Effect of CFR and Iron Supplementation on Iron Status and Gut Microbiota of 1-2 Years Old Myanmar Children

NCT ID: NCT01758159

Last Updated: 2013-10-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

433 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-02-28

Study Completion Date

2014-04-30

Brief Summary

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Complementary feeding diet in developing countries cannot meet iron requirements of infants and young children. Iron supplementation is mostly used to treat iron deficiency whereas iron fortification is cost-effective strategy to control iron deficiency in developing countries. However, a recent study showed that iron fortification imposed negative impact on gut microbiota by increasing colonization of gut pathogen over beneficial bacteria. Gut microbiota plays essential roles in nutrient absorption, vitamin synthesis; intestinal mucosal barrier function and pathogen displacement. Iron is essential for growth and virulence of most gut pathogens and so iron supplementation might have similar negative impact on gut microbiota composition. Therefore, nutrition interventions would not be justified by assessing micronutrient status alone ignoring any possible deterioration of gut microbiota. The investigators hypothesized that optimizing the nutrient intake from locally available foods according to complementary feeding recommendation (CFR) can improve the iron status of these children while maintaining healthy gut microbiota composition.

A randomized, placebo-controlled, community-based, intervention trial will be conducted in Ayeyarwady division of Myanmar where childhood undernutrition is prevalent. The aim of this study is to compare the effect of optimized CFR to iron supplementation on iron status and gut microbiota composition of 1-2years old Myanmar children. Cluster randomization will be done at the village level to randomly allocate the villages into CFR or non-CFR villages. Individual randomization will be done to randomly assign each child into iron or placebo syrup so that individual children will receive one of 4 treatment groups (CFR, Fe, CFR + Fe, and Control) for a period of 24 weeks. Based on expected between-groups difference of hemoglobin 5g/L, at 80% power, 5% level of significance, 15% drop-out rate; after taking into account the cluster effect; required sample will be 109 per group (total = 436). A sub-sample of 15 children from each group will be randomly selected for gut microbiota assessment (total = 60). Blood samples for iron status and stool samples for gut microbiota assessment will be collected at baseline and endline. Anthropometric measurements, usual intake of iron and infectious disease morbidity will also be assessed.

Detailed Description

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Conditions

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Iron Deficiency Iron Deficiency Anemia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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CFR group

The children in this group will receive complementary feeding with locally available foods according to optimized complementary feeding recommendation (CFR)

Group Type EXPERIMENTAL

Iron supplementation

Intervention Type DIETARY_SUPPLEMENT

Fe group

The children in this group will receive iron supplementation 2mg/kg/day of ferric Na EDTA (in the form of syrup) daily for 24 weeks duration.

Group Type EXPERIMENTAL

CFR

Intervention Type OTHER

Complementary feeding with locally available foods according to optimized complementary feeding recommendation (CFR)

CFR + Fe group

The children in this group will receive both local food-based complementary feeding according to CFR and Iron supplementation for 24 weeks duration

Group Type EXPERIMENTAL

Iron supplementation

Intervention Type DIETARY_SUPPLEMENT

CFR

Intervention Type OTHER

Complementary feeding with locally available foods according to optimized complementary feeding recommendation (CFR)

Control group

The children in this group will receive basic health services and placebo syrup.

Group Type PLACEBO_COMPARATOR

No interventions assigned to this group

Interventions

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Iron supplementation

Intervention Type DIETARY_SUPPLEMENT

CFR

Complementary feeding with locally available foods according to optimized complementary feeding recommendation (CFR)

Intervention Type OTHER

Other Intervention Names

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Complementary Feeding Recommendation

Eligibility Criteria

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Inclusion Criteria

* Age between 12-18 months
* Apparently healthy
* Not consuming regular iron containing supplements during the last 4 months

Exclusion Criteria

* With severe anemia (Hemoglobin \< 50g/L)
* Malaria test positive with Immuno-chromatographic test (ICT)
* Mothers/ Caregivers are not willing to join the study
* Suffer from chronic diseases which can affect their dietary intake
Minimum Eligible Age

12 Months

Maximum Eligible Age

18 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Nutrition Center, Department of Health, Ministry of Health, Myanmar

UNKNOWN

Sponsor Role collaborator

National Health Laboratory (Department of Health,Ministry of Health, Myanmar)

UNKNOWN

Sponsor Role collaborator

SEAMEO Regional Centre for Food and Nutrition

OTHER

Sponsor Role lead

Responsible Party

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Lwin Mar Hlaing

Medical Officer, PhD Candidate (Nutrition)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lwin Mar Hlaing, M.B.,B.S, MPH

Role: PRINCIPAL_INVESTIGATOR

1. National Nutrition Center, Ministry of Health, Myanmar. 2. South East Asian Ministers of Education Organization - Regional Center for Food and Nutrition (SEAMEO-RECFON), University of Indonesia

Locations

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National Nutrition Center, Ministry of Health, Myanmar

Pan Ta Naw Township and Kyaungon Township, Ayeyarwady Region, Burma

Site Status

Countries

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Burma

References

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Santika O, Fahmida U, Ferguson EL. Development of food-based complementary feeding recommendations for 9- to 11-month-old peri-urban Indonesian infants using linear programming. J Nutr. 2009 Jan;139(1):135-41. doi: 10.3945/jn.108.092270. Epub 2008 Dec 3.

