Iron Fortification of Whole Wheat Flour Reduces Iron Deficiency and Iron Deficiency Anemia and Increases Body Iron Stores in Indian School-Aged Children4

Muthayya, Sumithra; Thankachan, Prashanth; Hirve, Siddhivinayak; Amalrajan, Vani; Thomas, Tinku; Lubree, Himangi; Agarwal, Dhiraj; Srinivasan, Krishnamachari; Hurrell, Richard F.; Yajnik, Chittaranjan S.; Kurpad, Anura V

doi:10.3945/jn.111.155135

Cited by 63 publications

(86 citation statements)

References 39 publications

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“…Of these, 121 [25-145] studies were on infants and children and 79 [146-224] were on women, while one study had both women and children as their study population [33] (Figure 2). Furthermore 125 [25-28,30,32-39,41-44,47,48,51,53],[54,56,59,60,62,63,65-73,75-77],[81-83,85,86,88-90,92,93,95-104,107-109],[111-117,119-127,129,130,132-136,139-144,223,225-228] of these trials were RCTs; the rest were quasi-experimental [46,55,61,74,78,87,91] and before-after studies [29,31,40,45,49,50,52,57],[58,79,80,84,94,95,105,131],[137,138,149,150,153,157,159-169,172],[174,177,181,183-186,189-191,193,195-…”

Section: Resultsmentioning

confidence: 99%

“…Food vehicles chosen varied for each micronutrient fortification and are described in detail in the relevant section. For the 125 RCTs included in this review, randomization and allocation concealment were adequate in 41 of the studies [33-37,56,60,63,65,68,69,72],[75,77,83,88,92,97,99,101],[103,107,108,112,113,115,116,122],[125,127,132,135,139,140,142,143],[146,147,188,214,217], information regarding attrition rates was adequately discussed with reasons in 110 studies [33-39,41-44,47,48,51,53,54,56],[59,60,62,63,65,67-73,75-77,81-83],[85,86,88-90,92,93,96-104,107-109,111-117],[119-127,129,130,132-136,139-144,171,173,175],[176,178-180,182,187,188,192,194,201],[…”

Section: Resultsmentioning

confidence: 99%

“…A total of 41 [25,26,28,30-32,35,39,48,49],[54,56,57,65,70,77,80,81],[83,85,88,89,97,99,101,104],[106-108,112-114,116,120,124,126],[127,129,135,136,139] studies reported outcomes for impact of iron fortification. Four of the studies were before-after studies and the rest were RCTs.…”

Section: Resultsmentioning

confidence: 99%

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Micronutrient fortification of food and its impact on woman and child health: a systematic review

2013

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BackgroundVitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies.MethodsA comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact of fortification was analyzed on the health outcomes and relevant biochemical indicators of women and children. We performed a meta-analysis of outcomes using Review Manager Software version 5.1.ResultsOur systematic review identified 201 studies that we reviewed for outcomes of relevance. Fortification for children showed significant impacts on increasing serum micronutrient concentrations. Hematologic markers also improved, including hemoglobin concentrations, which showed a significant rise when food was fortified with vitamin A, iron and multiple micronutrients. Fortification with zinc had no significant adverse impact on hemoglobin levels. Multiple micronutrient fortification showed non-significant impacts on height for age, weight for age and weight for height Z-scores, although they showed positive trends. The results for fortification in women showed that calcium and vitamin D fortification had significant impacts in the post-menopausal age group. Iron fortification led to a significant increase in serum ferritin and hemoglobin levels in women of reproductive age and pregnant women. Folate fortification significantly reduced the incidence of congenital abnormalities like neural tube defects without increasing the incidence of twinning. The number of studies pooled for zinc and multiple micronutrients for women were few, though the evidence suggested benefit. There was a dearth of evidence for the impact of fortification strategies on morbidity and mortality outcomes in women and children.ConclusionFortification is potentially an effective strategy but evidence from the developing world is scarce. Programs need to assess the direct impact of fortification on morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Micronutrient fortification of food and its impact on woman and child health: a systematic review

2013

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“…We used absorption of intrinsically labeled bread iron as a surrogate for nonheme-iron absorption because results with bread are available in both normal subjects (71) and patients with IDA (69) and because wheat is a major source of dietary nonheme iron (87)(88)(89). As shown in Table 1, subjects without IDA absorbed 6.4% of nonheme iron in bread if they secreted gastric acid and 0.1% if they were achlorhydric (71).…”

Section: Effect Of Achlorhydria On Iron Absorption From Heme and Hemomentioning

confidence: 99%

Is achlorhydria a cause of iron deficiency anemia?

