The Effect of Iron Fortification on Iron (Fe) Status and Inflammation: A Randomized Controlled Trial

Abstract

BackgroundIron deficiency (ID) is common in toddlers in developing countries. Iron fortified or meat-based complementary foods may be effective to prevent ID.ObjectiveOur objective was to compare iron status at 18 months and growth from 6 to 18 months in rural poor toddlers fed 3 different complementary foods.MethodsThe study was nested within a larger trial in which 6-month-old infants were randomized to receive 50g/d meat (MG), an equi-caloric fortified cereal supplement (FG) or local cereal supplement (LG) for 1 year. Hb, sTfR, HsCRP, ferritin and AGP were measured in 410 blood samples collected by a random sampling (MG, 137; FG, 140; LG, 133); calprotectin was measured in feces. Body iron = -[log (sTfR ×1000/ferritin)-2.8229] /0.1207. ID = ferritin<12ug/L.ResultsThe toddlers in FG had the significantly highest levels in serum ferritin and body iron (P = 0.043, 0.004), and the rates of both ID and iron deficiency anemia (IDA) were the lowest in FG (P = 0.010, 0.021). The rate of systemic inflammation in FG was 30.71%, which was the highest among three groups (P = 0.042). No intervention effects on either the rates of ID and IDA or iron stores (serum ferritin and body iron) were shown in MG. The change in length-for-age z scores (LAZ) from 6 to 18 months among three groups was significantly different (P = 0.021) and a smaller decrease of LAZ in MG and a larger decrease of LAZ in FG were observed.ConclusionIron fortified cereal improved iron status of poor rural toddlers but was also associated with systemic inflammation which was likely to impair their growth.

Micronutrient-fortified infant cereal improves Hb status and reduces iron-deficiency anaemia in Indian infants: an effectiveness study

“…Limited data are currently available on the impact of lower doses of FeF of less than 5 mg Fe/d. In Chinese infants, a low dose of approximately 1 mg additional Fe/d as FeF from a multi-fortified infant cereal fed for 12 months showed marginally improved SF concentrations and had no effect on Hb (27) . Further evidence on low to moderate doses of FeF is needed.…”

Iron in Micronutrient Powder Promotes an Unfavorable Gut Microbiota in Kenyan Infants

“…Another study [ 10 ] by the same group showed that in older African children, 20 mg/day iron fortification resulted in a significant increase in the abundance of enterobacteria, a decrease in lactobacilli, and a significant increase in fecal calprotectin. Findings from a complementary feeding intervention of older infants, with a larger sample size and longer intervention, suggested that iron-fortified cereal was associated with higher systemic inflammation and impaired linear growth; the effect on the gut microbiota was not reported [ 28 ]. These studies, although differing from our study by the environment, iron dosage, and subjects’ age, all demonstrated the potential pathogen-promoting nature of elevated iron in the human gut in low-resource settings.…”

“…Another limitation, common to other studies, was the lack of long-term follow up. Although the relative abundance of some potential pathogens remained with iron supplementation, it is not clear how this would affect the health status of the host in the long term, for example, in relation to growth [ 28 ]. Lastly, some of infants (in all groups) had already started complementary foods at baseline, but the foods were likely to have been virtually the same as those consumed during the intervention period.…”

Effects of dietary intervention on vitamin B12 status and cognitive level of 18-month-old toddlers in high-poverty areas: a cluster-randomized controlled trial

“…The substudy was nested within a cluster-randomized, nonmasked, controlled efficacy trial conducted from March 2009 to December 2011 in a poor rural area, Xichou County, located in the Yunnan Province of China. Details of the study design have been described elsewhere [8, 9].…”

“…Sixty administrative villages (clusters) in 9 districts in Xichou County were included in this study. Six-month-old infants were randomized to receive 50 g/d of pork (meat group), an equi-caloric micronutrient-fortified rice cereal-based supplement (fortified cereal group), or a local nonfortified rice cereal supplement (local cereal group) for one year [8, 9]. Approximately 20–30 infants were involved in each administrative village.…”