Effect of iron fortification of nursery complementary food on iron status of infants in the DPRKorea. Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children. Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population. Evaluation of the effectiveness of stainless steel cooking pots in reducing iron-deficiency anaemia in food aid-dependent populations. Iron intake and iron nutritional status of infants fed iron-fortified beikost with meat. Fermented soyabean and vitamin C-rich fruit: a possibility to circumvent the further decrease of iron status among iron-deficient pregnant women in Indonesia. Effect of an improved local ingredient-based complementary food fortified or not with iron and selected multiple micronutrients on Hb concentration. Efficacy of different iron fortificants in wheat flour in controlling iron deficiency. Ferrous sulfate is more bioavailable among preschoolers than other forms of iron in a milk-based weaning food distributed by PROGRESA, a national program in Mexico. Therapeutic effects of NaFeEDTA-fortified soy sauce in anaemic children in China. Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. Efficacy of a microencapsulated iron pyrophosphate-fortified fruit juice: a randomised, double-blind, placebo-controlled study in Spanish iron-deficient women. Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Dietary practices and nutritional status of 0-24-month-old children from Brazilian Amazonia. A comparative intervention trial on fish sauce fortified with NaFe-EDTA and FeSO4+citrate in iron deficiency anemic school children in Kampot, Cambodia. Efficacy of different strategies to treat anemia in children: a randomized clinical trial Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children. Longitudinal measurements of zinc absorption in Peruvian children consuming wheat products fortified with iron only or iron and 1 of 2 amounts of zinc. Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico. Effect of iron or multiple micronutrient supplements on the prevalence of anaemia among anaemic young children of a malaria-endemic area: a randomized double-blind trial. Iron Nutrition and Growth of Breast- and Formula‐Fed Infants During the First 9 Months of Life
The aim of this study was to determine the iron status of infants who consumed porridge cooked in water with added ferrous sulphate .  A total of 234 infants , aged 6 - 12 months , were recruited from 36 nurseries in the Democratic Peoples Republic of Korea ( DPRK North Korea ) and r and omly divided into iron ( Fe ) and placebo groups . At baseline , almost half the children had Hb<110 g/L and no significant differences between the two groups were found with regard to hemoglobin concentration and anemia prevalence . The Fe group received rice porridge fortified with 10 mg of iron ( as ferrous sulfate ) per day , added to the water in which the rice was cooked and the placebo group non-fortified cereal for 6 months . After which , the hemoglobin ( Hb ) , serum ferritin ( SF ) and packed cell volume ( PCV ) were measured and it was found that the proportion of children with anemia ( Hb<110 g/L ) was lower ( 24.3 % v 48.1 % p<0.01 ) , the Hb levels ( 117.6 g/L v 109.8 g/L p<0.001 ) and serum ferritin were higher ( 40.7 v 26.8 mcg/L p<0.001 ) ; and iron deficiency anemia ( Hb<110 g/L , SF<12 mcg/L ) was lower in the Fe group ( 3 % v 22 % p<0.001 ) when compared to the placebo group . Ferrous sulphate , added to the water in which rice was cooked , lowered the prevalence of iron deficiency anemia of infants in the DPRK with no adverse reactions . This simple fortification would be suitable as a nationwide program in the DPRK and other countries with large infant nurseries In Vietnam , nutrition interventions do not target school children despite a high prevalence of micronutrient deficiencies . The present r and omised , placebo-controlled study evaluated the impact of providing school children ( n 403 ) with daily multiple micronutrient-fortified biscuits ( FB ) or a weekly Fe supplement ( SUP ) on anaemia and Fe deficiency . Micronutrient status was assessed by concentrations of Hb , and plasma ferritin ( PF ) , transferrin receptor ( TfR ) , Zn and retinol . After 6 months of intervention , children receiving FB or SUP had a significantly better Fe status when compared with the control children ( C ) , indicated by higher PF ( FB : geometric mean 36·9 ( 95 % CI 28·0 , 55·4 ) μg/l ; SUP : geometric mean 46·0 ( 95 % CI 33·0 , 71·7 ) μg/l ; C : geometric mean 34·4 ( 95 % CI 15·2 , 51·2 ) μg/l ; P < 0·001 ) and lower TfR concentrations ( FB : geometric mean 5·7 ( 95 % CI 4·8 , 6·52 ) mg/l ; SUP : geometric mean 5·5 ( 95 % CI 4·9 , 6·2 ) mg/l ; C : geometric mean 5·9 ( 95 % CI 5·1 , 7·1 ) mg/l ; P = 0·007 ) . Consequently , body Fe was higher in children receiving FB ( mean 5·6 ( sd 2·2 ) mg/kg body weight ) and SUP ( mean 6·1 ( sd 2·5 ) mg/kg body weight ) compared with the C group ( mean 4·2 ( sd 3·3 ) mg/kg body weight , P < 0·001 ) . However , anaemia