Milk-and-Dairy-Products-in-Human-Nutrition-FAO

Chapter 7 – Milk and dairy programmes affecting nutrition 289
beneficiaries annually with 18 000 tonnes of food at a cost of US$38 million per
year (Ruz et al., 2005). Two small studies examined the consumption of fortified
milk in association with mineral absorption and status. A cross-sectional study of 34
male children was carried out in an urban slum area. The children, aged 18 months,
had all been exposed to the fortified-milk programme for at least six months. In
this sample, the prevalence of anaemia was 12 percent, low iron stores (ferritin less
than 10 μg/dl) was 39 percent and low plasma zinc (less than 12.3 μM/litre) was
54.8 percent. The investigators suggested programme exposure was associated with
improved iron status compared with national averages (e.g. anaemia prevalence of
30–40 percent) but not improved zinc status (Torrejon et al., 2004). Unfortunately,
the study, assigned adequacy ranking, was not designed to draw inferences about
the programme impacts.
The Mexican government has been operating a federal programme called Liconsa
for many decades, selling subsidized milk to low-income households with children
between one and 11 years old (Villalpando et al., 2006). In 2000, the government
began fortifying the subsidized milk with micronutrients (ferrous gluconate, zinc
oxide and ascorbic acid) in an effort to address the problem of anaemia and iron
deficiency among vulnerable groups. The initial research that led to this programme
was a well-designed, double-blinded, RCT, which demonstrated the efficacy of fortified
milk for reducing anaemia among infants (Villalpando et al., 2006). The RCT,
which achieved a probability ranking, was conducted in a poor, peri-urban region
of Mexico to test the efficacy of the milk fortification. Children of 10–30 months
old received a daily supplement of 400 ml of milk that was either fortified with
iron, zinc and ascorbic acid (FM) or not fortified (NFM) for six months. The study
found that the prevalence of anaemia in the FM group dropped from 41.4 percent to
12.1 percent but remained unchanged in the NFM group. Similarly, using logistic
regression analysis, the study found that other iron biomarkers were positively
affected in the FM group when age, gender and baseline status were controlled for
(P