Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Efficacy of Iron-Fortified Ultra Rice in Improving the Iron Status of Women in Mexico Effect of Daily versus Once-Weekly Home Fortification with Micronutrient Sprinkles on Hemoglobin and Iron Status among Young Children in Rural Bangladesh Dual fortification of salt with iodine and micronized ferric pyrophosphate: a randomized, double-blind, controlled trial. Iron fortification of domestic drinking water to prevent anemia among low socioeconomic families in Brazil. Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. The use of NaFeEDTA-fortified fish sauce is an effective tool for controlling iron deficiency in women of childbearing age in rural Vietnam. Maize porridge enriched with a micronutrient powder containing low-dose iron as NaFeEDTA but not amaranth grain flour reduces anemia and iron deficiency in Kenyan preschool children. Dual fortification of salt with iodine and microencapsulated iron: a randomized, double-blind, controlled trial in Moroccan schoolchildren. In a randomized controlled trial of iron fortification, anthelmintic treatment, and intermittent preventive treatment of malaria for anemia control in Ivorian children, only anthelmintic treatment shows modest benefit. A comparative intervention trial on fish sauce fortified with NaFe-EDTA and FeSO4+citrate in iron deficiency anemic school children in Kampot, Cambodia. Studies of the elderly in Boston. I. The effects of iron fortification on moderately anemic peole. Iron-fortified bread. A long-term controlled therapeutic community-based experiment with ferrous sulphate-enriched flour. Effect of iron fortification of nursery complementary food on iron status of infants in the DPRKorea. Oxidative Stress among Non-Anemic Adults following Flour Fortification with Iron: Baseline Data Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized ferric pyrophosphate and encapsulated ferrous fumarate in southern India. Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women. Characterization and Differentiation of Iron Status in Anemic Very Low Birth Weight Infants Using a Diagnostic Nomogram A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. Domestic Drinking Water—An Effective Way to Prevent Anemia among Low Socioeconomic Families in Brazil Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. NaFeEDTA fortified soy sauce showed higher iron absorption rate in Chinese females. Effect of Consuming Zinc-fortified Bread on Serum Zinc and Iron Status of Zinc-deficient Women: A Double Blind, Randomized Clinical Trial
Although iron deficiency is the most common single-nutrient deficiency in infants and children , other deficiencies may develop concurrently , including zinc deficiency . In previous studies , we used home-fortification with " Sprinkles , " single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods , to successfully treat anemia . This mode of micronutrient delivery is amenable to the delivery of other micronutrients . However , the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions . Thus , we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants , compared with Sprinkles formulated with iron alone . We studied 304 anemic infants ( mean age 10.3 + /- 2.5 mo ; hemoglobin 87.4 + /- 8.4 g/L ) in rural Ghana . A combined supplementation group ( FeZn ) received daily Sprinkles containing 80 mg iron and 10 mg zinc ; a comparison group ( Fe ) received Sprinkles ( 80 mg iron ) without zinc for 2 mo . The rate of recovery from anemia was higher in the Fe group compared with the FeZn group ( 74.8 vs. 62.9 % ; P = 0.048 ) . The plasma zinc concentration decreased significantly in both groups ( P < 0.05 ) . A significant decline in the height for age Z-score was observed in the FeZn group ( P = 0.0011 ) , but there was no change in the Fe group . These results suggest that in a controlled setting , home-fortification using micronutrient Sprinkles with iron , or iron and zinc , was very successful in treating anemia ; however , this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population Background Universal fortification of staple foods with iron has been widely promoted as a cost-effective strategy to reduce iron deficiency in developing-country population s. Nonetheless , relatively few efficacy trials have been reported to date to demonstrate impact on iron status . The Ultra Rice technology provides a means of delivering fortificant iron via rice . Objective The objective of this study was to test the efficacy of rice fortified with microencapsulated , micronized iron pyrophosphate to improve the iron status of women in Mexico in a r and omized , controlled intervention trial . Methods Nonpregnant , nonlactating women 18 to 49 years of age were recruited from six factories . The women received a daily portion of cooked rice 5 days per week for a period of 6 months , before and after which iron status indicators were determined in venous blood sample s. Results The average intake of iron from the fortificant was 13 