Efficacy of Malunggay ( Moringa oleifera ) leaves in improving the iron and vitamins A and B status of Filipino schoolchildren

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Acta Hortic. 1158. ISHS 2017. DOI 10.17660/ActaHortic.2017.1158.33
Proc. I International Symposium on Moringa
Eds.: A.W. Ebert and M.C. Palada
293
Efficacy of Malunggay (Moringa oleifera) leaves in
improving the iron and vitamins A and B status of
Filipino schoolchildren
M.E. Seraficoa, L.A. Perlas, C.R. Magsadia, J.A. Desnacido, R.V. Viajar, E.O. Rongavilla,
G.P.AzanaandT.P.Trinidad
FoodandNutritionResearchInstitute,DepartmentofScienceandTechnology,Bicutan,TaguigCity,Philippines.
Abstract
Theprevalenceofirondeficiencyanemia(IDA)andvitaminAdeficiency(VAD)
remainatasignificantpublichealthlevelinthePhilippinesasshownbyNational
NutritionSurveysconductedbytheFNRI-DOST.Whileriboflavinandfolicacid
deficienciesamongschoolchildrencouldalsobeareasofconcern,nutritional
assessmentofthesevitaminsarelacking.Inthisstudy,Moringa oleifera,locally
knownasMalunggay,wasconsideredasapossiblesolutiontotheseproblems
becauseofitshighnutritionalcontent.Thestudywasconductedintwopublic
elementaryschoolsinMuntinlupaCitywhere121underweightchildrenaged8-10
yearsoldweredividedintocontrol(n=60)andexperimental(n=61)groups.The
controlgroupwasfedwithsnackfoods(arrozcaldo, ginataang mais,macaronisoup,
pancit cantonandpolvoron)duringrecesswhiletheexperimentalgroupwasfedwith
thesamesnackfoodswhereinthreegramsMalunggayleafpowder(MLP)wasadded.
Heightandweight,foodintakeandhemoglobin,serumferritin,vitaminA,riboflavin
andfolicacidweremeasuredbeforeandafterthe120-dayfeedingperiod.Results
showedthattheconsumptionofthesnackfoodssignificantlyincreasedthenutrient
intakesofthechildren.GreatestincreasewasrecordedforvitaminAintakeofthe
childrengiven3gMLP.EndlinevitaminAintakeexceededtherequirementfor
vitaminA.Increaseinheightandweightbetweenthegroupswerenotdifferent.
Increaseinhemoglobinlevelswasgreateramongchildrenwhoconsumedsnackfoods
withMLPwhileincreaseinserumvitaminAlevelswasobservedinbothgroups.A
significantincreaseinserumfolicacidwasrecordedintheexperimentalgroup.In
conclusion,regularconsumptionofMalunggayleavesmayhelpalleviatecertain
micronutrientdeficienciessuchasIDA,VAD andfolicaciddeficiency.
Keywords:moringa,hemoglobin,vitaminAdeficiency,folicacid,riboflavin
INTRODUCTION
IronandvitaminAdeficienciescontinuetobeproblemsindevelopingcountries(Yang
etal.,2006b).InthePhilippines,theprevalenceofironandvitamin A deficiencies
continuouslyremainat levels thatpose a publichealth concern.The7th National Nutrition
Surveyconducted by the Foodand Nutrition Research Institute-Department ofScienceand
Technology (FNRI-DOST) in 2008 showed that among 6-12 years old children, 19.8 and
11.1%wereanemicandvitaminAdeficient,respectively(Foodand Nutrition Research
Institute-DepartmentofScienceandTechnology(FNRI-DOST),2010a,b).
Ontheotherhand,thestatusofB-vitaminsofFilipinoschoolchildren has not been
assessedfor thepasttenyears.Vitamin B deficiencies maybecomeapublichealthconcern
becausefoodsrichinthesevitaminssuchasdairyproductsanddarkgreenleafyvegetables
likeromainelettuce,kale,spinach,watercressandbroccoliarerelativelyexpensive.
Governmentinvestmentshavepouredtovariousinterventionprograms designed to
addressthemalnutritionproblem.Approacheshaveincludedfortification,supplementation,
nutrition education and supplementary feeding programs utilizingnutritiousandlowcost
aE-mail: mes@fnri.dost.gov.ph

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foods.
