The use of iron-fortified wheat flour to reduce anemia among the estate population in Sri Lanka. Efficacy of Iron-Fortified Ultra Rice in Improving the Iron Status of Women in Mexico Use of iron-fortified rice reduces anemia in infants. Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: a double-blind randomized controlled trial. Oxidative Stress among Non-Anemic Adults following Flour Fortification with Iron: Baseline Data Iron fortification of domestic drinking water to prevent anemia among low socioeconomic families in Brazil. Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal. Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren Efficacy of iron-fortified rice in reducing anemia among schoolchildren in the Philippines. 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. Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Efficacy of Pandesal Baked from Wheat Flour Fortified with Iron and Vitamin A in Improving the Iron and Anthropometric Status of Anemic Schoolchildren in the Philippines Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico.
The use of flour fortified with 66 mg/kg of electrolytic or reduced iron to reduce the prevalence of anemia was determined in a two-year , double-blind , controlled trial . The trial was conducted in Sri Lanka among preschoolers between 9 and 71 months old , primary schoolers 6 to 11 years old , and nonpregnant women . At baseline , 18.4 % of the preschoolers had low hemoglobin ( Hb ) concentrations .  Neither electrolytic nor reduced iron had an effect on Hb concentration among preschoolers . Only 7 % of the primary schoolers were anemic at the start of the trial and , again , fortification had no effect on Hb concentration . Twenty-nine percent of women had a low Hb at outset and there was no evidence that fortification had an effect on Hb in this group . The findings from this study suggest that fortification of flour with electrolytic iron or reduced iron was not beneficial in reducing anemia in this population . This was probably due to the low prevalence of anemia and low bioavailability of the fortificant iron . Fortification with either iron fortificant was acceptable 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 Food fortification is advocated to tackle iron deficiency in anemic population s. Our objective was to evaluate the impact of iron-fortified rice ( Ultrarice ( ® ) ) weekly on hemoglobin and anemia levels compared with st and ard rice ( control ) . This cluster-r and omized study deals with infants ( 10 - 23 months ) from two public child day care centers in Brazil , n = 216 , in an 18 week intervention . The intervention group received individual portions of fortified rice ( 50 g ) provided 56.4 mg elemental/Fe . For intervention center : baseline mean hemoglobin was 11.44 ± 1.07 g/dl , and after intervention 11.67 ± 0.96 g/dl , p < 0.029 ; for control : baseline mean hemoglobin value was 11.35 ± 4.01 g/dl , and after intervention 11.36 ± 2.10 g/dl , p = 0.986 . Anemia prevalence for intervention center was 31.25 % at baseline , and 18.75 % at end of study , p = 0.045 ; for control 43.50 % were anemic at baseline , and 37.1 % at the end of study , p = 0.22 . Number Needed to Treat was 7 . Iron-fortified rice was effective in increasing hemoglobin levels and reducing anemia in infants BACKGROUND Iron fortification of rice could be an effective strategy for reducing iron deficiency anemia in South Asia . OBJECTIVE We aim ed to determine whether extruded rice grains fortified with micronized ground ferric pyrophosphate ( MGFP ) would increase body iron stores in children . DESIGN In a double-blind , 7-mo , school-based feeding trial in Bangalore , India , iron-depleted , 6 - 13-y-old children ( n = 184 ) were r and omly assigned to receive either a rice-based lunch meal fortified with 20 mg Fe as MGFP or an identical but unfortified control meal . The meals were consumed under direct supervision , and daily leftovers were weighed . All children were dewormed at baseline and at 3.5 mo . Iron status and hemoglobin were measured at baseline , 3.5 mo , and 7 mo . RESULTS At baseline , the prevalences of iron deficiency and iron deficiency anemia in the total sample were 78 % and 29 % , respectively . After 7 mo of feeding , there was a significant increase in body iron stores in both study groups ( P < 0.001 ) , with a greater increase in the iron group than in the control group ( P < 0.05 ) . There was a