Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: a double-blind randomized controlled trial

Moretti, Diego; Zimmermann, Michael; Muthayya, Sumithra; Thankachan, Prashanth; Lee, Tung-Ching; Kurpad, Anura V; Hurrell, Richard F.

doi:10.1093/ajcn/84.4.822

Cited by 136 publications

(118 citation statements)

References 45 publications

(50 reference statements)

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“…Biotechnology may also provide crops with decreased phytate content and, hence, less interference with iron absorption. A strategy of using ferrous sulphate or ferric pyrophosphate for rice and flour fortification may provide up to 40% of the recommended daily intake of iron from these commonly consumed foodstuffs alone [41][42][43].…”

Section: Discussionmentioning

confidence: 99%

Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

Rammohan¹,

Awofeso²,

Robitaille³

2012

ISRN Public Health

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Objectives. We examined the influence of vegetarian diet on the risk of developing anaemia among Indian women and suggest initiatives for addressing diet-related iron-deficiency anaemia. Methods. We analysed data on diet, social class, and haemoglobin levels from the nationally representative Indian National Family and Health Survey 2005/06 for a sample of 81,301 women aged 15-49 years using logistic regression models. Results. After controlling for individual-level factors and household level socioeconomic characteristics, daily consumption of meat, fish, and eggs was associated with lower odds of being moderately or severely anaemic. Our analysis also revealed that economic characteristics such as being from higher wealth quintiles, being in paid employment, and rural residence reduced the odds of having iron-deficiency anaemia among Indian women. Discussion. As a large proportion of Indians subsist on iron-poor vegetarian diets for religious, economic, and cultural reasons, large-scale iron supplementation and fortification of commonly consumed vegetarian foodstuffs constitute a feasible, culturally appropriate, and cost-effective strategy for addressing this major public health problem. Consumption of cheap iron-rich foodstuffs should be promoted. Effective poverty alleviation and hookworm prevention programs are also important. Large-scale cohort and intervention studies are urgently required to further define the influence of vegetarianism on iron deficiency anaemia in India.

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Section: Discussionmentioning

confidence: 99%

Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

Rammohan¹,

Awofeso²,

Robitaille³

2012

ISRN Public Health

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“…33 Baseline and intervention studies in children The four pediatric studies analyzed in this paper were baseline surveys followed by controlled efficacy trials of iron fortification, and have been reported elsewhere. [34][35][36] From the baseline surveys, we included all children in this analysis; from the intervention trials, because we wanted to examine the effect of weight status on response to the iron treatment, we included only children from the iron treatment groups. Body weight was measured using a digital scale to the nearest 100 g and height was measured using a rigid stadiometer or a nonstretchable pull-down measuring tape to the nearest 0.5 cm.…”

Section: Methodsmentioning

confidence: 99%

“…36 In the first, urban, 6-to 13-year-old children were given a rice-based lunch meal fortified with 20 mg Fe as ferric pyrophosphate for 7 months. 36 The second study was in a semi-rural area south of Bangalore, where 5-to 16-year-old children were given fortified salt containing 2 mg Fe per gram salt as ferric pyrophosphate or encapsulated ferrous fumarate for 9 months (Personal communication; Maria Andersson, 2008). The study protocols were approved by the respective ethical committees in Morocco and India, as well as at the ETH Zurich, Switzerland.…”

Section: Methodsmentioning

confidence: 99%

Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification

et al. 2008

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Background: Overweight is increasing in transition countries, while iron deficiency remains common. In industrialized countries, greater adiposity increases risk of iron deficiency. Higher hepcidin levels in obesity may reduce dietary iron absorption. Therefore, we investigated the association between body mass index (BMI) and iron absorption, iron status and the response to iron fortification in populations from three transition countries (Thailand, Morocco and India). Methods: In Thai women (n ¼ 92), we examined the relationship between BMI and iron absorption from a reference meal containing B4 mg of isotopically labeled fortification iron. We analyzed data from baseline (n ¼ 1688) and intervention (n ¼ 727) studies in children in Morocco and India to look for associations between BMI Z-scores and baseline hemoglobin, serum ferritin and transferrin receptor, whole blood zinc protoporphyrin and body iron stores, and changes in these measures after provision of iron. Results: In the Thai women, 20% were iron deficient and 22% were overweight. Independent of iron status, a higher BMI Z-score was associated with decreased iron absorption (P ¼ 0.030). In the Indian and Moroccan children, 42% were iron deficient and 6.3% were overweight. A higher BMI Z-score predicted poorer iron status at baseline (Po0.001) and less improvement in iron status during the interventions (Po0.001). Conclusions: Adiposity in young women predicts lower iron absorption, and pediatric adiposity predicts iron deficiency and a reduced response to iron fortification. These data suggest the current surge in overweight in transition countries may impair efforts to control iron deficiency in these target groups. Interactions of the 'double burden' of malnutrition during the nutrition transition may have adverse consequences.