Recent developments in the search for finding solutions to malnutrition, have
identified food-based approaches as a sustainable complement to supplementation
programs. Findings of Yang’s group (2006) showed that Moringaoleifera is one of the
promising crops which could contribute to increased intake of micronutrients and
antioxidants. The World Health organization has likewise promotedmoringaasan
alternative to imported food supplies to treat malnutrition (Sreelatha and Padma, 2009;
Johnson,2005).
Foodbased approachesto eliminatemicronutrient deficiencies havebeenconducted
and found to be effective, both in animal and human studies. Inseveralanimalstudies,
feedingMoringaoleiferaleavestorats(NambiarandSeshadri,2001),cows(Sarwattetal.,
2004)andhens(Kakengietal.,2007)resultedinbothweightgainandimprovednutritional
status.
Most of the studies on the efficacy of Moringaoleifera on improvement of the
nutritionalandhematologicalstatusofmalnourishedhumanswereconductedinveryyoung
children.Weightgainwasrecordedwheninfantswerefedcomplementaryfoodsmixedwith
moringaseedsinBurkinaFaso(Compaoréetal.,2011)andmoringaleafpowderinUganda
(Jilcottetal.,2010). An interventionstudy using traditionalcomplementaryfood(CF)with
moringa among infants in Nigeria resulted in improved hemoglobin, serum ferritin and
serumretinol level(Nnam,2009).Ontheotherhand,increaseinhemoglobinlevelwas not
significantintheCFwithmoringaamonginfantsinBurkinaFaso(Compaoréetal.,2011).
In-vitro studies on bioavailability of micronutrients from moringa leaves were also
reported. In a recent study conducted by Trinidad et al. (2013), the bioavailability of iron
and zinc from moringa leaves was 17.1 and 70.6%, respectively. Beta-carotene and lutein
fromfreshanddriedmoringaleavesarealsohighlybioavailable(PullakhandamandFailla,
2007).
In the Philippines, Moringaoleifera, is commonly called Malunggay. Its leaves are
amongthetop30commonlyconsumedfooditemsofFilipinos(FoodandNutritionResearch
Institute-DepartmentofScienceand Technology(FNRI-DOST), 2010a, b). Among 6-12year
oldchildren,consumptionofMalunggayis15gday-1.
Efficacyof Malunggayforundernourishedchildrenhasnotbeenfullyestablisheddue
tolimitedscience-basedstudiesinhumans.Itishopedthatthisstudycan supportclinical
evidence to the various claims on the effectiveness of Malunggay, particularly on the
alleviationofmicronutrientdeficiency.
Thestudywas carried out todetermine the efficacy ofMalunggayleafpowderadded
tosnackproductsinimprovingtheironandvitaminsAandBstatusof8-10yearsold
schoolchildren.Specifically,thestudysoughttocomparethechangesin weight and height,
hemoglobin, serum ferritin, serum retinol, serum folic acid concentrations and riboflavin
statusamongthestudyparticipants.
MATERIALSANDMETHODS
Studysettinganddesign
ThestudywasconductedinMuntinlupaCityinthesouthernmostpartoftheNational
Capital Region. Two public elementary schools with similar socio-economic and
environmental characteristics werepurposely selected as study sites. Children with below
normalbodymassindex(BMI)wereconsideredasparticipantsofthestudy.Atotalsample
sizeof121childrenwasconvenientlyallocatedintoexperimental(60studentsfromSchool
1)andcontrol(61studentsfromSchool2)groups.
Theexperimentalgroupwasfedsnackproductswith3gofMLP,while the control
group was fed with snack products without MLP.  Nutrient composition of the snack foods
werecomputedfromthePhilippineFoodCompositionTables(FNRI-DOST,1997). Feeding
lastedfor120days.Baselineandend-linedatacollectionwasconductedforbothgroups.
The study protocol was reviewed and approved by the Food and Nutrition Research
InstituteInstitutionalEthicsandReviewCommittee(FIERC).Informed,writtenconsentwas

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obtained from the children’s parents after the purpose and procedures of the study were
explained.
Moringaleaves
MoringaleafpowderwaspurchasedfromJapan-PhilippinesMalunggayEcoFarm,Inc.
(JPM)locatedintheProvinceofLaguna.NutrientcontentofMLP was determined by the
FoodAnalyticalServiceLaboratoryofFNRI.
Dataandbloodcollectionandanalyticalmethods
Parentsofstudychildrenwereinterviewedface-to-faceusingapre-testedstructured
questionnaire.Atbaseline,generalprofileofthechildrenaswellashealthandnutritiondata
wascollected.Selecteddemographicandsocio-economicdatawerealso obtained. Intakeof
vitaminsandmineralsupplementsonemonthpriortodatacollection andtwoweeks prior
tobloodextractionwasrecorded.Allchildrenparticipantsweredewormedbeforethestart
ofthefeedingtrial.