mg/day . Mean plasma ferritin concentration and estimated body iron stores were significantly higher , and transferrin receptors were lower , in the iron-fortified rice group following the intervention . Mean hemoglobin concentration also increased in the treatment group , but the increase was significant only when the analysis was restricted to those with baseline hemoglobin < 12.8 g/dL. The absolute reduction in anemia and iron deficiency was 10.3 and 15.1 percentage points , respectively . Total iron intake from fortificant was a significant covariate of change in body iron stores . The overall prevalence of anemia was reduced by 80 % . Conclusions Fortification of rice with iron using this technology is an efficacious strategy for preventing iron deficiency Background The effectiveness of commonly suggested public health interventions to control  childhood iron- deficiency anemia  has been low . Objective To determine whether iron provided in Sprinkles daily or in a higher dose once weekly affected hemoglobin , serum ferritin levels , and serum transferrin receptor levels , and to determine whether there were dif- ferences in the effects of the two regimens . Methods In this cluster-r and omized , community- based trial conducted in rural areas of Bangladesh , 136 children aged 12 to 24 months with mild to moderate anemia ( hemoglobin 70–109 g/L ) were r and omly allo- cated to receive Sprinkles daily ( 12.5 mg of elemental iron , n = 79 ) or once weekly ( 30 mg of elemental iron , n = 73 ) for 8 weeks . Hemoglobin , serum ferritin , and serum transferrin receptor were assessed at the start and end of the intervention . Results In both groups , there were significant increases in hemoglobin and serum ferritin and a significant decrease in serum transferrin receptor ( p < .01 ) . There were no significant differences between the groups in the increases in hemoglobin ( 16.1 ± 13.2 g/L for the group receiving Sprinkles daily and 12.3 ± 13.3 g/L for the group receiving Sprinkles once weekly ) and serum ferritin ( 10.6 and 5.7 μg/L , respectively ) . The decrease in serum transferrin receptor also did not significantly differ between the groups ( median , −2.5 and −1 . 8 mg/L , respectively ) . The prevalence rates of iron-deficiency anemia , depleted iron stores , and tissue iron deficiency decreased significantly within each group ( p < .01 ) , with no significant differences between the groups . Conclusions Home fortification of complementary foods with Sprinkles given either daily or once weekly improved iron-deficiency anemia and iron status among young children BACKGROUND In many developing countries , children are at high risk for both goiter and anemia . In areas of subsistence farming in rural Africa , salt is one of the few regularly purchased food items and could be a good fortification vehicle for iodine and iron , provided that a stable yet bioavailable iron fortificant is used . OBJECTIVE We tested the efficacy of salt dual-fortified with iodine and micronized ferric pyrophosphate for reducing the prevalence of iodine and iron deficiencies in children . DESIGN In rural northern Morocco , we fortified local salt with 25 microg I ( as potassium io date ) /g salt and 2 mg Fe ( as micronized ferric pyrophosphate ; mean particle size = 2.5 microm)/g salt . After storage and acceptability trials , we compared the efficacy of the dual-fortified salt ( DFS ) with that of iodized salt in a 10-mo , r and omized , double-blind trial in iodine-deficient 6 - 15-y-old children ( n = 158 ) with a high prevalence of anemia . RESULTS After storage for 6 mo , there were no significant differences in iodine content or color lightness between the DFS and iodized salt . During the efficacy trial , the DFS provided approximately 18 mg Fe/d ; iron absorption was estimated to be approximately 2 % . After 10 mo of treatment in the DFS group , mean hemoglobin increased by 16 g/L ( P < 0.01 ) , iron status and body iron stores increased significantly ( P < 0.01 ) , and the prevalence of iron deficiency anemia decreased from 30 % at baseline to 5 % ( P < 0.001 ) . In both groups , urinary iodine ( P < 0.001 ) and thyroid volume ( P < 0.01 ) improved significantly from baseline . CONCLUSION A DFS containing iodine and micronized ferric pyrophosphate can be an effective fortification strategy in rural Africa Iron deficiency anaemia is a most common micronutrient deficiency affecting mostly the low socioeconomic population s of the developing world . The objective of this study was to evaluate the feasibility of iron fortification of household drinking water to prevent iron deficiency anaemia among members of the low socioeconomic families of Southern Brazil . A total of 21 low socioeconomic families representing 88 subjects including 1 - 6 years old children whose haemoglobin level was between 10 and 12 g/dl were selected to participate in this study . Nine families in the control group were supplied with placebo solution and 12 families in the experimental group were