significant time x treatment interaction for iron deficiency , which fell from 78 % to 25 % in the dewormed iron group and from 79 % to 49 % in the dewormed control group . Iron deficiency anemia decreased from 30 % to 15 % ( NS ) in the iron group but remained virtually unchanged in the control group ( 28 % and 27 % ) . In sensory tests , the MGFP-fortified rice ( fortified at 3 and 5 mg Fe/100 g ) was indistinguishable from natural rice , in both cooked and uncooked form . CONCLUSIONS Extruded rice fortified with MGFP has excellent sensory characteristics . Fed in a school lunch meal , it increases iron stores and reduces the prevalence of iron deficiency in Indian children 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 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 Although uncommon , iron deficiency ( ID ) occurs in breastfed infants . The regular provision of iron may prevent ID . OBJECTIVE The objective was to test the feasibility and effectiveness of 2 modalities of providing iron ( medicinal iron or iron-fortified cereal ) to breastfed infants . The study tested the hypothesis that regular provision of iron improves iron status of breastfed infants without adverse effects . DESIGN In this prospect i ve , r and omized , open-label trial , breastfed infants received on a regular basis either medicinal iron ( n = 48 ) or an iron-fortified fruit-cereal combination ( n = 45 ) from 4 to 9 mo or no intervention ( control group ; n = 59 ) . The interventions provided 7.0 - 7.5 mg ferrous sulfate/d . Infants were enrolled at 1 mo and were followed to 2 y. Iron-status indicators were determined periodically , stool characteristics were recorded , and growth was monitored . RESULTS The regular provision of iron led to improved iron status during and for some months after the intervention . Both sources of iron were about equally effective . Iron affected stool color but had no effect on feeding-related behavior . However , medicinal iron was associated with a small but significant reduction in length gain and a trend toward reduced weight gain . ID anemia was observed in 4 infants ( 2.3 % ) , most of whom had a low birth iron endowment .  Mild ID was common in the second year of life . CONCLUSIONS Regular provision of medicinal iron or iron-fortified cereal improves the iron status of breastfed infants and may prevent ID . Both modalities are equally effective , but medicinal iron leads to somewhat reduced growth . This trial was registered at Clinical Trials.gov as NCT00760890 The effect of iron fortification is generally assumed to be less than iron supplementation ; however , the magnitude of difference in effects is not known . The present study aims to compare the efficacy of these two strategies on anaemia and iron status . After screening on low Hb , 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a r and omized , placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group , with children in all groups having been dewormed .  Blood sample s were collected before and after intervention for haemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) , C-reactive protein ( CRP ) , and haemoglobinopathies analysis . Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration , SF , TfR , body iron , and anaemic status as outcome variables . The improvement of haemoglobin , SF , and body iron level in the group receiving iron fortification was 42 % ( 2.6 g/L versus 6.2 g/L ) , 20 % ( 23.5 μg/L versus 117.3 μg/L ) , and 31.3 % ( 1.4 mg/kg versus 4.4 mg/kg ) of that in the iron supplementation group . The prevalence of anaemia dropped to 15.1 % in the control group , with an additional reduction of anaemia of 8.5 % in the iron supplementation group . The additional reduction due to iron fortification was 5.4 % , which amounts to well over 50 % of the impact of supplementation . In conclusion , the efficacy of iron fortification based on reduction of prevalence of anaemia , and on the change in haemoglobin level , is about half of the maximum impact of supplementation in case of optimal compliance . Thus , in a population of anaemic children with mild iron deficiency , iron fortification should be the preferred strategy to combat anaemia BACKGROUND Iron deficiency anemia ( IDA ) in the Philippines is a serious public health problem . Fortifying rice offers a great opportunity to control IDA . However , information on other types of fortificants that can be used is scarce . OBJECTIVE To compare the effects of two types of iron fortificants in rice in improving the hematological status of schoolchildren . DESIGN 180 r and omly selected 6-to 9-year-old anemic children were r and omly allocated to three groups in a double-blinded manner : One group received iron-enriched rice ( IER ) with extruded iron premix rice ( IPR ) using ferrous sulfate as fortificant ( ExFeSO4 ) ; the second group received IER with extruded IPR using micronized dispersible ferric pyrophosphate ( ExFeP80 ) ; and the third group received non-fortified rice ( Control ) . These were administered daily for 5 days a week for 6 months . Blood sample s were collected at baseline after 3 and 6 months . RESULTS At baseline , one child in the ExFeP80 group was suffering from IDA ; at 3 months , no IDA was found in any groups ; while at 6 months , one child in the ExFeP80 developed IDA . The baseline prevalence of anemia in all groups , which was 100 % , was significantly reduced to 51 % , 54 % , and 63 % in the ExFeSO4 , ExFeP80 and Control groups respectively . After 6 months , further significant reductions were observed in the ExFeSO4 ( 38 % ) and ExFeP80 ( 33 % ) but remained at 63 % in the Control group . Greater , significant increases were also observed in plasma ferritin in the fortified groups than in the Control group from baseline to 6 months . The predictors of change in hemoglobin ( Hb ) and plasma ferritin were group allocation and basal values . CONCLUSION The consumption of rice fortified with FeP80 using extrusion technology has similar effects as that of FeSO4 in reducing the prevalence of IDA among schoolchildren 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 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 Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries , despite longst and ing efforts to fortify foods or to distribute medicinal supplements to pregnant women . The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients ( iron , iodine , zinc , vitamin A , vitamin C , niacin , riboflavin , folate , vitamin B-12 , vitamin B-6 and vitamin E ) on the hemoglobin , iron and vitamin A status of pregnant women in Tanzania . A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a r and omized double-blind controlled trial in which study women received 8 wk of supplementation .  Hemoglobin , ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period . The supplement result ed in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56 % , respectively . The risk of iron deficiency was reduced by 70 % among those who had iron deficiency at baseline and by 92 % among those who had adequate stores . The micronutrient-fortified beverage may be a useful and convenient preventative measure , one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies 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 BACKGROUND Iron deficiency continues to be a common problem among infants throughout the world .  Iron-fortified formula is effective in preventing iron deficiency but the benefit of iron-fortified cereal is controversial . METHODS We compared iron-fortified rice cereal to unfortified rice cereal in infants who were exclusively breast-fed for more than 4 months and to iron-fortified formula  in infants who were weaned to formula before 4 months of age . The design was double blind in respect to the presence or absence of fortification iron in the cereal or formula and included 515 infants who were followed on the protocol from 4 to 15 months of age .  Rice cereal was fortified with 55 mg of electrolytic iron per 100 g of dry cereal and infant formula with 12 mg of ferrous sulfate per 100 g of dry powder , levels approximating those in use in the United States . Measures of iron status were obtained at 8 , 12 , and 15 months . Infants with hemoglobin levels of < 105 g/L were excluded from the study and treated . RESULTS Consumption of cereal reached plateaus at means of about 30 g/d after 6 months of age in the formula-fed groups and 26 g/d after 8 months in the breast-fed groups ; these amounts are higher than the 19-g/d mean intake by the 73 % of infants who consume such cereal in the United States . Among infants weaned to formula before 4 months , the cumulative percentages of infants excluded for anemia by 15 months were 8 % , 24 % , and 4 % , respectively , in the fortified cereal , unfortified cereal and formula , and fortified formula groups ( P < .01 