A Functional Food for the Prevention of Iron-deficiency Anemia
Condition: Anemia
MeSH terms: Anemia; Anemia, Iron-Deficiency; Iron Deficiencies
Study type: Interventional
Phase: Phase 1

Summary: 
      It has been estimated that 1 in 2 women expecting a baby will be diagnosed with iron
      deficiency. In turn iron deficiency can affect the health and wellbeing or both mother and
      child. Studies show that low iron stores prior to conception and low iron intakes during
      pregnancy may both be contributing to this problem. Although dietary supplements may be one
      solution, research indicates that daily compliance is low (Nguyen et al., 2008). Furthermore,
      prescribed iron supplements may result in uncomfortable side-effects, including constipation
      (Wulff & Ekstrom, 2003).

      It is been observed in Ethiopia that iron deficiency anemia is lower than average; a finding
      that has been attributed to regular "Teff" consumption (Gies et al., 2003). Teff (Eragrostis
      tef) is a staple food usually consumed in the form of Enjera (flat bread prepared using a
      range of cereals). Research has shown that Teff is a rich source of iron that is easily
      absorbed by the body.

      Although it is believed that regular Teff consumption may prevent to onset of iron deficiency
      anemia there is no research to support this. Therefore, the aim of the present study is to
      es-tablish whether incorporating Teff into the daily diet may be one way to improve blood
      profile and prevent the onset of iron deficiency anemia in expectant mothers. Study findings
      will demonstrate whether Teff may be an alternative source of iron that can be easily
      incorporated into the daily diet of both pregnant mothers and the lay public.
    

Detailed description: 
      Rationale Iron deficiency anemia is considered to be one of the most prevalent forms of
      malnutrition in Europe (Stoltzfus, 2003 & Hercberg et al., 2001). Pregnant mothers are
      particularly susceptible to the onset of iron deficiency anemia (Daily & Wylie, 2008). It has
      been estimated that 1 in 2 pregnant women will be diagnosed with iron deficiency (Scholl,
      2005). During pregnancy maternal plasma volume expands, increasing iron requirements (Scholl
      et al., 2000) whilst dietary intakes generally remain unchanged (Milman, 2006).
      Physiologically, intestinal iron absorption may increase during pregnancy but only after iron
      depletion has already commenced (Milman, 2006). Research strongly suggests that pregnant
      women are not meeting dietary guidelines for iron (Derbyshire et al., 2009).

      A Sheffield (UK) study has reported that pregnant women consume around 10.2mg of iron per day
      (Mouratidou et al., 2006). Another investigation undertaken in a London population found that
      expectant mothers had a mean intake of 10.7mg iron per day (Rees et al., 2005). A further
      study investigating the diet of educated, Caucasian pregnant mothers reported similar figures
      (Derbyshire et al., 2006). Diets deficient in iron during gestation may subsequently affect
      infant health, in both the short and longer term (Scholl & Reilly, 2000). Iron deficiencies
      in pregnancy have been linked to preterm deliveries, reduced infant birth weight, length and
      iron stores (Daily & Wylie, 2008). Low iron stores during periods of infant brain growth may
      permanently impede cognitive development (Lozoff, 2007 & Lozoff & Georgieff, 2006).

      Teff (Eragrostis tef) is a staple food consumed in northern, western and central Ethiopia;
      usually in the form of Enjera (flat bread prepared using a range of cereals, including
      Eragrostis tef) (Umeta et al., 2005). Research has shown that Teff is a rich source of
      bioavailable iron which may be attributed to its low phytate content. Bread made with Tef
      enjera contains around 30mg of iron per 100g and up to 35mg when the food is fermented (Umeta
      et al., 2005). The iron content dramatically exceeds that of common Western foods (Corn
      flakes 7.9mg, boiled brown rice, 0.5mg and brown bread, 2.2mg, all per 100g consumed) (FSA,
      2006). Furthermore, studies have shown that the prevalence of pregnancy iron deficiency
      anemia is relatively low in Ethiopia (Gies et al., 2003) which may be attributed to
      Eragrostis tef forming a staple part of the diet (Haidar et al., 1999).

      Incorporation of Teff into the daily diet of expectant mothers may help to reduce the
      incidence of iron-deficiency anemia. Research shows that women do not adhere to taking large
      tablet supplements (Nguyen et al., 2008). Teff may therefore provide an alternative source of
      dietary iron that can be easily incorporated into the daily diet of both pregnant mothers and
      the lay public.
    

Intervention name(s): Control bread; Teff Bread
Intervention type(s): Other; Other
Intervention description(s): Control bread; Teff bread
Other intervention name(s): Low-iron bread; High-iron bread
Intervention MeSH terms: Iron
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: iron; bioavailability; status; deficiency; anaemia; functional foods; child bearing