supplied iron solution with ascorbic acid to be added to their domestic drinking water over a period of 4 months . The feasibility and acceptability of iron fortified drinking water was assessed through home visits and question naires . Blood sample s were collected at the beginning and after 4 months of the study for the determination of haemoglobin and serum ferritin levels . The results of this study indicated that iron fortified drinking water was well received by the low socioeconomic families and that it was effective in improving the haemoglobin and serum ferritin levels . It can be concluded from this study that iron fortification of household drinking water is a simple and effective alternative for developing countries along with other technological approaches to iron fortification of foods BACKGROUND Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia One cost-effective strategy for controlling iron deficiency is the fortification of staple foods or condiments with iron . We evaluated the effectiveness of fortifying fish sauce with NaFeEDTA for improving iron status in women of childbearing age in Vietnam in a double-blind intervention with r and omization by village . All families in the selected villages were supplied with fish sauce that was either unfortified ( Group C , 10 villages ) or fortified with NaFeEDTA [ 9 mmol ( 500 mg ) Fe/L , Group F , 11 villages ] for 18 mo . The effect of fortification was assessed in the 576 women ( n = 288/group ) by measuring hemoglobin and serum ferritin ( SF ) at 6 , 12 , and 18 mo . Analysis of the group x time interaction using a repeated- measures test for each response demonstrated a significant effect of fortification on hemoglobin ( P = 0.039 ) and log SF ( P < 0.0001 ) in Group F with no significant changes in Group C. The prevalence of iron deficiency ( SF < 12 microg/L ) decreased from 22.3 to 4.0 % and the prevalence of anemia ( hemoglobin < 120 g/L ) from 24.7 to 8.5 % in Group F with no significant changes in Group C. NaFeEDTA fortification of fish sauce is an effective method for reducing the prevalence of iron deficiency in women in Vietnam Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder ( MNP ) containing low doses of highly bioavailable iron to control iron deficiency anemia ( IDA ) in children . We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children . In a 16-wk intervention trial , children ( n = 279 ; 12 - 59 mo ) were r and omly assigned to : unrefined maize porridge ( control ; 4.1 mg of iron/meal ; phytate : iron molar ratio 5:1 ) ; unrefined maize ( 30 % ) and amaranth grain ( 70 % ) porridge ( amaranth group ; 23 mg of iron/meal ; phytate : iron molar ratio 3:1 ) ; or unrefined maize porridge with MNP ( MNP group ; 6.6 mg iron/meal ; phytate : iron molar ratio 2.6:1 ; 2.5 mg iron as NaFeEDTA ) . Primary outcomes were anemia and iron status with treatment effects estimated relative to control . At baseline , 38 % were anemic and 30 % iron deficient . Consumption of MNP reduced the prevalence of anemia [ -46 % ( 95 % CI : -67 , -12 ) ] , iron deficiency [ -70 % ( 95 % CI : -89 , -16 ) ] , and IDA [ -75 % ( 95 % CI : -92 , -20 ) ] . The soluble transferrin receptor [ -10 % ( 95 % CI : -16 , -4 ) ] concentration was lower , whereas the hemoglobin ( Hb ) [ 2.7 g/L ( 95 % CI : 0.4 , 5.1 ) ] and plasma ferritin [ 40 % ( 95 % CI : 10 , 95 ) ] concentrations increased in the MNP group . There was no significant change in Hb or iron status in the amaranth group . Consumption of maize porridge fortified with low-dose , highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children . In contrast , fortification with amaranth grain did not improve iron status despite a large increase in iron intake , likely due to high ratio of phytic acid : iron in the meal BACKGROUND In many developing countries , children are at high risk of both goiter and iron deficiency anemia . OBJECTIVE In a series of studies in northern Morocco , we developed and tested a dual-fortified salt ( DFS ) containing iodine and microencapsulated iron . DESIGN To establish the DFS fortification concentration , we measured salt intake by 3-d weighed food records and estimated iron bioavailability from the local diet by using published algorithms . We then formulated a DFS containing 25 micro g iodine/g salt ( as potassium iodide ) and 1 mg iron/g salt ( as ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil ) . After storage and acceptability trials , we compared the efficacy of the DFS to that of iodized salt in a 9-mo , r and omized , double-blind trial in iodine-deficient , 6 - 15-y-old children ( n = 377 ) . RESULTS Mean salt intake in school-age children was 7 - 12 g/d , and estimated iron bioavailability from the local diet was 0.4 - 4.3 % . After storage for 20 wk , the DFS and iodized salt were not significantly different in iodine content , and color stability was acceptable when the compounds were added to local meals . During the efficacy trial , urinary iodine concentrations and thyroid