Fortifying complementary foods with NaFeEDTA – considerations for developing countries

Abstract

As a highly bioavailable iron compound, sodium iron (iii) ethylenediaminetetraacetate (NaFeEDTA) has been recommended as a food additive for fortification. The amount of a food additive that can be ingested daily over a lifetime without appreciable health risk is termed the acceptable daily intake (ADI). The ADI for NaFeEDTA is based on body weight. For complementary foods and food supplements for infants and young children in low-income countries, where prevalence of underweight is high yet nutrient needs are also high, it is not clear which doses might be appropriate. The objective is to calculate the dosage of NaFeEDTA for fortifying complementary foods assuming different population prevalences of underweight. Mathematical models were used to simulate the dosage of NaFeEDTA for 6-to 8-month-old infants under different prevalences of underweight ranging from 5% to 40%. In order to keep NaFeEDTA intake below the ADI for ethylenediaminetetraacetate (EDTA) recommended by the Joint Food and Agriculture Organization (FAO)/World Health Organization (WHO) Expert Committee on Food Additives for 95% of 6-to 8-month-old infants, the daily iron dose from NaFeEDTA in fortified complementary foods should be set between 2.2 mg and 1.8 mg in countries with a prevalence of underweight among 6-to 8-month-old infants between 5% and 40%, respectively. If 2 mg of iron is given to all 6-to 8-month-old infants, the percentage exceeding the ADI for EDTA would be <10% for populations with <30% of children who are underweight, which is the case for many countries. In conclusion, 2 mg of iron from NaFeEDTA could be used for fortifying one daily serving of complementary food to ensure EDTA levels are below the ADI for infants 6-8 months of age. An additional source of iron (such as ferrous sulfate) should be included to increase the iron dose to desired fortification levels.

Prospective Study on the Effectiveness of Complementary Food Supplements on Improving Status of Elder Infants and Young Children in the Areas Affected by Wenchuan Earthquake

“…Our baseline survey showed that there were 74.3% of elder infants and young children suffered from anemia. Based on our data at the monitoring time point at the six months, anemia prevalence was significantly decreased to near 30% through daily supplementation of complementary food supplements contained iron 5 mg/g, and this beneficial effect lasted during 18 month intervention, which indicated that food-based intervention would be an effective way to reduce anemia in children from 6 to 24 months of age [30], [31].…”

“…Because our current study is an observational study, probably the results can not directly demonstrate a causal link. However, such as complementary food supplements have been demonstrated effectively to improve nutritional status and elevate hemoglobin level in elder infants and young children [29]–[31].…”

Maize Porridge Enriched with a Micronutrient Powder Containing Low-Dose Iron as NaFeEDTA but Not Amaranth Grain Flour Reduces Anemia and Iron Deficiency in Kenyan Preschool Children

“…Recently, NaFeEDTA has been added to the list of vitamin and mineral substances allowed as food additives in the EU (61). In areas with an underweight prevalence of~30%, 2 mg of iron as NaFeEDTA is suggested for children 6-24 mo of age (62). The need for legislation in countries such as Kenya is therefore evident to allow the use of NaFeEDTA in childrenÕs food, because its efficacy has been shown.…”

Reasons for raising the maximum acceptable daily intake of EDTA and the benefits for iron fortification of foods for children 6–24 months of age

“…In spite of wide approval, iron EDTA cannot be used in the required amounts in complementary foods for older infants and young children (6–24 months of age) because of concern about exceeding the maximum acceptable daily intake (ADI) of EDTA (Yang et al . ).…”

“…The current maximum ADI of EDTA (JECFA ; JECFA ) allows a maximum daily dosage of 2–2.5 mg day −1 of iron as iron EDTA for infants and young children (Yang et al . ), whereas experts advocate that this amount should be two to four times higher (Rosenberg et al . ).…”