Weight of children was measured at baseline and end-line using a calibrated 160-kg
capacitybeambalance weighing scale.Heightwasmeasuredusingamicrotoisepostedflat
againstawall.
A two-day non-consecutive 24-h food recall was collected at baseline and end-line.
Studychildrenortheirparent/caregiverswereinterviewedontheirfoodintakeforthepast
24h.
Bloodsampleswerecollectedfromallstudychildrenatbaselineandafter120daysof
the intervention study. About 5 mL blood by venipuncture was extracted from each child
withapproximately2mLtransferredinatubewithananticoagulant.Remainingbloodwas
allowed to set and serum was separated within 2 h after collection. Serum and
anticoagulatedbloodwerethenkeptina-80°Cfreezeruntilanalyzed.
Hemoglobinwasdeterminedonsite using thecyanmethemoglobinmethod(Zwartet
al., 1996), ferritin using an immunoradiometric assay procedure(DPC)andvitaminAvia
HPLC method (Furr et al., 1992). For riboflavin status, erythrocyte glutathione reductase
activityinbloodwasdetermined,whileserumfolicacidwasdetermined using a
radioimmunoassaymethod(DPC).
Statisticalanalysis
Alldataweretransformedtonumericalcodesguidedbyacodingmanualpreparedfor
thestudy.TheStatisticalPackageforSocialSciencesversion9.0was usedforencodingand
statistical analysis. Parametrictests such as t-test and paired t -testwere used to compare
means among normally distributed variables. Chi-square test wasusedtocompare
proportionsbetweengroups.
RESULTS
Energyandnutrientcontentofsnackproducts
Theenergyandnutrientcontentofthefivedifferentsnackfoodsutilizedinthefeeding
interventionispresentedinTable1.The3gMLPcontainsabout11.5kcal,0.8gprotein,37.7
mgcalcium,0.4mgiron,225.9µgvitaminA,and2.1mgvitaminC.Amongthesnackfoods,
polvorongavethehighestnutrientsperserving.Ontheotherhand,arrozcaldohadtheleast
amountofnutrientsperserving.Meatwasnotaddedtothedevelopedsnackfoodstoavoid
confoundingwiththenutrientsfromthemeat.Flavorenhancerswereaddedinstead.
Characteristicsofstudychildren
There were slightlymore females (53.3 and 54.1% for the experimental and control
groups,respectively)than males in bothstudy groups. Childreninthe experimentalgroup
weresignificantlyolder(9.8±0.5years)comparedwiththecontrolgroup(9.1±0.8years).
Lessthanhalf(40.0%fortheexperimentaland44.3%forthecontrol  group) ofth e
childreninbothstudygroupsgotsickinthepasttwoweeksatbaseline,whereasatend-line

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alowerpercentageforbothgroupswerenoted(datanotshown).
Table1.NutrientcontentofsnacksfoodsandMalunggayleafpowderperserving.
Snack products
Energy and nutrient content
Energy
(kcal)
CHO
(g)
Pro
(g)
Fe
(mg)
Vit. A
(µg)
B2
(mg)
Vit.C
(mg)
Arrozcaldo (210 g)219.640.4 5.1 1.5 0.8 0.10.0
Ginataang mais (210 g)421.571.4 6.4 1.8 6.8 0.10.0
Pancit canton (210 g)342.643.6 8.8 2.5 154.8 0.14.6
Macaroni soup (240 g)262.445.1 9.6 2.4 35.8 0.20.0
Polvoron (60 g)625.477.3 13.7 3.0 192.3 0.52.8
Malunggay leaves powder (3 g)11.51.51 0.8 0.4 225.91No data2.1
1Converted from ß-carotene.
Anthropometricstatus
Baselinemeanweightofchildrenwassimilarforbothgroups(20.45±1.73 and
20.17±2.37kgfortheexperimentalandcontrolgroup,respectively)aspresentedinTable2.
Mean weights for both groups increased significantly (p<0.001), with the control group
havingslightlyhigherincrease.Themeanchangeinweightacross periods between study
groupswasnotsignificant.
Table2.Meanweightandheight(±SD)ofchildrenbystudygroupandperiod.