Reference Type BACKGROUND
PMID: 19056658 (View on PubMed)

Ferguson EL, Darmon N, Fahmida U, Fitriyanti S, Harper TB, Premachandra IM. Design of optimal food-based complementary feeding recommendations and identification of key "problem nutrients" using goal programming. J Nutr. 2006 Sep;136(9):2399-404. doi: 10.1093/jn/136.9.2399.

Reference Type BACKGROUND
PMID: 16920861 (View on PubMed)

Fahmida U, Preedy VR. Food-Based Complementary Feeding and Its Impact on Growth: Southeast Asian Perspectives, Handbook of Growth and Growth Monitoring in Health and Disease. Springer New York; 2012. p. 1599-610.

Reference Type BACKGROUND

Gibson RS, Anderson VP. A review of interventions based on dietary diversification or modification strategies with the potential to enhance intakes of total and absorbable zinc. Food Nutr Bull. 2009 Mar;30(1 Suppl):S108-43. doi: 10.1177/15648265090301S107.

Reference Type BACKGROUND
PMID: 19472604 (View on PubMed)

Gibson RS, Ferguson EL, Lehrfeld J. Complementary foods for infant feeding in developing countries: their nutrient adequacy and improvement. Eur J Clin Nutr. 1998 Oct;52(10):764-70. doi: 10.1038/sj.ejcn.1600645.

Reference Type BACKGROUND
PMID: 9805226 (View on PubMed)

Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet. 2007 Aug 11;370(9586):511-20. doi: 10.1016/S0140-6736(07)61235-5.

Reference Type BACKGROUND
PMID: 17693180 (View on PubMed)

Iannotti LL, Tielsch JM, Black MM, Black RE. Iron supplementation in early childhood: health benefits and risks. Am J Clin Nutr. 2006 Dec;84(6):1261-76. doi: 10.1093/ajcn/84.6.1261.

Reference Type BACKGROUND
PMID: 17158406 (View on PubMed)

World Health Organization. Conclusions and recommendations of the WHO Consultation on prevention and control of iron deficiency in infants and young children in malaria-endemic areas. Food Nutr Bull. 2007 Dec;28(4 Suppl):S621-7. doi: 10.1177/15648265070284s414. No abstract available.

Reference Type BACKGROUND
PMID: 18297899 (View on PubMed)

Prakash S, Rodes L, Coussa-Charley M, Tomaro-Duchesneau C. Gut microbiota: next frontier in understanding human health and development of biotherapeutics. Biologics. 2011;5:71-86. doi: 10.2147/BTT.S19099. Epub 2011 Jul 11.

Reference Type BACKGROUND
PMID: 21847343 (View on PubMed)

Zimmermann MB, Chassard C, Rohner F, N'goran EK, Nindjin C, Dostal A, Utzinger J, Ghattas H, Lacroix C, Hurrell RF. The effects of iron fortification on the gut microbiota in African children: a randomized controlled trial in Cote d'Ivoire. Am J Clin Nutr. 2010 Dec;92(6):1406-15. doi: 10.3945/ajcn.110.004564. Epub 2010 Oct 20.

Reference Type BACKGROUND
PMID: 20962160 (View on PubMed)

Monira S, Nakamura S, Gotoh K, Izutsu K, Watanabe H, Alam NH, Endtz HP, Cravioto A, Ali SI, Nakaya T, Horii T, Iida T, Alam M. Gut microbiota of healthy and malnourished children in bangladesh. Front Microbiol. 2011 Nov 21;2:228. doi: 10.3389/fmicb.2011.00228. eCollection 2011.

Reference Type BACKGROUND
PMID: 22125551 (View on PubMed)

Yap GC, Chee KK, Hong PY, Lay C, Satria CD, Sumadiono, Soenarto Y, Haksari EL, Aw M, Shek LP, Chua KY, Zhao Y, Leow D, Lee BW. Evaluation of stool microbiota signatures in two cohorts of Asian (Singapore and Indonesia) newborns at risk of atopy. BMC Microbiol. 2011 Aug 26;11:193. doi: 10.1186/1471-2180-11-193.

Reference Type BACKGROUND
PMID: 21875444 (View on PubMed)

Other Identifiers

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HHlaing CFR Myanmar

Identifier Type: -

Identifier Source: org_study_id