Iron deficiency and anemia are prominent contributors to the preventable disease burden worldwide. A substantial proportion of people with inadequate dietary iron rely on rice as a staple food, but fortification efforts are limited by low iron bioavailability. Furthermore, using high iron fortification dosages may not always be prudent in tropical regions. To identify alternative fortification formulations with enhanced absorption, we screened different iron compounds for their suitability as rice fortificants, measured in vitro gastric solubility, and assessed dietary iron bioavailability using stable isotopic labels in rural Ghanaian children. Isotopic incorporation in red blood cells indicates that in the two age groups of children investigated (4 to 6 and 7 to 10 years), formulations provided 36 and 51% of the median daily requirement in absorbed iron, respectively. We describe approaches to enhancing iron bioavailability from fortified rice, which can substantially contribute to the prevention of iron deficiency in rice-eating populations.
Rice fortification can be a viable approach to combat iron deficiency in rice‐consuming populations, but it is crucial to identify micronutrient formulations with high iron bioavailability and acceptable sensory properties. To date, ferric phosphates are the only iron compounds resulting in sensory acceptable iron fortified rice grains.We measured fractional iron absorption (FAFe) from isotopically labeled ferric‐pyrophosphate (54FePP, 57FePP, 58FePP) in a cross‐over multiple meal absorption study. Fortified extruded rice meals either contained: zinc oxide (ZnO; 54FePP+ZnO), zinc sulphate (ZnSO4; 57FePP+ZnSO4), alone or in combination with a citrate buffer CA/TSC (54FePP+ZnO+CA/TSC or 57FePP+ZnSO4+CA/TSC) or ZnO, CA and edetate (EDTA; 58FePP+ZnO+CA+EDTA).Iron depleted school‐age children with and without anemia (N=26) in Northern Ghana were fed six different rice meals (all meals containing 2mg iron) over the course of six weeks. Each type of meal was administered twice daily for five consecutive days. FAFe was compared from meals 54FePP+ZnO, 57FePP+ZnSO4, 54FePP+ZnO+CA/TSC, 57FePP+ZnSO4+CA/TSC, 58FePP+ZnO+CA+EDTA versus non‐fortified extruded rice with 58FeSO4 (reference) added after cooking. FAFe was measured as erythrocyte‐incorporation of stable iron isotopes at least 11 days after meal‐administration.Geometric mean FAFe (95% CI) from meals 54FePP+ZnSO4+CA/TSC (6.3%; 5.3,7.4) and 58FePP+ZnO+CA+EDTA (6.5%; 5.3,8.1) did not differ from the reference (6.6%; 5.4,8.1). FAFe between 57FePP+ZnSO4 (3.5%; 2.7,4.5) and 54FePP+ZnO+CA/TSC (4.4%; 3.6,5.5) was not different, but both differed from 54FePP+ZnSO4+CA/TSC, 58FePP+ZnO+CA+EDTA and the reference (P<0.038), however, 54FePP+ZnO (2.3%; 1.9,2.8) showed the lowest FAFe and significantly differed from all other meals (P<.035).ConclusionsIron absorption from FePP‐fortified rice is affected by both the zinc source (ZnO or ZnSO4) and absorption enhancers (CA/TSC and CA+EDTA). For maximal iron absorption, rice fortification should be implemented using ZnSO4 as the zinc fortificant and CA/TSC or CA+EDTA as iron absorption enhancers.Support or Funding InformationThis study was funded by the Laboratory of Human Nutrition, DSM Nutritional Products, USAID and Abbott Nutrition.
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