prevalence was significantly lower only in the FB group ( 1·0 % ) compared with the C group ( 10·4 % , P = 0·006 ) , with the SUP group being intermediate ( 7·4 % ) . Children receiving FB had better weight-for-height Z-scores after the intervention than children receiving the SUP ( P = 0·009 ) . Vitamin A deficiency at baseline modified the intervention effect , with higher Hb concentrations in vitamin A-deficient children receiving FB but not in those receiving the SUP . This indicates that vitamin A deficiency is implicated in the high prevalence of anaemia in Vietnamese school children , and that interventions should take other deficiencies besides Fe into account to improve Hb concentrations . Provision of biscuits fortified with multiple micronutrients is effective in reducing anaemia prevalence in school children Wheat is the primary staple food for nearly one-third of the world 's population . NaFeEDTA is the only iron ( Fe ) compound suitable for fortifying high extraction flours . We tested the hypothesis that NaFeEDTA-fortified , whole wheat flour reduces Fe deficiency ( ID ) and improves body Fe stores ( BIS ) and cognitive performance in Indian children . In a r and omized , double-blind , controlled , school feeding trial , 6- to 15-y-old , Fe-depleted children ( n = 401 ) were r and omly assigned to either a daily wheat-based lunch meal fortified with 6 mg of Fe as NaFeEDTA or an otherwise identical unfortified control meal .  Hemoglobin ( Hb ) and Fe status were measured at baseline , 3.5 mo , and 7 mo . Cognitive performance was evaluated at baseline and 7 mo in children ( n = 170 ) at one of the study sites . After 7 mo , the prevalence of ID and ID anemia in the treatment group significantly decreased from 62 to 21 % and 18 to 9 % , respectively . There was a time x treatment interaction for Hb , serum ferritin , transferrin receptor , zinc protoporphyrin , and BIS ( all P < 0.0001 ) . Changes in BIS differed between the groups ; it increased in the treatment group ( 0.04 ± 0.04 mmol/kg body weight ) and decreased in the control group ( -0.02 ± 0.04 mmol/kg body weight ) ( P < 0.0001 ) . In sensory tests , NaFeEDTA-fortified flour could not be differentiated from unfortified flour . There were no significant differences in cognitive performance tests between the groups . NaFeEDTA-fortified wheat flour markedly improved BIS and reduced ID  in Fe-depleted children . It may be recommended for wider use in national school feeding programs OBJECTIVE To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification . DESIGN Pre- and post-intervention study using a longitudinal cohort . SETTING Nangweshi refugee camp , Zambia . SUBJECTS Two hundred and twelve adolescents ( 10 - 19 years ) , 157 children ( 6 - 59 months ) and 118 women ( 20 - 49 years ) were selected at r and om by household survey in July 2003 and followed up after 12 months . RESULTS Maize grain was milled and fortified in two custom- design ed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration . During the intervention period mean Hb increased in children ( 0.87 g/dl ; P < 0.001 ) and adolescents ( 0.24 g/dl ; P = 0.043 ) but did not increase in women . Anaemia decreased in children by 23.4 % ( P < 0.001 ) but there was no significant change in adolescents or women . Serum transferrin receptor ( log10-transformed ) decreased by -0.082 microg/ml ( P = 0.036 ) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency ( -8.5 % ; P = 0.079 ) . In adolescents , serum retinol increased by 0.16 micromol/l ( P < 0.001 ) and vitamin A deficiency decreased by 26.1 % ( P < 0.001 ) . CONCLUSIONS The introduction of fortified maize meal led to a decrease in  anaemia in children and a decrease in vitamin A deficiency in adolescents . Central ised , camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations OBJECTIVE To evaluate the effectiveness of stainless steel ( Fe alloy ) cooking pots in reducing Fe-deficiency anaemia  in food aid-dependent population s. DESIGN Repeated cross-sectional surveys . Between December 2001 and January 2003 , three surveys among children aged 6 - 59 months and their mothers were conducted in 110 households r and omly selected from each camp . The primary outcomes were changes in Hb concentration and Fe status . SETTING Two long-term refugee camps in western Tanzania . SUBJECTS Children ( 6 - 59 months ) and their mothers were surveyed at 0 , 6 and 12 months post-intervention . Stainless steel pots were distributed to all households in Nduta camp ( intervention ) ; households in Mtendeli camp ( control ) continued to cook with aluminium or clay pots . RESULTS Among children , there was no change in Hb concentration at 1 year ; however , Fe status was lower in the intervention camp than the control camp ( serum transferrin receptor ( sTfR ) concentration : 6.8 v. 5.9 microg/ml ; P < 0.001 ) . There was no change in Hb concentration among non-pregnant mothers at 1 year . Subjects in the intervention camp had lower Fe status than