Betesh

Ana

Cole

et al. 2015

The American Journal of Clinical Nutrition

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We re-evaluated the old hypothesis that gastritis-induced achlorhydria is a cause of iron deficiency anemia (IDA) in humans. First, we analyzed the currently available research on the association between achlorhydria and IDA. When gastric acid secretion was measured after maximal stimulation, the frequency of achlorhydria (or severe hypochlorhydria) was 44% in patients with idiopathic IDA and 1.8% in healthy controls. In some patients with pernicious anemia, presumed achlorhydria preceded the development of IDA in time. However, we found no credible evidence that IDA caused gastritis or that IDA preceded the development of achlorhydria. Thus, correlational results favor achlorhydria as the causal factor in the association between achlorhydria and IDA. Second, we sought to determine whether gastritis and achlorhydria cause negative iron balance. When biosynthetic methods were used to isotopically label iron in food, achlorhydric patients were found to have severe malabsorption of nonheme iron, which persisted after the development of IDA. In 1 study, achlorhydria reduced the normal increase in heme-iron absorption from hemoglobin in response to iron deficiency. After an injection of isotopic iron into normal men, the physiologic loss of iron from the body was found to be 1 mg/d. Patients with chronic gastritis had excess fecal loss of isotopically tagged plasma iron. Calculations based on these results indicate that the absorption of iron from a typical Western diet by achlorhydric patients would be less than physiologic iron losses, creating a negative iron balance that could not be overcome by the adaptive increase in duodenal iron absorptive capacity that occurs in response to iron deficiency. The combination of results from these correlational and pathophysiologic studies supports the hypothesis that gastritis-induced achlorhydria can be an independent cause of IDA.

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“…Increase in iron intake can be achieved either through pharmacological iron supplementation, through food fortification or through biofortification [4]. The best food for fortification is wheat and maize flour [9]. Flour fortification with iron was launched in some provinces of Iran in 2001.…”

Section: Introductionmentioning

confidence: 99%

Effect of Iron Enriched Bread Intake on the Oxidative Stress Indices in Male Wistar Rats

Heidari

Omidi

Gheisari

et al. 2016

Zahedan J Res Med Sci

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Background: Contrary to the proven benefits of iron, few concerns in producing the oxidative stress is remained problematic. Objectives: The aim of the study was to evaluate the oxidative stress in the male Wistar rats fed bread supplemented with iron in different doses i.e., 35 (basic), 70 (two fold), 140 (four fold), and 210 mg/kg (six fold) with or without NaHCO3 (250 mg/kg). Methods: In this experimental study Iron, ceruloplasmin, ferritin, total iron binding capacity (TIBC), albumin, total protein, uric acid and plasma superoxide dismutase (SOD), glutathione peroxidase (GPX), catalase (CAT), malondialdehyde (MDA), and total antioxidant capacity (TAC), were evaluated in 30 rats at the first and last day of the experiment (day 30). In addition, phytic acid levels were detected in all baked breads. The data were analyzed by ANOVA and t test procedure though SPSS statistical software version 20. Results: Serum iron level in rats that received basic level of iron plus NaHCO3 decreased significantly in the last day of the trial. Higher level of serum iron was seen in rats that received iron twofold, fourfold and sixfold and rats that received iron fourfold plus NaHCO3. Serum ceruloplasmin and ferritin in groups of rats that received fourfold level of iron plus NaHCO3 and rats that received

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Iron Fortification of Whole Wheat Flour Reduces Iron Deficiency and Iron Deficiency Anemia and Increases Body Iron Stores in Indian School-Aged Children4

Cited by 63 publications

References 39 publications

Micronutrient fortification of food and its impact on woman and child health: a systematic review

Micronutrient fortification of food and its impact on woman and child health: a systematic review

Is achlorhydria a cause of iron deficiency anemia?

Effect of Iron Enriched Bread Intake on the Oxidative Stress Indices in Male Wistar Rats

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