies applied in large-scale programs is needed for planning interventions aimed at reducing the prevalence of iron and zinc deficiencies and anemia in children.This study aims to document the effectiveness on iron and zinc deficiencies,anemia and stunting, in young children of a large-scale program that distributes iron and zinc fortified milk to low income households at subsidized prices.

Methods The subsidized milk distribution program. The program was created in 1944 and is operated by a public organization (Liconsa)(15). It distributes whole milk at subsidized prices to families living in poverty. The milk distributed is intended mostly for children 1-11 y.

It is distributed in milk distribution centers throughout the Country as dry powder in 240 g sachets which yield two liters of fluid milk after hydration or as a 1 L container of fluid milk. Children receive the equivalent of 400 mL of fluid milk per day either in dry or fluid form for reducing the prevalence of iron deficiency anemia and other micronutrient deficiencies, through the fortification of the product with iron, zinc, vitamin C and micronutrients that were deficient in the diet of low income children in Mexico (5, 16). The program serves approximately 5 million individuals of which about 4.2 million are children <11 years and about 650,000 were children 12-30 months of age.