Variables
Study Group
p-value1 Experimental Control
n=60 n=61
Weight (kg)
Baseline20.45±1.73 20.17±2.37 0.468
End-line21.89±2.18 22.00±2.94 0.813
Difference+1.44 +1.82
p-value20.001 0.001
Height (cm)
Baseline124.68±4.78 123.64±6.69 0.325
End-line126.51±5.01 126.14±6.95 0.742
Difference+1.82 +2.51
p-value0.001 0.001
1Using independent sample t-test.
2Using paired-sample t-test.
Thebaselinemeanheightofstudychildrenintheexperimentalgroup (124.68±4.78
cm)wasnotdifferentwiththatofchildreninthecontrolgroup(123.64±6.69cm).Similarly,
atend-linetheirmeanheightswerenotsignificantlydifferentfromeachother(126.51±5.01
vs.126.14±6.95cm).Themeanchangeinheightbetweenstudygroupswasnotsignificantly
different,whilethemeanchangeinheightfrombaselinetoend-linewithinstudygroupswas
significantlydifferent(p<.001).
ThemeanBMI-for-agez-scoreofchildrenintheexperimentalandcontrolgroupswere
both significantly different across periods but differences were not significant between
groups.
Biochemicalindices
Table 3 showsmean hemoglobin,ferritin,serumretinol,folicacidandEGR-ACofthe
study children. Atthe start of the feeding trial, hemoglobin levels of the experimentaland
controlgroupswerestatisticallythesame(p=0.854).Attheendofthefeedingperiod,mean

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hemoglobinlevelsof theexperimental group increasedby 0.3 gdL-1(p=0.015) andthatof
thecontrolgroupincreasedby0.2gdL
-1(p=0.025). Both had significant increases in
hemoglobinlevelswiththeexperimentalgrouphavingaslightlyhigherincrease.
Table3. Mean concentration (±SD) of hemoglobin, ferritin, serum retinol, folic acid and
EGR-ACbystudygroupandperiod.
Biochemical parameter
Study group
p-value1Experimental Control
n=60 n=61
Hemoglobin (g dL-1)
Baseline12.5±0.10 12.5±0.13 0.854
End-line12.8±0.11 12.7±0.11 0.540
p-value20.015 0.025
Ferritin (ng mL-1)
Baseline53.9±6.11 47.8±3.5 0.386
Endline39.4±3.7 39.4±3.7 0.998
p-value0.010 0.033
Serum rerinol (µg dL-1)
Baseline34.0±0.89 32.9 ± 0.88 0.375
End-line34.8±0.90 34.6 ± 0.85 0.897
p-value0.438 0.036
Riboflavin
Baseline1.03±0.015 1.03 ± 0.021 0.932
End-line1.01±0.016 1.03 ± 0.018 0.487
p-value0.384 0.931
Serum folic acid (ng mL-1)
Baseine
End-line
p-value
8.6±0.32
9.2±0.29
0.047
9.1±0.30
9.4±0.35
0.328
0.241
0.593
1Using Chi-square test.
2Using Independent sample t-test.
Serum ferritin levelsfor both groups were similar at the start of the trial and at the
endof thestudy. Surprisingly, serum ferritinlevelsdecreased significantlyfor both groups
(p=0.01fortheexperimentalgroupandp=0.033forthecontrolgroup).
Table3alsoshowsresultsforretinol,riboflavinandfolatestatusofthechildrenbefore
andafterfeeding.Atthestartandendofthefeedingtrial,boththeexperimentalandcontrol
groupshadadequatevitaminAlevels.TherewasanincreaseinvitaminAconcentrationin
bothgroups.Unexpectedly, however,theincrease in vitaminAconcentration of thecontrol
groupwassignificantlyhigher(p=0.036).Althoughthestudywaslimitedtotheanalysisofa
fewnutrients,otherstudiessuggestthatdriedmoringaleavescontain a relatively high
vitamin E content (Moyo et al., 2006; Sá nchez-Machado et al., 2006; Yang et al., 2006a)
whichcouldhavehadnegativeinteractionwiththebeta-carotenepresent.
There was no change in the riboflavin status of both groups of participants. On the
otherhand,serumfolicacidhadincreasedsignificantly(p=0.042) at the end of the feeding
trialfortheexperimentalgroup.Althoughserumfolicacidalso increased for the control
group,thechangewasnotsignificant.
Energyandnutrientintakeofstudychildren
Meanone-dayenergyandnutrientintakesofthechildrenweredeterminedbeforeand
after the intervention. Table 4 presents the intake of the children during the intervention
period. The control group had higher mean one-day energy intake (1235.13±297.54 kcal)
comparedtotheexperimentalgroup(1131.83±360.58kcal),meeting64.3and74.3%ofthe

298
energy requirement, respectively. There was no change in energy intake from baseline to
end-line for both groups, but end-line energy intake was significantly higher among the
participants in the control group (p=0.016). A similar trend was observed for the other
nutrients,withthecontrolgrouphavinghigherintakescomparedtotheexperimentalgroup.
