Vehicle For Iron Fortification Research Articles

Key Considerations for Policymakers—Iodized Salt as a Vehicle for Iron Fortification: Current Evidence, Challenges, and Knowledge Gaps

Could DFS help prevent iron deficiency and anemia? Studies in controlled settings (efficacy) demonstrate that double-fortified salt (DFS; iron added to iodized salt) reduces the prevalence of anemia and iron deficiency anemia. Studies in program settings (effectiveness) are limited and reported differing levels of DFS coverage, resulting in mixed evidence of impact on anemia.What iron formulations are available and how do they affect iodized salt? Ferrous sulfate and encapsulated ferrous fumarate (both with various enhancers and/or coating materials) are the main iron formulations currently in use for DFS. Adding iron to iodized salt may lead to adverse changes in the product, specifically discoloration and losses in iodine content. These changes are greatest when the iodized salt used in DFS production is of low quality (e.g., contain impurities, has high moisture, and is of large crystal size). DFS requires iodized salt of the highest quality and a high-quality iron formulation in order to minimize adverse sensory changes and iodine losses. Appropriate packaging of iodized salt is also important to prevent losses.What is known about the minimum requirements to manufacture DFS? DFS producers must use high-quality refined iodized salt meeting the minimum standards for DFS production (which is higher than standards for salt intended for iodization alone), and an iron formulation for which there are rigid quality-assurance measures to ensure consistent quality and blending techniques. The actual proportion of iodized salt meeting the stringent requirements necessary for DFS production is unclear, but likely to be low in many countries, especially those with fragmented salt industries and a low proportion of industrially produced salt.What are the financial implications of adding iron to iodized salt? As a result of higher input costs both for input salt and the iron compound, DFS is more expensive to produce than iodized salt and thus has a higher production cost. Various grades of iodized salt are produced and consumed in different sectors of the market. Experience in India indicates that, on average, producing DFS costs 31–40 US dollars/metric ton or 0.03–0.04 US dollars/kg more than high-quality refined iodized salt. The exact impact of this production-level cost difference on profit margins and consumer price is specific to the conditions of different salt markets. Factors such as transport costs, customary wholesale and retail mark-ups, and taxes all vary greatly and need to be assessed on a case by case basis.Is DFS in alignment with salt-reduction efforts? The WHO has long recognized that salt iodization is an important public health intervention to achieve optimal iodine nutrition and is compatible with salt-reduction goals. Fortification of salt (with any nutrient) should not be used to justify or encourage an increase in salt intake to the public. Any effort to expand salt fortification to other nutrients should be done in close consultation with WHO and those working on salt reduction.What has been the experience with DFS delivery under different platforms? To date, DFS has been introduced into the retail market and in social safety net (primarily in India) programs, but sensory changes in DFS have been raised as concerns. The higher price for DFS has limited expansion in the retail market. In social safety net programs where the cost of DFS is subsidized for beneficiaries, programs must consider long-term resourcing for sustainability.Overall: The optimal production and delivery of DFS are still under development, as many challenges need to be overcome. There is a beneficial impact on hemoglobin in efficacy trials. Thus, if those conditions can be replicated in programs or the technology can be adapted to better fit current production and delivery realities, DFS may provide an effective contribution in countries that need additional food-fortification vehicles to improve iron intake.

Bioavailability of Stabilised Ferrous Gluconate with Glycine in Fresh Cheese Matrix: a Novel Iron Compound for Food Fortification

Iron fortification of foods continues to be one of the preferred ways of improving the iron status of the population. Dairy product is a common product in the diet; therefore, it is a plausible vehicle for iron fortification. This study aims to investigate the bioavailability of ferrous gluconate stabilised with glycine (FGSG) in a fresh cheese fortified with zinc. The iron bioavailability of fresh cheese fortified with either FGSG and with or without zinc and FGSG in aqueous solution and a water solution of ferrous ascorbate (reference dose) was studied using double radio iron ((55)Fe and (59)Fe) erythrocyte incorporation in 15 male subjects. All subjects presented with normal values for iron status parameters. The geometric mean of iron bioavailability for the water solution of FGSG was 38.2 %, adjusted to 40 % from reference doses (N.S.). Iron bioavailability in fresh cheese fortified with Ca and Zn was 15.4 % and was 23.1 % without Zn, adjusted to 40 % from reference doses (N.S.). The results of the present study show that the novel iron compound ferrous gluconate stabilised with glycine in a fresh cheese matrix is a good source of iron and can be used in iron fortification programmes.

