The Effectiveness of Zinc-Biofortified Wheat Flour Intake on the Growth and Morbidity Outcomes of Rural Pakistani Children and Adolescent Girls: A Cluster-Randomised, Double-Blind, Controlled Trial.

Summary

This double-blind, cluster-randomised controlled trial in rural north-west Pakistan evaluated whether consuming zinc-biofortified wheat flour (providing a 3.7 mg/kg zinc differential) for 25 weeks improved growth and reduced zinc-related morbidity in 517 adolescent girls and 517 children aged 1–5 years. The intervention resulted in a small but significant increase in head circumference in children (0.29 cm, p = 0.003) and a lower incidence of respiratory tract infections towards the trial's end in both age groups, but did not significantly affect height, weight, lung function, or overall infection prevalence when cumulative illness days were considered.

Regional applicability

This trial was conducted in rural Pakistan with population characteristics (zinc-deficient populations, dietary reliance on wheat products) that differ substantially from the United Kingdom. However, the findings are relevant to UK-supported global nutrition interventions and inform evidence on wheat biofortification efficacy in resource-limited settings; transferability to UK contexts would be limited but could inform policy on grain fortification standards in aid programmes.

Key measures

Height, weight, head circumference, lung function tests, incidence and duration of respiratory tract infection (RTI), incidence and duration of diarrhoea, longitudinal prevalence of RTI (cumulative days of sickness as percentage of total days)

Outcomes reported

The study measured anthropometric outcomes (height, weight, head circumference), lung function, and incidence and duration of respiratory tract infections and diarrhoea in children (1–5 years) and adolescent girls (10–16 years) over 25 weeks of zinc-biofortified wheat flour consumption.

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