However,thedifferencesbetweenthetwogroupswerenotsignificant.
Table4. Mean one-day energy and nutrient intake (±SD) of childrenbystudygroupand
period.
Energy and nutrients
Study Group
p-value1 Experimental Control
n=60 n=61
Energy (kcal day-1)
Baseline1131.83±360.58 (64.3) 1235.13±297.54 (74.3)0.088
End-line1510.57±392.46 (85.9) 1684.34±438.87 (101.8)0.023
p-value20.0000.000
Protein (g day-1)
Baseline32.22±12.32 (69.6) 35.34±9.00 (79.8)0.115
End-line42.36±11.94 (91.7) 46.58±13.74 (105.6)0.074
p-value0.0000.000
Iron (mg day-1)
Baseline6.52±2.80 (50.8) 6.99±2.70 (58.5)0.348
End-line8.85±2.21 (70.1) 9.11±2.83 (77.4)0.582
p-value0.0000.000
Vitamin A (µg day-1)
Baseline236.11±150.96 (59.0) 279.82±198.58 (70.0)0.716
End-line515.04±105.00 (128.8) 284.66±124.00 (71.2)0.000
p-value0.0000.869
Vitamin C (mg day-1)
Baseline12.38±15.31 (30.8) 13.16±14.23 (35.5)0.772
End-line14.06±11.41 (36.0) 17.55±34.98 (48.0)0.462
p-value0.0000.000
1Using independent sample t-test.
2Using paired-sample t-test.
DISCUSSION
Moringaolefeira is said to beo ne of theworld’s most useful plants. Almost all ofits
parts–leaves,fruitsandrootshavebeenusedforavarietyoffoodandmedicinalpurposes
(bar.gov.ph).It is anexcellentsourceof nutrition anda natural energybooster. It isloaded
withnutrientsandvitaminsandaminoacids.LocallyknownasMalunggay,itsleavesarerich
inproteinandother nutrients, which canbeused bydoctors, nutritionists andcommunity
healthworkerstotreatundernutritionandavarietyofillnesses(ThurberandFahey,2009).
Malunggayisknowntobeveryrichinseveralmacronutrients,micronutrients and
antioxidants(ThurberandFahey,2009;Oduroetal.,2008)andthusisoneofthepromising
crops that could help alleviate micronutrient deficiencies. To date, there are very few
documentedstudiesonthis.Thus,thepresentstudyaimedtodeterminetheefficacyofMLP
inimprovingtheiron,andvitaminsAandBstatusofFilipinochildren.
Popularsnackfoodssuchasarrozcaldo,ginataangmais,pancitcanton,macaronisoup
andpolvoronwerechosenforthefeedingtrial.Acceptabilitytestswereconductedbeforethe
actualfeedingtrial,however,theamountofMLPaddedwaslimitedbecauseoftheverydark
coloritimpartedtothesnackfoods.Aswell,tasteoffoodwithmorethan3gMLPwasbitter
and unacceptable even for adults. This is lower than the 5-7 g of dried M.oleiferaleaf
powderaddedtodailysaltysnacksof1-5yearoldchildreninIndia(Nambiaret.al.,2003).

299
Nutrientintakeof thechildreninthecontrolgroupatend-linewashigherwhen only
householdfoodandsnackfoodswereconsidered,butthedifferencewasreducedwhenMLP
wasadded.Highestreductionswererecordedforprotein,energy, calcium, vitamin A and
vitamin C intakes. It is widely reported that Malunggayisaveryrichsourceofnutrients.
NutrientsfromtheMLPconsumedbythestudychildrenmaynothaveprovidedtherequired
amountforittoresultinasignificantincreaseinnutrientintakeamongthechildrengiven3
gMLPdailybutresultedinincreaseinheightandweightofthechildren.
InBurkinaFaso,acomplementaryfood(CF)madewithMoringaoleifera seeds, was
testedandcomparedtotheexistingCFinthearea(Compaoréetal.,2011).Thestudywas
conducted among severely malnourished, 6-36 months old infants. Feeding lasted till
childrenwereeligibleforthehome-basedtherapystudywhencomplicationswereresolved
andtheir appetitereturned.Durationof recoverywasabout45daysforthegroupgivenCF
withmoringacomparedtoabout100daysforthegroupgiventheexistingCF.Weightgain
washigher in thosegivenCFwith moringa. However, increase in hemoglobinlevelwasnot
significantintheCFwithmoringa.