those in the control camp ( sTfR concentration : 5.8 v. 4.7 microg/ml ; P = 0.003 ) . CONCLUSIONS Distribution of stainless steel pots did not increase Hb concentration or improve Fe status in children or their mothers . The use of stainless steel prevents rusting but may not provide sufficient amounts of Fe and strong educational campaigns may be required to maximize use . The distribution of stainless steel pots in refugee context s is not recommended as a strategy to control Fe deficiency We compared iron intake and iron nutritional status of two groups of healthy term infants who received meat-containing baby foods fortified with ferrous sulphate ( 2 mg Fe/100 g ) . One group received an Fe-fortified formula ( 1.6 mg Fe/100 kcal ) and the other a nonfortified formula . Fe intake of the group fed the nonfortified formula was significantly lower ( p less than 0.0001 ) . These infants received Fe mainly from fortification Fe with beikost ( 75 - 86 % ) and less than 10 % met the recommended intake of 1 mg.kg-1.d-1 ; whereas 80 - 85 % of the infants fed the Fe-fortified formula did . Hb , Hct , FEP , and ferritin were similar in both groups with the exception of lower ferritin values at age 365 d ( p less than 0.05 ) in the group fed the nonfortified formula . No infant had hemoglobin less than 100 g/L. We conclude that regular consumption of commercially prepared Fe-fortified beikost with meat prevents most healthy term infants from Fe deficiency even if Fe intake is substantially below the recommended intake OBJECTIVE Increasing the consumption of Fe-rich foods and thus improving Fe bioavailability without significantly increasing diet cost is the most sustainable intervention for improving Fe intake . We assessed the effect of supplementary food consisting of fermented soyabean ( tempeh ) and vitamin C-rich fruit consumed during pregnancy on  maternal iron deficiency ( ID ) . DESIGN Pregnant women were r and omly allocated by village into optimized diet and control groups . Supplementary food was given 6 d/week at home . The average weekly food provided comprised 600 g of tempeh , 30 g of meat , 350 g of guava , 300 g of papaya and 100 g of orange .  Hb , ferritin and transferrin receptor ( TfR ) concentrations were measured at 12 - 20 and at 32 - 36 weeks of gestation . SETTING Thirty-nine villages in Indonesia . SUBJECTS Pregnant women ( 12 - 20 weeks of gestation , n 252 ) . RESULTS At baseline , mean Hb , ferritin and TfR concentrations and body Fe concentration were within the normal range and did not differ between groups . At near term , mean Hb , ferritin and body Fe decreased , whereas mean TfR increased significantly in both groups . The mean changes in Fe status were similar in both groups . In Fe-deficient women , consumption of an optimized diet was associated with smaller decreases in Hb ( 1·02 ( 95 % CI 0·98 , 1·07 ) g/l ; P = 0·058 ) , ferritin ( 1·42 ( 95 % CI 1·16 , 1·75 ) μg/l ; P = 0·046 ) and body Fe ( 2·57 ( 95 % CI 1·71 , 3·43 ) mg/kg ; P = 0·073 ) concentrations , compared with a state of no intervention . Fe-deficient women at baseline benefited more from supplementary food compared with Fe-replete women . CONCLUSIONS Daily supplementary food containing tempeh and vitamin C-rich fruits during pregnancy might have positive effects on maternal ID OBJECTIVE To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients ( MM ) on  Hb concentration of young children . DESIGN In a nutrition centre that we opened in their villages , children received either MM supplement ( containing iron , zinc , vitamin A , vitamin C and iodine ) with the improved gruel ( MMGG ) or the improved gruel only ( GG ) , twice daily , 6 d/week , for 6 months . We assessed baseline and endpoint Hb concentration and anthropometric indices . SETTING Kongoussi , a rural and poor district of Burkina Faso . SUBJECTS In a community-based trial , we r and omly assigned 131 children aged 6 - 23 months with Hb concentrations in the range of 80 - 109 g/l into two groups . RESULTS The groups did not differ significantly at baseline . Mean baseline Hb concentration was 89·2 ( sd 6·5 ) g/l and 90·3 ( sd 8·4 ) g/l in the GG and the MMGG , respectively ( P = 0·42 ) . It increased to 104·1 ( sd 11·4 ) g/l in the GG ( P < 0·001 ) and 107·6 ( sd 14·7 ) g/l in the MMGG ( P < 0·001 ) . The between-group difference of 3·5 ( 95 % CI -1·0 , 8·1 ) g/l in mean ( sd ) endpoint Hb concentration was not significant ( P = 0·13 ) . The endpoint anthropometric indices were not different between the groups . CONCLUSIONS This MM supplement  had no additional effect on Hb concentration . Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine OBJECTIVE To observe the different impacts of electrolytic iron , FeSO4 , and NaFeEDTA on body iron store of anemic school students . METHODS Four hundreds anemic students at the age of 11 - 18 years were divided into four groups . Of which , three consumed different iron fortificants from wheat flour as food vehicle for six months and one consumed non-fortified flour ( control ) . The fortification level of electrolytic iron , FeSO4 , and NaFeEDTA was 60 mg Fe/kg , 30 mg Fe/kg , and 20 mg Fe/kg , respectively . Blood sample s were collected at 0 , 2 , 4 , and 6 months and hemoglobin ( Hb ) , serum ferritin ( SF ) , and transferrin receptor ( TfR ) were measured . RESULTS The hemoglobin levels in three intervention groups increased , the increments of Hb in the NaFeEDTA group were significantly higher than that in the other groups . SF and TfR levels increased in the tested groups and body iron store in the NaFeEDTA group was higher than that in the other groups . These parameters did not show any significant changes in the control group . CONCLUSION NaFeEDTA and FeSO4 fortified wheat flour has positive impacts on iron status in anemic students and NaFeEDTA is more effective than FeSO4 , while electrolytic iron is less effective in improving iron store in anemic students After 1 y of distributing a milk-based fortified weaning food provided by the Mexican social program PROGRESA , positive effects on physical growth , prevalence of anemia , and several vitamin deficiencies were observed . There was no effect on iron status , which we hypothesized was related to the poor bioavailability of the reduced iron used as a fortificant in PROGRESA . The objective of this study was to compare the iron bioavailability from different iron sources added as fortificants to the weaning food . Children ( n = 54 ) aged 2 - 4 y were r and omly assigned to receive 44 g of the weaning food fortified with ferrous sulfate , ferrous fumarate , or reduced iron + Na(2)EDTA .  Iron absorption was measured using an established double-tracer isotopic methodology . Iron absorption from ferrous sulfate ( 7.9 + /- 9.8 % ) was greater than from either ferrous fumarate ( 2.43 + /- 2.3 % ) or reduced iron + Na(2)EDTA ( 1.4 + /- 1.3 % ) ( P < 0.01 ) . The absorption of log-(58)Fe sulfate given with the iron source correlated with serum ferritin ( s-ferritin ) concentration ( n = 13 , r = 0.63 , P = 0.01 ) and log-(57)Fe absorption ( reference dose ) ( n = 14 , r = -0.52 , P = 0.02 ) . Absorption from ferrous fumarate and reduced iron + Na2EDTA did not correlate with s-ferritin or absorption of (57)Fe . The recommended daily portion of the fortified complementary food provides an average of 0.256 , 0.096 , 0.046 mmol ( 1.44 , 0.54 , and 0.26 mg ) of absorbed iron , if fortified with sulfate , fumarate and reduced iron + Na(2)EDTA , respectively . Ferrous sulfate was more bioavailable than either ferrous fumarate or reduced iron + Na(2)EDTA when added to the milk-based fortified food and more readily met the average daily iron requirements for children 2 - 3 y of age The therapeutic effects of NaFeEDTA-fortified soy sauce on anaemic students were investigated . Three hundred and four iron-deficient anaemic school children ( 11 - 17 years ) were r and omly assigned to three treatment groups : control group ( consuming non-fortified soy sauce ) , low-NaFeEDTA group ( consuming fortified soy sauce , providing 5 mg Fe/day ) and high-NaFeEDTA group ( consuming fortified soy sauce , providing 20 mg Fe/day ) . Blood haemoglobin ( Hb ) levels were determined before and after 1 month , 2 months and 3 months of intervention . In addition , serum iron ( SI ) , serum ferritin ( SF ) , free erythrocytic porphyrin ( FEP ) , total iron binding capability ( TIBC ) and transferritin ( TF ) were measured before and after consumption of soy sauce for 3 months . The results obtained herein show that the parameters measured were not changed remarkably within the 3-month intervention in the control group ( P < 0.05 ) . However , increased Hb , SI , SF and TF levels and decreased TIBC and FEP levels were observed in both the high-NaFeEDTA group ( P < 0.01 ) and the low-NaFeEDTA group ( P < 0.05 ) . The effectiveness of iron intervention in the low-NaFeEDTA group and high-NaFeEDTA group had no statistical significance after 3 months . It was concluded that nutritional intervention for anaemic students using NaFeEDTA-fortified soy sauce could play a positive role in the improvement of iron status and control of anaemia BACKGROUND Iron deficiency anemia is the most prevalent nutrition problem in young children . One possible strategy to prevent iron deficiency anemia in this population group is the fortification of affordable food . OBJECTIVE This study was design ed to assess whether iron-fortified c and ies can improve iron status and are acceptable to children aged 4 - 6 y. DESIGN A double-blind , placebo-controlled intervention study was conducted in Jakarta , INDONESIA : The children were r and omly assigned to 1 of 2 treatment groups : a fortified group ( n = 57 ) and a placebo group ( n = 60 ) . Every week for 12 wk , 30 g ( 10 pieces ) c and y was given to the children . The c and y given to the fortified group contained 1 mg elemental Fe/g and very small amounts of other vitamins and minerals . RESULTS The hemoglobin concentration