Association between multi-vitamin food fortification in infants aged 6 to 12 months and decreased rates of visits to primary care clinics and the emergency room for infectious diseases

Introduction: Childhood micronutrient deficiencies are known to influence host resistance mechanisms, thereby altering susceptibility to infectious diseases. Methods: Controlled cluster randomized trial, with Maternal and Child Health clinics (MCHCs) as the randomization unit, stratified by population group (Bedouin Arab and Jewish) was performed. Infants at age 6m were enrolled during 2005-2007 at MCHCs which were randomized to receive home food fortification with "Sprinkles", containing iron, folic acid, vitamins A, D, C and zinc; or standard supplementation, liquid iron, Vitamin A&D ("Controls"). Hematological indices, and iron stores, zinc and folate, were measured at age 6&12m. Data on primary care and emergency room (ER) visits due to infectious diseases was obtained during monthly home interviews. Results: The study population included 328 Bedouin Arab infants (192 in "Sprinkles" and 136 in "Controls"). Receiving "Sprinkles" was associated with a significantly lower rate of reporting of clinic visits, 43.0% of visits among Bedouin in the "Sprinkles" versus 62.5% among "Controls"; p<0.001. Corresponding rates for the Jewish population were 23.4% versus 40.8%; p=0.002. "Sprinkles" supplementation was associated with significantly fewer ER visits due to infectious disease in both populations (8.1% in the "Controls" versus 3.7% in "Sprinkles" for Bedouins, p=0.06; and 17.8% in "Controls" versus 9.2% in "Sprinkles" for Jews; p=0.04. Conclusion. Multi-nutrient food fortification by "Sprinkles" has protective effect on reported infectious diseases serious enough to warrant a clinic or ER visits. These results need to be confirmed with a study with enough power to identify those infectious diseases most preventable by multi-nutrient food supplementation.