The additional nutrients provided by 3 g MLP resulted in minimal changes in the
biochemicalparametersstudied.Asignificantincreaseinhemoglobinwasrecordedforboth
groups.Three grams of MLPprovided0.4 mg Fed-1(Table1),whichunfortunatelywas not
enough to meet the requirement for iron. Moreover, the bioavailability of iron coul d have
beeninhibitedbythepresenceofphytateandfiberinMLP.Ithasbeenshownthataslittleas
2mgphytatecanreduceironabsorptionby18%(Hallbergetal.,1989).Thebioavailability
ofironinMLPwasreportedtobe17.1%(Trinidadetal.,2013).
WehavenotfoundanystudyonefficacyofMLPamong8-10yearoldchildren.Afour-
week intervention study using the maize traditional CF with moringa, among infants 6-12
months, conducted in Nigeria, resulted in an increase in hemoglobin, serum ferritin and
serumretinollevel(Nnam,2009).Likewise,meanhemoglobinlevelsincreasedsignificantly
ina3-monthefficacytrialamongmoderatelyanemiclactatingwomeninSenegal (Idohou-
Dossouet al.,2011). Thesewomen received100 gof MLPeach weekwhichismuchmore
thanwhatwegavetothechildreninthisstudy.Wegave3gday-1 or 21 g week-1. Serum
ferritinlevelsremainedunchangedattheendoftheintervention, which is similar to
findingsofourstudy.Meanferritinlevelsofthechildreninourstudywerenormal.
Malunggayisveryrichinβ-carotenewhicheventuallyconvertstovitamin A. Beta-
carotene and lutein from fresh and dried Malunggay leaves are also highly bioavailable
(PullakhandamandFailla,2007).IncreaseinvitaminAintakeintheexperimentalgroupwas
highlysignificantasaresultofthe3gMLP.Theend-linemean vitamin A intake of the
experimentalgrouphasincreasedtoalevelhigherthanthatoftherequirementforvitamin
Aforthisagegroup.However,thisamountdidnotresultinan increase in serum retinol
levelsofthechildren.Meanserumretinollevelsofthechildrenwerenormalatthestartof
theintervention.Studieshaveshownthatinterventionandsupplementationtrialsaremore
effectiveinthosewithlowmicronutrientlevels.
Asignificant increase inserum folic acidwasrecordedamong the childrengiven3 g
MLP day-1.Thisisanindicatorofrecentintakeofthenutrient.Amonggreen, leafy
vegetables, Malunggay leaves contain the highest dietary folate equivalents amounting to
370 µg 100 g-1 (Food and Nutrition Research Institute-Department of Science and
Technology (FNRI-DOST), 2010a, b). These could have been the drivertoincreasethe
concentrationofserumfolateamongthechildrenintheexperimentalgroup.
CONCLUSIONS
Thefollowingconclusionscanbedrawnfromthestudy:
- Increase inmean hemoglobin levelwas greater forchildren givensnack foodswith
three grams of Malunggay leaf powder compared to those given only snack foods.
However,bothgroupshadasignificantincreaseinhemoglobinlevel.
-ChildrengivensnackfoodswiththreegramsMLPachievedmorethan100%oftheir
dailyvitaminArequirement.
- Improved serum folic acid concentration could be attributed to the high folate

300
content of MLP. Significant increase in serum folic acid level was observed among
childrengivensnackfoodswithMLPbutnotinthecontrolgroup.
ACKNOWLEDGEMENTS
The authors would like to express their deepest gratitude to the following: the
PhilippineCouncil forHealthResearchandDevelopmentforfunding thestudy,DepEdNCR,
parents and student participants. In addition, thank you is extendedtothestaffof
Nutritional Biochemistry Section, Ms. Marites Alibayan, Ms. Joselita Rosario Ulanday, Ms.
AsuncionTorres,Ms.AdorieSabenecio,Ms.EvaRebato,Ms.Ma.Estrella Valle, Ms. Dovie
Domiquel,andMr.HerbertPatalenwhohelpedpreparethesnackfoodsandassistedinfield
data collection; Mr. Carl Vincent Cabanilla for retinol analysis;Mr.JeffreydeLeon,Mr.
EldridgeFerrerandMs.AileenJoyRamosforthestatisticalanalyses.
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