volumes improved significantly ( P < 0.001 and < 0.05 , respectively ) from baseline in both groups . At 40 wk , mean hemoglobin concentrations in the DFS group had increased by 14 g/L ( P < 0.01 ) , and serum ferritin , transferrin receptor , and zinc protoporphyrin concentrations were significantly better ( P < 0.05 ) in the DFS group than in the iodized salt group . The prevalence of iron deficiency anemia in the DFS group decreased from 35 % at baseline to 8 % at 40 wk ( P < 0.001 ) . CONCLUSION A DFS containing iodine and encapsulated iron can be an effective fortification strategy Anemia is common among children in sub-Saharan Africa and its etiology is multifactorial . Likely causes of anemia are low bioavailability of dietary iron , malaria , and helminth infection . In this study , we aim ed to assess the effect of iron fortification , intermittent preventive treatment ( IPT ) of malaria , and anthelmintic treatment on hemoglobin concentration and anemia prevalence among school children . The study was a 6-mo , r and omized , double-blind , controlled trial enrolling 591 6- to 14-y-old school children in Côte d'Ivoire using the following : 1 ) iron-fortified biscuits providing an additional 20 mg iron/d as electrolytic iron 4 times/wk ; 2 ) IPT of malaria with sulfadoxine-pyrimethamine at 0 and 3 mo ; and 3 ) anthelmintic treatment at 0 and 3 mo as the interventions . Prevalence of anemia , iron deficiency , malaria parasitemia , and helminth infection was 70.4 , 9.3 , 57.7 , and 54.8 % , respectively . Iron fortification did not improve iron status , IPT of malaria did not affect malaria burden , and neither had an impact on anemia prevalence . Anthelmintics significantly reduced the burden of helminth infections and decreased anemia prevalence ( odds ratio : 0.4 , 95 % CI : 0.3 , 0.7 ) . The low prevalence of iron deficiency and an extended dry season that decreased malaria transmission likely reduced the potential impact of iron fortification and IPT . In this setting , anthelmintic treatment was the only intervention that modestly decreased rates of anemia 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 It has been reported that large numbers of elderly Americans are moderately anemic because of iron deficiency anemia . In the present study , information has been obtained concerning blood composition , health , and nutritional habits of 779 people over 60 years of age , institutionalized or free-living in the Boston area . This paper presents the results of their blood examinations . Two hundred twenty-one of the free-living people examined who showed hemoglobin levels between 9 and 12.9 g/dl agreed to participate in an iron fortification study .  Two-thirds of them received iron-fortified grain products daily for 6 to 8 months . The rest received the same foods without added iron . At the end of the experimental period a marked increase in hemoglobin levels averaging 1.4 g/dl was observed in both groups . This appeared to be attributable to an undefined intervention effect ; no measurable effects attributable to the iron fortification were observed . Three months of daily ferrous sulfate administration to those whose hemoglobin levels remained below 13 g/dl was without effect . Examination of the data obtained suggests that the cause of the moderately low hemoglobin levels initially observed was not occult bleeding or folic acid or iron deficiency The hematinic effect of ferrous sulphateenriched flour has been examined in a long-term , community-based experiment . During a period of 20 consecutive months 17000 metric tons of iron-fortified flour were produced at Tau M@lle in Stavanger , Norway ( total iron content 6.2 mg/100 g flour ) . There were neither complaints of rancidity of the flour nor of any harmful effect on its baking qualities . The monitoring of the effect of the iron-fortification programme was performed on an experimental group of 202 women of child-bearing age living in Stavanger . A control group of 215 women was established in Bergen .  Blood examinations ( Hb , Hct and MCHC ) were performed at the start of the experiment and repeated on three occasions during the study . The results failed to give conclusive evidence of the hematinic effect of the iron supplement . However , the results obtained in the few women with the lowest circulating Hlb levels ( Hb < 12 g/lOO ml ) suggested that the added iron was absorbed and utilized for Hb synthesis . The authors have recommended to the Norwegian health authorities that all white flour should be fortified with ferrous sulphate . I mt seems reasonable to apply the same level of enrichment as was recently proposed by the US Commissioner of Food and Drug Administration ( total level of iron 9 mg/ 100 g flour ) . Food fortification is a public health measure aim ed at improving and maintaining the health of individuals in the population through the provision of adequate levels of nutrient intake ( 13 ) . Iron is one of the nutrients which requires special consideration . Based