Child development is impaired by nutritional deficiencies, such as iron deficiency and anemia.  Many approaches are used globally to reduce deficiencies.  India has adopted a government-sponsored integrated nutrition and child development program that is implemented in preschools.  The impact of this approach on child growth and development is not fully known, so Black and colleagues conducted an intervention study there to explore the relationships.  Their results are published in the July 2021 issue of The Journal of Nutrition.

Preschools in rural India were randomly assigned to receive a placebo or multiple micronutrient powder added to meals for 6 days each week over an 8 month period.  The children were between 29 and 49 months, and blood samples were collected at baseline and at the end of the study.  In addition, anthropometry measures, morbidity, and measures of development were determined.  School quality was also determined so that it was possible to discern if intervention effectiveness was impacted.

A relatively large percentage of children were anemic (48%), stunted (42%), or wasted (20%) at baseline.  Expressive and receptive language scores were higher in children attending higher quality preschools.  At study end, expressive language, inhibitory control, and social-emotional scores were improved by the intervention, but only in children attending lower quality preschools.  The micronutrient powder was more effective than the placebo at reducing anemia and iron deficiency, but there was no effect on growth or morbidity of children in higher or lower quality preschools.  These observations led the authors to conclude that a multiple micronutrient supplement applied to meals would improve nutritional status and development of children that attended low quality preschools.  They also suggest that efforts to improve school nurturing are another way to promote student development.

In a commentary, Prado considers these outcomes to be promising as they support the ability of interventions after the first 1000 days of life to improve child development, even if the interventions do not influence linear growth.  Prado also suggest more studies need to be conducted during the second 1000 days of life to determine which programs are best able to improve long term developmental outcomes.


Black MM, Fernandez-Rao S, Nair KM, Balakrishna N, Tilton N, Radhakrishna KV, Ravinder P, et al.  A randomized multiple micronutrient powder point-of-use fortification trial implemented in Indian preschools increases expressive language and reduces anemia and iron deficiency. The Journal of Nutrition, Volume 151, Issue 7, July 2021, Pages 2029–2042,

Prado EL. Children staying smaller but growing smarter beyond the first 1000 days. The Journal of Nutrition, Volume 151, Issue 7, July 2021, Pages 1684–1685,

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