of the fortified group increased by 10.2 g/L ( 95 % CI : 8.3 , 12 g/L ) whereas that of the placebo group increased by 4.0 g/L ( 2.0 , 6.0 g/L ; P < 0.001 ) . Anemia prevalence decreased from 50.9 % at the start of the intervention to 8.8 % after 12 wk of intervention in the fortified group ( P < 0.001 ) and from 43.3 % to 26.7 % in the placebo group ( P < 0.05 ) . After 12 wk of intervention , the serum ferritin concentration was 71 % higher than at baseline in the fortified group and 28 % higher in the placebo group ( P < 0.001 ) . Acceptability of the iron-fortified c and ies was good . The per capita cost of the supplement was approximately US$ 0.96 - 1.20 for the 12 wk of intervention . CONCLUSION Iron-fortified c and ies were effective for improving the iron status  of young children and might be an affordable way to combat iron deficiency in children of low-to-middle income groups Micronutrient-fortified , cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries , but their nutritional quality is not always optimal . In a double-blind r and omized trial , we compared the efficacy of a locally produced porridge based on maize , beans , bambaranuts , and groundnuts fortified with 19 ( rich ) or 9 ( basal ) micronutrients .  Infants aged 6 mo from Lusaka , Zambia were r and omized to receive the richly fortified ( n = 373 ) or basal ( n = 370 ) porridge daily for 12 mo along with routine vitamin A supplements .  Baseline and final micronutrient status and inflammation ( based on α-1-glycoprotein ) were assessed using nonfasting blood sample s. Baseline prevalence of anemia ( 39 % ) and zinc deficiency ( 51 % ) were a public health concern . There were overall treatment effects on hemoglobin ( Hb ) ( P = 0.001 ) , serum transferrin receptor ( P < 0.001 ) , serum ferritin ( P < 0.001 ) , and serum selenium ( P = 0.009 ) ; biomarker responses for iron and zinc were modified by baseline concentrations , and for Hb and iron by socioeconomic status . At 18 mo , the adjusted odds of anemia , iron deficiency anemia ( Hb < 105 g/L and transferrin receptor > 11.0 mg/L ) , and iron deficiency were 0.37 ( 95 % CI = 0.25 , 0.55 ) , 0.18 ( 0.09 , 0.35 ) , and 0.30 ( 0.18 , 0.50 ) times those in the basal group , respectively . The rich level of fortification had no overall treatment effect on serum zinc ( 1.09 ; 0.66 , 1.80 ) but improved serum zinc in children with lower Hb concentrations at baseline ( P = 0.024 ) . A locally produced cereal- and legume-based infant food richly fortified with micronutrients  reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian infants Fe-deficiency anaemia is a worldwide health problem . We studied the influence of consuming an Fe-fortified fruit juice on Fe status in menstruating women . A r and omised , double-blind , placebo-controlled study of 16 weeks of duration was performed . Subjects were r and omised into two groups : the P group ( n 58 ) or the F group ( n 64 ) , and consumed , as a supplement to their usual diet , 500 ml/d of a placebo fruit juice or an Fe-fortified fruit juice , respectively . The Fe-fortified fruit juice , containing microencapsulated iron pyrophosphate , provided 18 mg Fe/d ( 100 % of the RDA ) . At baseline and monthly , dietary intake , body weight and Fe parameters were determined : total erythrocytes , haematocrit , mean corpuscular volume ( MCV ) , red blood cell distribution width ( RDW ) , Hb , serum Fe , serum ferritin , serum transferrin , transferrin saturation , soluble transferrin receptor ( sTfR ) and zinc protoporphyrin ( ZnPP ) . The fruit juice consumption involved increased intake of carbohydrates and vitamin C , and increased BMI within normal limits . Ferritin was higher in the F group after week 4 ( P < 0·05 ) and became 80 % higher than in the P group after week 16 ( P < 0·001 ) , and transferrin decreased in the F group compared with the P group after week 4 ( P < 0·001 ) . RDW was higher at weeks 4 and 8 in the F group compared with the P group ( P < 0·05 ) . Transferrin saturation increased after week 8 , and haematocrit , MCV and Hb increased after week 12 , in the F group compared with the P group . Serum Fe did not change . sTfR and ZnPP decreased in the F group at week 16 ( P < 0·05 ) . Iron pyrophosphate-fortified fruit juice improves Fe status and may be used to prevent Fe-deficiency anaemia Objective : Fortified spreads ( FSs ) have proven effective in the rehabilitation of severely malnourished children . We examined acceptability , growth and change in blood haemoglobin ( Hb ) concentration among moderately underweight ambulatory infants given FS . Methods : This was a r and omised , controlled , parallel-group , investigator-blind clinical trial in rural Malawi . Six- to 17-month-old underweight infants ( weight for age < −2 ) , whose weight was greater than 5.5 kg and weight-for-height z score greater than −3 received for 12 weeks at home 1 of 8 food supplementation schemes : nothing , 5 , 25 , 50 , or 75 g/day milk-based FS or 25 , 50 , or 75 g/day soy-based FS . Outcome measures included change in weight , length and blood Hb concentration . Results : A total of 126 infants started and 125 completed the intervention . All infants accepted the spread well , and no intolerance was recorded . Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS . Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS . All average gains were largest among infants receiving 50 g of FS daily : mean difference ( 95 % confidence interval ) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g ( range , −130 to 700 g ) , 0.9 cm ( range , −0.3 to 2.2 cm ) , and 17 g/L ( range , 0 to 34 g/L ) for weight , length and blood Hb concentration , respectively . In soy- vs milk-based FS groups , average outcomes were comparable . Conclusions : Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants . Further trials should test this hypothesis OBJECTIVE To assess the nutritional status and dietary practice s of 0 - 24-month-old children living in Brazilian Amazonia . DESIGN Cross-sectional study . Information on children 's dietary intakes was obtained from diet history data . Weight and length were measured for anthropometric evaluation . Fe status was assessed using fasting venous blood sample s ; Hb , serum ferritin and soluble transferrin receptor concentrations were measured . SETTING The towns of Assis Brasil and Acrelândia in the state of Acre , north-west Brazil . SUBJECTS A total of sixty-nine r and omly selected 0 - 24-month-old children . RESULTS Of these children , 40.3 % were anaemic  , 63.1 % were  Fe-deficient  , 28.1 % had  Fe-deficiency anaemia  and 11.6 % were stunted .  Breast-feeding was initiated by 97.1 % of mothers , followed by early feeding with complementary foods . The dietary pattern reflected a high intake of carbohydrate-rich foods and cow 's milk , with irregular intakes of fruit , vegetables and meat . All infants and 92.3 % of toddlers were at risk of inadequate Fe intakes . Fe from animal foods contributed on average 0.5 % and 14.3 % to total dietary Fe intake among infants and toddlers , respectively . CONCLUSIONS Poor nutritional status and inadequate feeding practice s in this study population reinforce the importance of exclusive breast-feeding during the first 6 months of life . Greater emphasis is required to improve the bioavailability of dietary Fe during complementary feeding practice BACKGROUND Inhabitants of agrarian villages of rural Cambodia suffer from high prevalences of iron deficiency and anemia in the context of a monotonous diet . OBJECTIVE To compare the efficacy and safety of placebo Khmer fish sauce to that of 10 mL of fish sauce containing 10 mg of iron , added to daily school meals either as NaFe-EDTA or as FeSO4 + citrate . METHODS 140 students aged 6 - 21 years were enrolled in a double-blinded , placebo-controlled intervention trial . They were r and omly allocated to one of three treatment groups , and followed for 21 weeks during which 114 school meals seasoned with 10 mL of fish sauce were consumed by each participant . Changes in the concentrations of hemoglobin ( hb ) , serum ferritin ( SF ) , and C-reactive protein ( CRP ) and in body weight and st and ing height were determined . Prevalences of vomiting , diarrhea , and acute respiratory infections were monitored weekly . RESULTS Both iron-fortified fish sauces increased hb and SF concentrations significantly as compared to placebo . No significant differences were observed between FeSO4+citrate and NaFe-EDTA fortification , regarding mitigation of iron-deficiency anemia ( IDA ) or regarding CRP , growth , infections , or side-effects . CONCLUSIONS Iron-fortified Khmer fish sauce added to Khmer food is a suitable vehicle for iron fortification in children and adolescents . FeSO4+citrate and NaFe-EDTA show equivalent efficacy and safety Background Anemia continues to be a major public health problem among children in many regions of the world , and it is still not clear which strategy to treat it is most effective . Objective To evaluate the efficacy and children 's acceptance of several recognized strategies to treat anemia . Methods Non-breastfed children ( n = 577 ) , 6 to 43 mo of age , were screened for the trial ; 267 were anemic ( hemoglobin < 11.7 g/dL ) , and 266 of those were r and omized into 1 of 5 treatments to received daily either : an iron supplement ( IS ) , an iron+folic acid supplement ( IFS ) , a multiple micronutrient supplement ( MMS ) , a micronutrient-fortified complementary food as porridge powder ( FCF ) , or zinc+iron+ascorbic acid fortified water ( FW ) . The iron content of each daily dose was 20 , 12.5 , 10 , 10 and 6.7 mg respectively . Hemoglobin ( Hb ) , ferritin , total iron , weight and height were measured at baseline and after 4 months of treatment . Morbidity , treatment acceptability and adherence were recorded during the intervention . Results All treatments significantly increased Hb and total iron concentration ; ferritin did not change