Universal iron fortification of foods: the view of a hematologist

Abstract

With the objective of reducing the high incidence of iron deficiency anemia, the Brazilian National Health Surveillance Agency (ANVISA) adopted Resolution 344 in December 2002, which made the addition of iron and folic acid to all industrialized wheat and maize flours in Brazil compulsory. After a series of doubts about this universal measure of food fortification, a review of case reports on long-term medicinal iron intake published in the medical literature was undertaken to investigate the clinical behavior of this hematological conduct. Long-term medicinal iron ingestion is an extremely rare and serious situation. The data suggest that there are cases of hemochromatosis in women whose illnesses were accelerated with this therapy. It is very difficult to determine the amount of iron ingested by Brazilian citizens in the current system of fortification, but there is evidence that there has been an appreciable increase. Although iron fortification of food has been recognized by some authors as a good strategy to combat iron deficiency, some nation shave abandoned this measure. The patient with hemochromatosis is the most affected by compulsory iron fortification and as this disease is now considered a public health problem, we believe that Resolution 344 of ANVISA should be reviewed in order to find a solution beneficial to all segments of the Brazilian population; one should not try to correct one condition (iron deficiency) by exacerbating another (acceleration of iron overload cases).

Partially Hydrolyzed Guar Gum Increases Ferroportin Expression in the Colon of Anemic Growing Rats

“…Iron deficiency is the most prevalent nutritional deficiency in the world, particularly in developing countries, but it is also common in developed countries [1]. According to the World Health Organization, around two billion people, approximately 30% of the population, are anemic, mainly due to alack of iron, which directly impacts the lives of affected people, especially in the late stages [2,3,4].…”

“…Children are among the groups of people vulunerable to iron deficiency anemia due to hematopoiesis, fast growth, and an active metabolic state that requires several micronutrients, especially in the first three years of life [5,6]. Low iron intake, the malabsorption of iron, and monotonous diets with low bioavailability of the mineral, especially in periods of high requirements, are the main causes of anemia [1,6]. …”

Physiology of Iron Metabolism

“…Finally, from a hematologist point of view, universal iron fortification of the food may be problematic, notably for individuals with hemochromatosis and other iron loading diseases [75]. Even if iron fortification of food has been recognized by some authors as a suitable strategy to combat iron deficiency, some health authorities have abandoned it.…”

Goals, globalization and the impact factor of the journal

“…Altimetry sets out to assess the impact as in its definition16 measuring the complete range of repercussions of articles, data and scientific information cited in the lay media, in print and electronic media, and as viewings (internet site visits), downloads, endorsements in the social media and new media, and as an influence to change government policies. 2 , 3 …”

“…Submissions until then had basically been limited to the states of Rio de Janeiro and São Paulo but with this change there was an increase in the numbers of contributions from every state in the country 1 . In order to illustrate this, I will mention subject matters such as the damaging effect of the fortification of flour with iron, 2 , 3 Dengue fever, 4 - 8 the compassionate use of cell therapy in the country, 9 articles on the Associação Médica Brasileira (AMB) and Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) guidelines project 10 - 14 and many others of scientific and national interest that were published and had a great impact. I endorse this and ask the readers a question: would the themes mentioned be accepted by a journal published in another country?…”