unfortified vs either fortified group ; the difference between the two fortified groups was not significant ) . In infants breast-fed for more than 4 months , the corresponding values were 13 % and 27 % , respectively , in the fortified and unfortified cereal groups ( P < .05 ) . Mean hemoglobin level and other iron status measures were in accord with these findings . CONCLUSION Iron-fortified infant rice cereal can contribute substantially to preventing iron deficiency anemia Objective : To determine the efficacy of p and esal baked from wheat flour fortified with iron , with or without vitamin A ( VA ) , in improving anemic schoolchildren 's iron and anthropometric status . Methods : Anemic 6- to 12-year-old Filipino children ( n = 250 ) received two 60 g  p and esal daily for 8 months . They were r and omized into 1 of 4 groups : ( 1 ) iron-fortified ( with hydrogen-reduced iron at 80 mg/kg , electrolytic iron at 80 mg/kg , or ferrous fumarate at 40 mg/kg ) , ( 2 ) iron and VA-fortified , ( 3 ) VA-fortified ( at 490 RE/100 g ) , and ( 4 ) nonfortified flour .  Hemoglobin ( Hb ) and zinc protoporphyrin ( ZnPP ) concentrations and weight and height were determined before and after intervention . Analyses of variance and chi-square and multiple regression analyses were performed . Results : Mean Hb increased by 1.3 g/dL ( p < 0.001 ) and mean ZnPP decreased by 24.4 µmol/mol ( p < 0.001 ) after 8 months . Anemia decreased to 26 % and iron deficiency decreased from 58 % to 12 % . After controls were applied for baseline concentration , age , and gender , Hb concentration at post intervention was significantly higher in the Iron + VA group than in the nonfortified group ( coefficient = 0.37 ; p = 0.034 ) . The odds of being iron deficient at post intervention were significantly lower in the Iron group than in the nonfortified group after controls were applied for age , gender , and baseline prevalence ( coefficient = 0.12 ; p = 0.006 ) . None of the 3 fortified groups had significantly different weight-for-age z-score , body mass index-for-age z-score , or height-for-age z-score compared with the nonfortified group after controls were applied for baseline z-scores , age , and gender . Conclusions : Our study shows that in a non – malaria-endemic area , iron fortification of flour significantly reduced the prevalence of iron deficiency among anemic schoolchildren , and double fortification with iron and VA significantly improved Hb status BACKGROUND Anemia during infancy impairs neurodevelopment . Little information has been published about the effectiveness of large-scale programs on anemia and iron-deficiency prevention . OBJECTIVE The objective was to assess the effectiveness of a large-scale program that distributes subsidized iron-fortified milk in Mexico on  anemia and iron deficiency in children aged 12 - 30 mo . DESIGN A double-blinded , group-r and omized effectiveness trial was conducted in 12 milk distribution clusters assigned to consume iron-fortified ( FM ; n = 7 ) or nonfortified ( NFM ; n = 5 ) milk . A daily portion of FM contained 5.28 mg Fe ( ferrous gluconate ) and 48 mg sodium ascorbate . RESULTS Overall treatment effects were documented at 6 and 12 mo for anemia and for iron deficiency assessed by both serum ferritin ( SF ) and serum soluble transferrin receptor ( sTfR ) ( interaction : P < 0.10 ) . Differential effects at 6 mo ( P = 0.004 ) and 12 mo ( P = 0.664 ) were documented only for sTfR. Estimated prevalences ( EPs ) of anemia ( hemoglobin < 110 g/L ) from baseline to 6 and 12 mo decreased from 42.6 % to 19.7 % and 9.4 % , respectively , in the NFM group ( n = 210 ) and from 44.5 % to 12.7 % and 4.0 % , respectively , in the FM group ( n = 357 ) . EPs of SF < 12 mug/L from baseline to 6 and 12 mo changed from 36.0 % to 41.8 % and 17.1 % , respectively , in the NFM group ( n = 43 ) and from 29.8 % to 18.6 % and 5.7 % , respectively , in the FM group ( n = 144 ) . EPs of sTfR > 3.3 mg/L from baseline to 6 and 12 mo decreased from 16.2 % to 8.3 % and 2.0 % , respectively , in the NFM group ( n = 114 ) and from 15.5 % to 0.7 % and 1.1 % , respectively , in the FM group . CONCLUSION A large-scale iron-fortified subsidized-milk program was effective at reducing the rates of anemia and iron deficiency in Mexican children during 12 mo of implementation . This trial was registered at clinical trials.gov as NCT00508131
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 .