on normal values for Hb concentration and other hematological parameters , we have in previous studies estimated the prevalence of anemia in various population groups ( 18 ) . Iron-deficiency anemia is rather prevalent in Norway : it is not uncommon in schoolchildren and is frequently found in women of reproductive age and in the elderly . At present the level of iron in the average Norwegian diet is only about 4 - 5 mg/l 000 kcal ( 28 , 29 ) . Infants and small children , elderly people , patients and physically inactive individuals with a low caloric intake , as well as those with an increased iron requirement due to growth , convalescence , menstrual bleeding , pregnancy and other special needs , are likely to receive an insufficient supply of iron . The recommended daily intake for women of reproductive age is , for example , 18 mg iron , which should be provided in no more than 1850 - 2 400 kcal ( 4 ) . Thus the lowcalorie consumer ( < 2 000 kcal/day ) requires a diet with no less than 10 mg iron/l 000 kcal in order to satisfy the iron needs . This is theoretically possible to accomplish by choosing foods with a high iron content ( blood , liver , kidneys , wholemeal bread , green vegetables ) . Apart from the fact that blood and entrails are in short supply , it is unrealistic to assume that the majority of people will change their food habits according to these suggestions . An increase in the dietary iron intake might be most easily accomplished through a fortification programme . Iron fortification of the Norwegian brown-cheese with ferrous sulphate was first performed on an experimental scale in the late 1960 's ( 26 ) . In 1972 the enriched cheese became available to the ordinary consumer . The most suitable vehicle , however , for iron fortification would probably be flour and bread . In Great Britain the Bread and Flour Regulations ( 1 ) require that either reduced iron or ferric ammonium citrate shall be added , if necessary , to restore the iron content of flour , other than wholemeal , to at least 1.65 mg/100 g flour . In Acta med . sc and . 194 464 H . Natvig and 0 . D. Vellar Denmark 3 mg iron/l00 g flour is added in the form of reduced iron to wheat and rye flour ( 12 ) . In Sweden iron enrichment of flour ( up to 7 mg iron/100 g flour as reduced iron , ferrous sulphate or ferrous fumarate ) is undertaken on a voluntary basis ( 14 ) . In the USA the level of iron in " enriched " flour is raised to that of wholemeal flour ( 3.5 mg Fe/100 g flour ) . However , the US Commissioner of the Food and Drug Administration has proposed an increase of the level of enrichment to ensure a level of 9 mg Fe/100 g flour ( 3 , 7 ) . Finch and Monsen ( 7 ) emphasize that such manipulation of the public diet carries with it the responsibility for monitoring its effect on the iron balance of the population and on the prevalence of iron deficiency and iron overload . Based on our previous Hb studies ( 18 ) we proposed that the possibility of iron enrichment of flour and bread should be considered also in Norway . I t would be necessary , however , to examine the biological effect of various iron preparations when baked into bread as well as the technological problems relating to the baking process . While iron fortification programmes have been in force for many years in many countries , there appear to have been few thorough attempts to evaluate their effectiveness until recently . Furthermore , the results of these studies have been controversial . Three long-term feeding trials with ferrous carbonate or ferrum-reductum-enriched bread ( 5 , 15 , 25 ) showed no effect on the Hb values . Studies reported by Stott ( 23 ) , however , are at variance with these negative results . Using prisoners , Stott fed ferrous-sulphate-enriched bread for four months and obtained a considerable increase in the Hb concentration . This work , however , has been justifiably criticized because there was no control group , and because the absorption of iron from the added ferrous sulphate would have to have been in excess of 30 % in order to account for the recorded Hb rise during the first two months of supplementation . During a long-term trial we fed ferrous-sulphate-enriched bread to 77 women inmates in a mental hospital ( 24 ) . A control group was given the same bread without fortification . After a 12week period the mean Hb level increased from 13.96 to 14.32 g/100 ml in the experimental group . This increase of 0.36 g/100 ml was statistically significant at the 5 % level . However , the Acta med . sc and . 