significantly . Groups MMS , IS and IFS  increased Hb ( g/dL ) [ 1.50 ( 95%CI : 1.17 , 1.83 ) , 1.48 [ ( 1.18 , 1.78 ) and 1.57 ( 1.26 , 1.88 ) , respectively ] and total iron ( ( μg/dL ) [ 0.15 ( 0.01 , 0.29 ) , 0.19 ( 0.06 , 0.31 ) and 0.12(-0.01 , 0.25 ) , respectively ] significantly more than FCF [ 0.92 ( 0.64 , 1.20 ) ] but not to FW group [ 0.14 ( 0.04 , 0.24 ) ] . The prevalence of anemia was reduced to a greater extent in the MMS and IFS groups ( 72 % and 69 % , respectively ) than in the FCF group ( 45 % ) ( p < 0.05 ) . There were no significant differences in anthropometry or in the number of episodes of diarrhea and respiratory infections among treatment groups . The supplements MMS and IS were less acceptable to children , than IFS , FCF and FW . Conclusion The three supplements IS , ISF and MMS  increased Hb more than the FCF ; the supplements that contained micronutrients ( IFS and MMS ) were more effective for reducing the prevalence of anemia . In general , fortified foods were better accepted by the study participants than supplements . Clinical Trial.gov BACKGROUND Iron deficiency is a major nutritional concern in developing countries , and food fortification is a common strategy to treat it . In Indonesia  wheat flour is fortified with 60 mg Fe/kg , but because of increasing concerns about marginal zinc status in at-risk population s , consideration is being given to cofortifying flour with zinc . However , little is known about the effect of zinc fortification of flour on iron bioavailability or about the optimum form of zinc supplementation . OBJECTIVE We measured iron and zinc bioavailability from wheat-flour dumplings containing 25 g flour fortified with 60 mg Fe/kg , either alone or with 60 mg Zn/kg as zinc oxide or as zinc sulfate . DESIGN Ninety children aged 4 - 8 y were recruited and assigned r and omly to the 3 groups ; 86 completed the study .  Iron and zinc absorption were measured with established stable-isotope methods . RESULTS Iron absorption from the flour fortified with iron only was good ( 15.9 + /- 6.8 % ) , but when corrections were made for hemoglobin concentrations , it was significantly lower from the flour cofortified with zinc sulfate ( 11.5 + /- 4.9 % ; P < 0.05 ) but not from the flour cofortified with zinc oxide ( 14.0 + /- 8.9 % ) . Zinc absorption was not significantly different between the zinc oxide and zinc sulfate cofortified flours ( 24.1 + /- 8.2 % compared with 23.7 + /- 11.2 % ; P = 0.87 ) . CONCLUSIONS Iron and zinc appear to be highly bioavailable from foods made from fortified flour , but zinc sulfate cofortification may have a detrimental effect on iron absorption BACKGROUND Information is needed on the fractional absorption of zinc ( FAZ ) and absorbed zinc ( AZ ) during prolonged exposure to zinc-fortified foods . OBJECTIVE The objective was to measure FAZ and AZ from diets fortified with different amounts of zinc and to determine whether zinc absorption changes over approximately 7 wk . DESIGN Forty-one stunted , moderately anemic children received daily , at breakfast and lunch , 100 g wheat products fortified with 3 mg Fe ( ferrous sulfate ) and 0 ( group Zn-0 ) , 3 ( group Zn-3 ) , or 9 ( group Zn-9 ) mg Zn ( zinc sulfate ) per 100 g flour . FAZ was measured on days 2 - 3 and 51 - 52 ; meal-specific AZs were calculated as the product of FAZ and zinc intake . RESULTS For the breakfast and lunch meals combined , mean total zinc intakes were 2.14 , 4.72 , and 10.04 mg/d in groups Zn-0 , Zn-3 , and Zn-9 , respectively , during the initial absorption studies ; mean ( + /-SD ) FAZ values were 0.341 + /- 0.111 , 0.237 + /- 0.052 , and 0.133 + /- 0.041 , respectively , on days 2 - 3 ( P < 0.001 ) and did not change significantly on days 51 - 52 in the subset of 31 children studied twice . Mean initial AZ was positively related to zinc intake ( 0.71 + /- 0.18 , 1.11 + /- 0.21 , and 1.34 + /- 0.47 mg/d , respectively ; P < 0.001 ) ; final values did not differ significantly from the initial values . CONCLUSIONS AZ from meals containing zinc-fortified wheat products increases in young children relative to the level of fortification and changes only slightly during approximately 7-wk periods of consumption . Although consumption of zinc-fortified foods may reduce FAZ , zinc fortification at the levels studied positively affects total daily zinc absorption , even after nearly 2 mo of exposure to zinc-fortified diets The impact of iron-only supplements ( FE ) versus multiple micronutrient supplements containing iron ( MM ) during pregnancy on iron status was assessed in a sub sample ( n = 453 ) of women who participated in a r and omized double-blind trial in Mexico . Compliance , monitored by observation , was high ( > 85 % ) . The two groups were similar at recruitment ( < 13 wk gestation ) for various sociodemographic characteristics and for mean hemoglobin ( Hb ) concentrations and prevalence of anemia ( Hb < 110 g/L ; 11 % ) . However , mean serum ferritin was higher ( P < 0.05 ) in