Efficacy and Safety of Multiple Micronutrient (MMN) Supplementation on Anemia in Children and Adults (Except Pregnant Women): A Meta-Analysis

Studies have shown that multiple micronutrient (MMN) supplementation may be equal or better than iron-only or iron-folic acid in the prevention and treatment of anemia in children and non-pregnant women. However, there is no updated evidence on this statement. We followed the Cochrane methodology and conducted a meta-analysis of the published literature with the application of GRADE. The searches were conducted till December 31, 2023. The primary objective was to compare the effect of MMN versus iron and/or folic acid alone on clinical and laboratory parameters of anemia in children and adults (except pregnant women). Review Manager software (version 5.3) was used for data analysis. Of 4640 citations, 12 studies were finally included. There was a significant decrease (20%) in the anemia prevalence in the 2-5 days/week MMN supplementation. A significant decrease (27%) in the prevalence of iron deficiency was noted in the daily MMN supplementation group but not in the weekly MMN supplementation group. No significant change in hemoglobin level was noted in any of the supplementation group. Regarding anthropometry parameters, a daily (not weekly) MMN supplementation led to a significant weight gain by 220 g without affecting the height gain in infants. The GRADE evidence varied from "very low to moderate certainty" for the outcome parameters. MMN supplements incorporating a high dose of iron and micronutrients when provided 2-5 days/week may lead to a significant decrease in the anemia prevalence. We need more evidence before firm conclusions can be made on MMN supplementation for prevention and/or treatment of anemia in children and adults (except pregnant women).