194 mean Hb increase in the control group was almost as great , but these results were difficult to assess as so many of the controls dropped out . Thus the experiment did not provide convincing proof of the effectiveness of the supplement , In a recent long-term feeding trial by Elwood et al. ( 6 ) the effect of ferric-ammonium-citrateenriched bread was examined . Although the results were not entirely consistent , they indicated a small hematinic effect of the iron supplement . Balance studies ( 9 ) with bread enriched with ferrum reductum , ferrous sulphate of ferric orthophosphate revealed some absorption ( OR an average 3 % ) of the added iron . There was no particular difference in the amount of iron absorbed from the three preparations . In absorption studies ( 24 ) we have found that ferrous-sulphate-enriched bread gave favourable results , with an increase in serum iron values two hours after the test meal . When reduced iron was used for enrichment , the response was not so pronounced . It was also observed that the added ferrous sulphate was better absorbed from white wheaten bread than from wholemeal bread . In radioactive absorption studies Steinkamp et al. ( 22 ) examined the effect of bread enriched with radioactive ferrous sulphate , reduced iron , ferric orthophosphate , and sodium ferric pyrophosphate , and found an equal effectiveness of all four forms of iron used for enrichment . In recent studies Hoglund and Reizenstein ( 10 , ll ) , using more modern technique with a whole body counter , found that the absorption of iron from ferrous-sulphate-enriched bread was much higher than when reduced iron was used for enrichment . When fine grain-reduced iron was used to enrich flour , the absorption was 50 % lower , and when a coarser grain-reduced iron was used , it was 85 % lower , than when ferrous sulphate was used for enrichment . Animal studies performed by Fritz et al. ( 8 , 20 , 21 ) of the biological availability of iron in iron-depleted chicks and rats also indicated that ferrous sulphate has a high relative biological value compared with other iron compounds . I t was also found that ferrous sulphate added to a biscuit mix prior to baking was utilized nearly as well as the same quantity of ferrous sulphate added directly to the test diet ( 8) . When these animal repletion studies were compared with human plasma iron responses following test doses of Iron-fortified bread 465 five sources of iron ( ferrous sulphate , reduced iron , sodium iron pyrophosphate , ferric orthophosphate and ferrous carbonate ) a similar ranking with ferrous sulphate as the best compound was obtained in both experiments ( 21 ) . According to three comprehensive reports on the subject of iron fortification ( 2 , 13 , 16 ) most of the evidence suggests that ferrous sulphate is among the most effective forms . As a supplement to our previous absorption and utilization studies ( 24 ) we felt that a longterm controlled , large-scale community-based feeding trial with ferrous-sulphate-enriched flour and bread should be conducted . Ideally such a trial should evaluate the beneficial effect , if any , on representative sample s of the community in terms of a change in morbidity . However , indices of morbidity are relatively insensitive . Changes in Hb levels and other hematological data might be used , as an indirect measure of health , to assess the immediate effect of the fortification programme , The plan was to supply iron-fortified flour and bread to the entire population in one particular community and to compare the changes in certain hematological data of one group of this experimental area with those obtained in a control group from an area without fortification . MATERIAL AND METHODS Iron enrichment of flour Western Norway was chosen for the trial , as in a previous study we had observed somewhat lower Hb values in the western than in other regions of the country ( 17 ) . Furthermore , in the western region it was also possible , from a practical point 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 Background : It has been suggested that food fortification might be an inexpensive , simple and effective way to control and prevent iron deficiency and its related anemia in many countries . Despite the advantages of this approach and the fact that it has been implemented in some provinces in Iran for more than 6 years , many scientists in the country worry about the negative aspects of the extra iron distributed among non-anemic persons in the community . Objective : This study was design ed to assess the effect of the flour fortification program on oxidative stress biomarkers and iron status among non-anemic 40- to 65-year-old adults . Study Design : This study had a special design that was implemented in 3 different parts . The main and first part was a field study . We r and omized 2 cities in 1 province . In each city , 200 volunteers ( 100 men and 100 women ) were selected using a multi-stage stratified method . Examination and interview ( filling out data collection forms ) were the methods of data gathering . In each of the 3 phases , demographic , anthropometric , blood pressure , micro- and macronutrient intakes , physical activities , and some oxidative stress biomarkers were the main data that were gathered . The results of this study can help health policy makers in design ing future interventions in the country based on food fortification BACKGROUND Dual fortification of salt with iodine and iron