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“…However, FePP in general is less than half as well absorbed as FeSO 4 in humans (14,15) . Nevertheless, the efficacy of FePP to reduce anaemia or ID has been shown in several randomised controlled trials (3,6,(16)(17)(18) . Limited evidence exists on potential enhancers of Fe bioavailability from FePP.…”

mentioning

confidence: 99%

Sodium pyrophosphate enhances iron bioavailability from bouillon cubes fortified with ferric pyrophosphate

et al. 2016

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Fe fortification of centrally manufactured and frequently consumed condiments such as bouillon cubes could help prevent Fe deficiency in developing countries. However, Fe compounds that do not cause sensory changes in the fortified product, such as ferric pyrophosphate (FePP), exhibit low absorption in humans. Tetra sodium pyrophosphate (NaPP) can form soluble complexes with Fe, which could increase Fe bioavailability. Therefore, the aim of this study was to investigate Fe bioavailability from bouillon cubes fortified with either FePP only, FePP + NaPP, ferrous sulphate (FeSO 4 ) only, or FeSO 4 + NaPP. We first conducted in vitro studies using a protocol of simulated digestion to assess the dialysable and ionic Fe, and the cellular ferritin response in a Caco-2 cell model. Second, Fe absorption from bouillon prepared from intrinsically labelled cubes (2·5 mg stable Fe isotopes/cube) was assessed in twenty-four Fe-deficient women, by measuring Fe incorporation into erythrocytes 2 weeks after consumption. Fe bioavailability in humans increased by 46 % (P < 0·005) when comparing bouillons fortified with FePP only (4·4 %) and bouillons fortified with FePP + NaPP (6·4 %). Fe absorption from bouillons fortified with FeSO 4 only and with FeSO 4 + NaPP was 33·8 and 27·8 %, respectively (NS). The outcome from the human study is in agreement with the dialysable Fe from the in vitro experiments. Our findings suggest that the addition of NaPP could be a promising strategy to increase Fe absorption from FePP-fortified bouillon cubes, and if confirmed by further research, for other fortified foods with complex food matrices as well.Key words: Iron bioavailability: Iron fortification: Ferric pyrophosphate: Bouillon cubes: Sodium pyrophosphate Fe deficiency (ID) is the most common aetiological factor for anaemia globally, and between 35 and 65 % of the anaemia burden in low-income regions in Africa, Asia and Latin America is attributable to ID (1) . Food fortification is regarded as a safe and cost-effective approach to counteract and prevent ID as long as the targeted populations consume significant quantities of industrially manufactured fortified foods (2) . Condiments are promising vehicles for fortification as they are among the very few regularly purchased food items in resource-poor areas (3) , and Fe-fortified condiments have been shown to be efficacious in improving Fe status (4)(5)(6)(7) .Bouillon cubes are a promising vehicle for Fe fortification, particularly in sub-Saharan Africa where previous national surveys have reported a high proportion of Burkinabe, Cameroonian, Nigerian, Senegalese and Ivorian women (79-96 %) who consumed bouillon cubes regularly (8)(9)(10) . However, ensuring the bioavailability of Fe and the stability of the cubes in these climates is challenging. Water-soluble Fe compounds such as ferrous sulphate (FeSO 4 ) provide the most bioavailable Fe but induce oxidative rancidity noticeable to consumers at very low levels (11) as well as other unwanted sensorial defects of the product in...

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Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: a double-blind randomized controlled trial

Cited by 136 publications

References 45 publications

Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification

Sodium pyrophosphate enhances iron bioavailability from bouillon cubes fortified with ferric pyrophosphate

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