Use of Iron as a Fortificant in Whole-Wheat Flour and Leavened Flat Bread in Developing Countries

Among various nutritional strategies to combat iron deficiency, fortification of food is generally considered to be the best and cost effective long-term strategy. Iron is a key micronutrient and an integral part of haemoglobin, required for the transport of oxygen and carbon dioxide in blood. Among the cereals, which the ability of being successfully fortified with iron, wheat has additional advantage to be used as a vehicle. The bioavailability of iron added to wheat is several times greater than other staple foods such as maize and rice. As breads and leavened flat bread are the major portion of routine diet of a large number of population segments in developing countries, so wheat could be used as a vehicle for iron fortification, as the fortification of iron in flour does not show any direct effect on product quality and taste and also it is a low cost staple routine diet. Reduced or elemental iron and FeEDTA do not react with fat in flour and thus do not promote rancidity. The stability of different forms of iron depends on various factors including the nature of the food it is added to, the particle size and the exposure to heat and air. Among the various forms of iron, ferrous sulphate has excellent bioavailability. It is the fortificant of choice when used in bakery flour and other types of low extraction wheat flours and is the best iron source because of its high bioavailability and low cost. Iron fortification of wheat flour and its bakes products is steadily expanding around the world and is expected to remain so with the intend to combat in the battle against the global health problem of iron deficiency anaemia.

Iron bioavailability from iron-fortified Guatemalan meals based on corn tortillas and black bean paste

Corn masa flour is widely consumed in Central America and is therefore a potentially useful vehicle for iron fortification. The goal was to evaluate the bioavailability of iron from meals based on corn tortillas and black bean paste that were fortified with ferrous fumarate, ferrous sulfate, or NaFeEDTA and to investigate the potential of Na(2)EDTA to increase the bioavailability of iron from ferrous fumarate. With use of a crossover study design, iron bioavailability was measured in Guatemalan girls aged 12-13 y by a stable-isotope technique based on erythrocyte incorporation 14 d after intake. Geometric mean iron bioavailability from test meals fortified with ferrous fumarate was 5.5-6.2% and was not improved significantly by the addition of Na(2)EDTA at molar ratios of 1:1 relative to fortification iron or to the total iron content of the fortified corn masa flour. Geometric mean iron bioavailability from test meals fortified with ferrous sulfate was 5.5% and was significantly higher in test meals fortified with NaFeEDTA (9.0%; P = 0.009, paired t test). The bioavailability of iron from ferrous fumarate was not improved by the addition of Na(2)EDTA, contrary to what was previously shown for ferrous sulfate in other cereal-based meals. However, the bioavailability of iron from the test meal was significantly enhanced when NaFeEDTA replaced ferrous sulfate. These results support the use of NaFeEDTA in the fortification of inhibitory staple foods such as corn masa flour.

Influence of iron alone or with fluoride on caries development in desalivated and intact rats.

Sugar is used as a vehicle for iron fortification in communities where anemia is prevalent. The purpose of the present study was to investigate the relationship between caries experience and iron concentration in sugar fed to rats subjected to a severe cariogenic challenge. Desalivated and intact animals were assigned to 4 different diet subgroups, 3 receiving iron sucrose (350, 175 and 88 ppm Fe) and a control group. The influence of iron sugar combined with 10 ppm F in drinking water was explored in an additional study. Iron reduces the incidence of smooth-surface carries in desalivated rats at concentrations as low as 88 ppm Fe. In addition, a combination of iron and fluoride reduced the incidence of dental caries in our rats.

Curry powder as a vehicle for iron fortification: effects on iron absorption

Curry powder was investigated as a vehicle for targeted iron (Fe) fortification, and especially for NaFeEDTA, by assessing its acceptability to consumers and its effects on Fe absorption. A random survey in an Indian community in the Republic of South Africa, indicated that fortified premixed curry powder was acceptable in terms of color, palatability, and stability. The effect of curry powder on Fe absorption from a potato meal was assessed in 64 Indian housewives. Curry powder caused a significant though modest rise in Fe absorption in two of the studies (t = 2.716, p less than 0.05 and t = 3.126, p less than 0.025) but, in the third, the effect was noted only in the more Fe-depleted subjects. There was no enhancement of Fe absorption from a dhal soup of low-Fe bioavailability (t = 0.224, p greater than 0.1). The results of both the human and animal studies suggested that curry powder’s overall mild enhancing effect on Fe absorption was due to its capacity to stimulate gastric acid secretion.

Sugar as a vehicle for iron fortification: further studies

The data presented confirm the advantages of sugar as a vehicle for iron fortification over other vehicles used in the past. The absorption comparison between ferric and ferrous salts added to sugar demonstrated that Fe(III)-EDTA Complex and ferrous sulfate exhibited the highest absorption, while ferric ammonium citrate was poorly absorbed. It was also found that Fe(III)-EDTA reacts slowly with the tannin contained in tea; the color of the tea changes slightly in the first 2 hr after the addition of the fortified sugar. Iron absorption of sugar fortified with ferrous sulfate was tested in seven beverages. The mean absorption ratio from fortified sugar given with beverages to reference dose of iron ascorbate ranged between 0.42 and 0.70, that is, more than 4 times the absorption from fortified sugar when it is administered with a meal containing one or more vegetals. An absorption of between 0.25 and 0.80 mg of iron/soft drink sugar fortified with 3 mg of iron as ferrous sulfate can be expected in subjects with various degrees of iron deficiency. Thus, two soft drinks per day between meals would be enough to meet the iron requirement in more than 95% of menstruating women, even though the daily iron absorption from the diet is about 0.8 to 1.0 mg.