Food fortification with multiple micronutrients: impact on health outcomes in general population

Das, Jai K; Mahmood, Salman Bin; Moin, Anoosh; Kumar, Rohail; Mukhtar, Kashif; Lassi, Zohra S; Bhutta, Zulfiqar A

doi:10.1002/14651858.cd011400.pub2

Cited by 56 publications

(54 citation statements)

References 160 publications

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“…22 In terms of evaluation, there are a few studies that have evaluated the impact of different calcium food fortification programs on markers of calcium metabolism in the blood, such as parathyroid hormone, serum calcium, and serum vitamin D. In two studies including 317 children, it was reported that fortification with only calcium resulted in a standard mean difference of -0.28 (95% CI: -0.50 to -0.06) in parathyroid hormone levels and one study in 231 children found a standard mean difference of -0.30 (95% CI: -0.56 to -0.04) in serum calcium levels. 57 In women, three studies with only calcium fortification found a standard mean difference of 0.69 (95% CI: 0.38-1.00) in serum vitamin D levels. The quality of the evidence was low.…”

Section: Evaluation and Impact Of Calcium Food Fortification Programsmentioning

confidence: 99%

Current calcium fortification experiences: a review

Palacios

Hofmeyr

Cormick

et al. 2020

Annals of the New York Academy of Sciences

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Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13-14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.

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Section: Evaluation and Impact Of Calcium Food Fortification Programsmentioning

confidence: 99%

Current calcium fortification experiences: a review

Palacios

Hofmeyr

Cormick

et al. 2020

Annals of the New York Academy of Sciences

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“…Second, we recommend that trial authors use standardized elemental iron dosages, regimes and consumption timing in order to produce more homogenous outcomes ( Camaschella, 2017 ; WHO, 2016 ). Disclosure of the compound and the presence of other micronutrients in each supplement that may affect the outcome is also essential ( Das et al, 2019 ). Third, current literature does not evaluate the potency of IPC and ferrous iron in terms of improvements in relevant clinical outcomes, or the cost-effectiveness of each oral iron supplement.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of iron polymaltose complex in treatment and prevention of iron deficiency anemia in children: a systematic review and meta-analysis

Rosli¹,

Norhayati²,

Ismail³

2021

PeerJ

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Background Iron deficiency anemia (IDA) is commonly treated with iron formulations. Despite the expanding acceptance of iron polymaltose complex (IPC) among clinicians, there is sparse and contradictory evidence regarding its efficacy in the management of IDA in children. This systematic review and meta-analysis aimed to assess the effectiveness of IPC in the treatment and prevention of IDA in children. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE and Epistemonikos for all randomized control trials (RCTs) comparing oral IPC with standard oral iron supplementation for the treatment or prevention of IDA in children. We independently screened the titles and abstracts of identified trials before the full text of relevant trials was evaluated for eligibility. We then independently extracted data on the methods, interventions, outcomes, and risk of bias from the included trials. A random-effects model was used to estimate the risk ratios and mean differences with 95% confidence intervals. Results Eight trials comprising 493 randomized patients were included and analyzed using three comparison groups. The comparison group of which was used to evaluate IPC and ferrous sulphate (FS) for treatment of IDA showed that IPC is less effective in increasing Hb (MD −0.81, 95% CI −1.08 to −0.53; I2 = 48%, P < 0.001; six studies, 368 participants; high certainty of evidence), ferritin (MD −21.24, 95% CI −39.26 to −3.23, random-effects; I2 = 65%, P = 0.020; 3 studies, 183 participants; moderate certainty of evidence) and MCV levels (MD −3.20, 95% CI −5.35 to −1.05; P = 0.003; one study, 103 participants; low certainty of evidence). There was no difference in the occurrence of side effects between IPC and FS group (MD 0.78, 95% CI 0.47 to 1.31; I2 = 4%, P = 0.35; three studies, 274 participants; high certainty of evidence). Conclusions There was moderate to high certainty evidence that FS is superior to IPC with a clinically meaningful difference in improving the Hb and ferritin levels in the treatment of IDA in children. There was no difference in the occurrence of gastrointestinal side effects with high certainty evidence between the IPC and FS groups. The body of evidence did not allow a clear conclusion regarding the effectiveness of IPC with iron gluconate and iron bisglycinate in the prevention and treatment of IDA. The certainty of evidence was low. Adequately powered and high-quality trials with large sample sizes that assess both hematological and clinical outcomes are required. PROSPERO registration number: CRD42019145020

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“…The experience of fortification has been successfully conducted for zinc, iron, selenium, vitamin A, vitamin B complexes (e.g., folate, niacin, thiamine), vitamin C, vitamin D and vitamin E [72] enrichment of foods. It is now well accepted that micronutrient fortification of foods has the potential to significantly increase serum micronutrient concentrations, reduce the incidence of micronutrient deficiencies in public health (e.g., Pellagra, Beriberi, childhood rickets, xerophthalmia), reduce clinical manifestations of deficiencies (including goiter, anemia and neural tube defects), and improve overall nutritional status [73,74].…”

Section: Food Fortificationmentioning

confidence: 99%

Perspective: Practical Approach to Preventing Subclinical B12 Deficiency in Elderly Population

et al. 2021

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Vitamin B12 (also known as cobalamin) is an essential water-soluble vitamin that plays a pivotal role for several physiologic functions during one’s lifespan. Only certain microorganisms are able to synthetize B12, thus humans obtain cobalamin exclusively from their diet, specifically from animal-derived foods. Specific sub-group populations are at risk of vitamin B12 subclinical deficiency due to different factors including poor intake of animal source foods and age-dependent decrease in the capacity of intestinal B12 uptake. Consumption of animal products produces some negative health issues and negatively impacts sustainability while a plant-based diet increases the risk of B12 deficiency. Taking a cue from the aforementioned considerations, this narrative review aims to summarize facts about B12 deficiency and the burden of inadequate dietary intake in elderly population, as well as to discuss sustainable approaches to vitamin B12 deficiency in aging population.

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Food fortification with multiple micronutrients: impact on health outcomes in general population

Cited by 56 publications

References 160 publications

Current calcium fortification experiences: a review

Current calcium fortification experiences: a review

Effectiveness of iron polymaltose complex in treatment and prevention of iron deficiency anemia in children: a systematic review and meta-analysis

Perspective: Practical Approach to Preventing Subclinical B12 Deficiency in Elderly Population

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