could be a sustainable approach to combating iodine and iron deficiencies . OBJECTIVE We compared the efficacy of dual-fortified salt ( DFS ) made by using 2 proposed contrasting formulas-one fortifying with iron as micronized ground ferric pyrophosphate ( MGFePP ) and the other with iron as encapsulated ferrous fumarate (EFF)-with the efficacy of iodized salt ( IS ) in schoolchildren in rural southern India . DESIGN After stability and acceptability testing , a double-blind , household-based intervention was conducted in 5 - 15-y-old children ( n = 458 ) r and omly assigned into 3 groups to receive IS or DFS with iron as MGFePP or EFF , both at 2 mg/g salt . We measured hemoglobin , iron status , and urinary iodine at baseline , 5 mo , and 10 mo . RESULTS Median serum ferritin and calculated median body iron improved significantly in the 2 groups receiving iron . After 10 mo , the prevalence of anemia decreased from 16.8 % to 7.7 % in the MGFePP group ( P < 0.05 ) and from 15.1 % to 5.0 % in the EFF group ( P < 0.01 ) . The median urinary iodine concentration increased significantly in the IS and EFF groups ( P < 0.001 ) but not in the MGFePP group . Losses of iodine in salt with 1.8 % moisture were high for MGFePP , whereas the EFF segregated in salt with 0.5 % moisture and caused color changes in some local foods . CONCLUSIONS Both DFSs were efficacious in reducing the prevalence of anemia and iron deficiency in school-age children . Local salt characteristics should be taken into consideration when choosing an iron fortificant for DFS to achieve optimal iodine stability and color BACKGROUND Fish sauce is consumed daily by a large proportion of the Vietnamese population and could therefore be a potentially useful food vehicle for iron-fortification programs . OBJECTIVE We evaluated the efficacy of iron-fortified fish sauce in improving the iron status of anemic women . DESIGN In a r and omized , double-masked study of 152 anemic ( hemoglobin concentration of 81 - 119 g/L ) women , a meal based on noodles or rice was served 6 d/wk with 10 mL fish sauce containing either 10 mg Fe as NaFeEDTA ( iron-fortified group ) or no added iron ( control group ) . Concentrations of hemoglobin , serum ferritin ( SF ) , and serum transferrin receptor ( TfR ) were measured at baseline and after 3 and 6 mo . RESULTS After 6 mo , hemoglobin and SF concentrations were higher and TfR concentrations were lower in the iron-fortified group than in the control group [ hemoglobin : 116.3 + /- 8.7 ( + /- SD ) compared with 107.6 + /- 11.0 g/L ( P < 0.0001 ) ; SF : 30.9 ( 95 % CI : 23.4 , 40.6 ) compared with 14.6 ( 11.3 , 19.0 ) micro g/L ( P = 0.0002 ) ; TfR : 7.2 ( 6.4 , 7.9 ) compared with 9.0 ( 8.1 , 9.9 ) mg/L ( P = 0.002 ) ] . The prevalence of iron deficiency ( SF < 12 micro g/L or TfR > 8.5 mg/L ) and iron deficiency anemia ( iron deficiency with hemoglobin < 120 g/L ) was lower in the iron-fortified group than in the control group [ 32.8 % compared with 62.5 % ( P = 0.0005 ) and 20.3 % compared with 58.3 % ( P < 0.0001 ) , respectively ] . CONCLUSIONS Regular consumption of iron-fortified fish sauce significantly reduced the prevalence of iron  deficiency anemia in Vietnamese women during the 6-mo intervention . Fortifying fish sauce with iron by using a water-soluble , highly bioavailable compound ( NaFeEDTA ) is a promising strategy for combating iron deficiency anemia in Vietnam Background : In the early weeks of life , very low birth weight ( VLBW ) infants experience intense laboratory blood sampling leading to clinical ly significant anemia and the need for red blood cell transfusion . Although controversial , treatment with recombinant human erythropoietin ( EPO ) and iron has been recommended to stimulate erythropoiesis ; optimal dosing of EPO and iron is still uncertain . Objectives : To assess the validity of a four-quadrant diagnostic plot of iron availability ( ferritin index ) versus iron dem and for erythropoiesis ( reticulocyte hemoglobin content , CHr ) for differentiating iron status in anemic VLBW infants . Methods : Study subjects were enrolled in a previously reported r and omized controlled trial of clinical ly stable VLBW infants < 31 weeks ’ gestation and < 1,300 g at birth to receive 18 days of treatment with : group 1 : oral iron ; group 2 : EPO + oral iron , and group 3 : EPO + intravenous + oral iron . Results : At the end of treatment the ferritin index was significantly higher in both EPO groups compared to the control group . By day 18 , CHr of the control group declined into the quadrant of the diagnostic plot characteristic of functional iron deficiency and anemia of chronic disease . Both EPO groups ended in the quadrants that are characteristic for latent iron deficiency and iron deficiency anemia , respectively . Conclusions : The diagnostic plot for differentiating anemia in VLBW infants may be an informative , clinical ly useful tool for iron status assessment under different physiologic and therapeutic erythropoietic states . Larger additional studies in difficult patient population s are needed before the clinical utility of this diagnostic procedure can be unequivocally confirmed 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 Iron deficiency and iron-deficiency anemia are common in the developing world . We evaluated the feasibility of iron fortification of domestic drinking water to prevent and control iron deficiency and iron-deficiency anemia .  