Improving Nutritional Status of Egyptian School Children by A Food-Based Natural Enhancer (Orange and Fish) to Iron Absorption and Omega 3 Supplement

Abstract
Background: Iron Deficiency is a major health problem in Egypt, especially among children. Several approaches have been used to alleviate such a problem, one of which is dietbased programs. Ascorbic acid has been shown to be an enhancer of iron bioavailability and is readily available in Egypt. Omega-3 is polyunsaturated essential fatty acid which can't be constructed by the body and must be obtained through
diet and is important for human health. Omega-3 fatty acids sources include salmon, sardine, tuna, mullet and olive and canola oils. Omega-3 fatty acids have anti-inflammatory properties and are helpful in treatment of many diseases.
Aim of Study: The present study was designed to determine if nutritional status could be improved by using a simple school food-based approach of an enhancer (orange and fish) to iron absorption and omega 3 fatty acid supplements.
Subjects and Methods: The first phase of the study started in January 2016, and the second phase in November 2016, and the oranges and fish (tuna sandwich) were served within the school lunch program to a group of school children. The period of intervention was 2 months in the 1 st phase, and 4
months in the 2nd phase, to assess the effect of longer periods of intervention. The oranges and fish (tuna sandwich) were provided 6 days a week for both phases duration. A school meal (biscuits fortified with iron) was also provided to those receiving the oranges and tuna sandwich and to the control group who did not receive either orange or fish (tuna sandwich).
The children were tested for their hemoglobin, serum ferritin and omega 3 index levels at the beginning and at end of the designated intervention period. Stool analysis for presence of parasites was also performed.
Results: During the first phase, there was slight improvement of the mean levels of hemoglobin, ferritin and omega 3 index due to the short duration of orange and tuna sandwich intake. The mean hemoglobin increased from 12.1g/dL to 12.33g/dL, the mean ferritin increased from 26.2ng/ml to 27.6ng/ml while the omega 3 index increased from 1.8% to 2.2%. One hundred and fifty of the intervention children were below 12g/dL (25%). At the post-test, mean hemoglobin for intervention children was 12.43 ± 1.04g/dL. Control group had a mean hemoglobin level of 11.67g/dL at the end. The same rising trend was also seen in the levels of the serum ferritin and the omega 3 index. About forty percent of the intervention group was found to be infected with at least one parasite. Hemoglobin levels, ferritin and omega 3 index were higher in children with no parasites. Conclusion: The results of this study showed significant improvement in the nutritional status among the intervention group, but not in the control group after providing the oranges and fish (tuna sandwich) for 4 months.