email to a colleague | support our research 

November 29, 2006

Fortified Milk Reduces Morbidity in Preschool Children

Diarrhea, Pneumonia and Severe Illness Caused by Micronutrient Deficiency

Sunil Sazawal, MD, MPH, PhD

Consumption of milk fortified with specific micronutrients—zinc, iron, selenium, copper, vitamin A, vitamin C and vitamin 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 November 28, 2006, on the website 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, MD, MPH, PhD, lead author of the study and an associate professor in the Bloomberg School of Public Health’s Department of International Health.

The authors conducted a randomized, controlled trial among 633 children aged 1-4 years in a peri-urban population in New Delhi, India, from April 2002-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 µg 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, of which 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). Fortified milk reduced the number of days with severe illness 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.

“Together, these results suggest an improved immunity against common infections in children,” said Robert E. Black, MD, MPH, co-author of the study and professor and chair of the Bloomberg School’s Department of International Health. “There is an urgent need to develop and implement strategies to reduce the burden of micronutrient deficiencies in the developing world. Our results suggest that micronutrients can be delivered successfully through fortified milk, which is also a well-accepted delivery method in these communities.”

Co-authors of the study from the Johns Hopkins Bloomberg School of Public Health are Sunil Sazawal, Usha Dhingra, Girish Hiremath and Robert E. Black. Jitendra Kumar, Pratibha Dhingra, Archana Sarkar and Venugopal P. Menon, with Annamalai University, also co-authored the study.

“Effects of fortified milk on morbidity in young children in north India: community based, randomized, double masked placebo controlled trial” was supported by Fonterra Brands.

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Kenna Lowe or Tim Parsons at 410-955-6878 or paffairs@jhsph.edu.