Twenty-one families representing 88 persons , including children , were selected to participate in this study . Twelve families added an iron solution plus ascorbic acid to their domestic drinking water over a four months period and nine families added a placebo . Blood sample s were collected , before and after the four months , for hemoglobin and serum ferritin measurements . Iron-fortified drinking water increased hemoglobin ( children 10.9 ±1.1 g/dl to 11.7 ± 1.1 g/dl p < .01 , adults 12.9 ± 1.7 g/dl to 13.7 ± 1.7 g/dl p < .01 ) and ferritin ( children 27.6 ± 21.6 ng/dl to 33.8 ± 22.1 ng/dl , adults 74.8 ± 41.3 ng/dl to 106.2 ± 93.9 ng/dl p < .05 ) . No significant changes in hemoglobin and ferritin were found in the placebo group after 4 months . Preparation , distribution , and consumption of the solutions were successful . Iron fortification of household drinking water can be a simple and effective alternative to deal with iron deficiency and iron-deficiency anemia in less developed areas 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 OBJECTIVE NaFeEDTA was considered as a promising iron fortificant for controlling iron deficiency anemia .  Soy sauce is a suitable food carrier for iron fortification and is a popular condiment in China .  Iron absorption rates of NaFeEDTA and FeSO4 were observed and compared in adult female subjects . METHODS The stable isotope tracer method was used in Chinese females consuming a typical Chinese diet . Ten healthy young Chinese women were selected as subjects in the 15-day study . A plant-based diet was used based on the dietary pattern of adult women in the 1992 National Nutrition Survey . Six milligram of 54Fe in 54FeSO4 soy sauce and 3 mg 58Fe in Na58FeEDTA soy sauce were given to the same subjects in two days . Food sample s and fecal sample s were collected and analyzed . RESULTS Iron absorption rates of NaFeEDTA and FeSO4 were 10.51 % + /- 2.83 and 4.73 % + /- 2.15 respectively . The 58Fe ( NaFeEDTA ) absorption was significantly higher than that of 54Fe ( FeSO4 ) ( P < 0.01 ) . The iron absorption rate from NaFeEDTA was 1.2 times higher than that from FeSO4 in Chinese adult women consuming a typical Chinese diet . CONCLUSION The higher absorption rate of NaFeEDTA suggested that NaFeEDTA would be a better iron fortificant used in soy sauce for the controlling of iron deficiency anemia in China After iron deficiency , zinc deficiency is the major micronutrient deficiency in developing countries , and staple food fortification is an effective strategy to prevent and improve it among at-risk- population s. No action has been taken to reduce zinc deficiency via flour fortification so far in Iran , and little is known about the influence of zinc fortification of flour on serum zinc and the iron status , and also about the optimum and effective amount of zinc compound that is used in food fortification . The objective of this study is to evaluate the influence of consuming zinc-fortified breads on the zinc and iron status in the blood serum . In this study , three types of bread were prepared from non-fortified and fortified flours , with 50 and 100 ppm elemental zinc in the form of sulfate .  Eighty zinc-deficient women aged 19 to 49 years were r and omly assigned to three groups ; The volunteers received , daily , ( 1 ) a non-fortified bread , ( 2 ) a high-zinc bread , and ( 3 ) a low-zinc bread for one month .  Serum zinc and iron were measured by Atomic Absorption before and after the study . Results showed a significant increase in serum zinc and iron levels in all groups ( p < 0.001 ) except in the control ( p > 0.05 ) . Absorption of zinc and iron in the group that consumed high-zinc bread was significantly greater than that in the group that received low-zinc bread ( p < 0.01 ) . It was concluded that fortification of flour with 50–100 ppm zinc was an effective way to achieve adequate zinc intake and absorption in zinc-deficient people . It also appeared that consuming zinc-fortified bread improved iron absorption
Sensitivity analyses and meta-regression for hemoglobin suggested a higher response with lower trial quality ( suboptimal allocation concealment and blinding ) , use of condiments , and sodium iron edetate and a lower response when adults were included .
Consumption of iron-fortified foods results in an improvement in hemoglobin , serum ferritin , and iron nutriture and a reduced risk of remaining anemic and iron deficient
BACKGROUND The utility of iron fortification of food to improve iron deficiency , anemia , and biological outcomes is not proven unequivocally .