the MM group ( n = 142 ) compared to the FE group ( n = 148 ) and the prevalence of iron deficiency ( serum ferritin < 12 micro g/L ) was lower in the MM group ( 44.4 % ) compared to the FE group ( 57.4 % ) . By the third trimester , almost half the women were anemic in both groups , and mean Hb ( g/L ) was lower for the MM group ( 104.2 ; 95 % CI : 102.5 , 106.0 ) compared to the FE group ( 108.1 ; 95 % CI : 106.4 , 109.8 ) after adjusting for baseline serum ferritin . In contrast , there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum ( 90.9 and 45.1 % for the MM group ; 92.6 and 47.3 % for the FE group , respectively ) . In conclusion , rather than improve Hb or iron status relative to FE-only supplements as hypothesized , MM supplements may have slightly reduced Hb concentrations during pregnancy . Neither supplement was able to meet iron needs as evidence d by dramatic increases in anemia and iron deficiency by the end of pregnancy OBJECTIVE To assess the effect of supplementation with iron or multiple micronutrients ( MM ) on the prevalence of anaemia in a malaria-endemic area . METHODS A community-based r and omized double-blind trial was conducted in rural Burkina Faso , including children aged 6 - 23 months with haemoglobin ( Hb ) concentrations of 70 - 109 g/l who were r and omized into an iron group ( Fe , n = 96 ) , an iron and zinc group ( IZ , n = 100 ) or an MM group ( MM , n = 100 ) , 5 days/week for 6 months . All children were provided with insecticide-treated bednets ; those who had a Plasmodium falciparum ( PF ) positive-smear at baseline and /or at each monthly checking received antimalarial therapy . RESULTS The mean ( SD ) endpoint Hb concentration was higher in the MM group [ 113.2 ( 13.6 ) g/l ] than in the IZ group [ 106.3 ( 15.6 ) g/l ] and the Fe group [ 107.1 ( 12.9 ) g/l ] ( P = 0.001 ) . Children in the MM group were more likely to recover from anaemia than those in the Fe group [ prevalence rate ratios , PRR ( 95 % confidence interval , CI ) = 1.62 ( 1.22 - 2.15 ) , P < 0.001 ] . The IZ group did not differ from the Fe group [ PRR ( 95 % CI ) = 0.94 ( 0.65 - 1.35 ) , P = 0.72 ] . None of the interactions on the effect of supplementation of baseline age ( 0.13 ) , or baseline height-for-age z-score ( P = 0.33 ) , or incident PF parasitemia ( P = 0.99 ) , was significant . CONCLUSION In this malaria-endemic area , in combination with malaria management , the MM supplement was more efficacious than the Fe supplement and the IZ supplement for reducing anaemia . Further investigation into limiting factors and amounts of micronutrients that would be more efficacious for reducing anaemia is recommended Feeding of iron (Fe)-fortified ( 12–15 mg/L ) infant formulas is an effective and convenient means to protect infants from Fe deficiency . To study lower levels of Fe fortification of infant formulas ( 3 or 6 mg/L ) compared with those currently in use , we compared Fe intake and Fe nutritional status of three groups of healthy , term infants between 90 and 274 days of age . One group received an Fe-fortified whey-predominant formula ( 3 mg/ L ) and the second group received the same formula with a higher Fe level ( 6 mg/L ) . A comparison group was breast-fed at least until 274 days of age . All infants received infant foods and cereals according to European Community recommendations . Mean Fe intake of infants fed formula fortified with 3 mg/L was significantly lower at 183 and 274 days of age ( p < 0.05 ) than that of infants fed formula fortified with 6 mg/L. None of the infants fed the formula fortified with 3 mg/L met the recommended daily allowance value ( 10 mg ) for infants between 6 and 12 months of age . Hemoglobin , hematocrit , mean corpuscular volume , free erythrocyte protoporphyrin , and serum ferritin levels were similar in the formula-fed groups ; none of the infants had depleted Fe stores ( ferritin < 10 μg/L ) at 183 and 274 days of age . Thirteen percent of breast-fed infants had depleted Fe stores at 183 days of age , but only 3 % were depleted at 273 days of age , when Fe-fortified beikost was already part of the diet . No influence of Fe nutritional status was found on zinc and copper nutritional status or on growth . We conclude that regular consumption of an infant formula fortified with 3 mg Fe/L , a level substantially below present recommendations , prevents healthy , term infants from developing Fe deficiency during the first 6 months of life . It is preferable that infants 6 months of age and older receive an Fe-fortified formula and a judicious selection of beikost to ensure an adequate dietary intake of Fe
We observed an association between intake of Fe-fortified foods  and Hb concentration in children aged < 10 years .
Fe-fortified foods could be an effective strategy for reducing Fe-deficiency anaemia in children
OBJECTIVE To combine evidence from r and omized controlled trials to assess the effect of Fe-fortified foods on mean Hb concentration in children ( < 10 years ) .