Revised Recommendations for Iron Fortification of Wheat Flour and an Evaluation of the Expected Impact of Current National Wheat Flour Fortification Programs

Brazilians’ experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy

“…The low bioavailability of this source may explain the findings of Assunção and colleagues (27) who showed that Fe fortification in Brazil had no impact on anaemia in children under 6 years old living in the urban area of the city of Pelotas, southern Brazil. Hurrell et al (8) reviewed the efficacy and effectiveness studies with various Fe-fortified foods and found strong evidence that reduced Fe and other forms of Fe with low bioavailability cannot be efficacious to a have satisfactory impact on Fe status. Thus, it is necessary that the government review the fortification policy in order to increase the effectiveness of the programme by use of an Fe form with better bioavailability.…”

An evaluation of the effectiveness of the flour iron fortification programme in Brazil

“…‡15 % absorption. consumed in Brazil is less than 150 g/d, electrolytic Fe seems not to be the most appropriate Fe compound to be used, because the high fortification levels required may cause sensory changes (16) . Ferrous sulfate is the most bioavailable Fe source, but it still has low absorption.…”

Governments and academic institutions play vital roles in food fortification: iron as an example

“…Hurrell et al (6) predicted that fortification programmes using reduced iron, such as that reported by Assunção et al (1) in Brazil, could not be expected to have the desired impacts because of the low bioavailability of this iron fortificant. We agree with the authors of the Brazilian study that the programme of this country requires adjustments and we hope that their study results will help bring about the needed changes.…”

“…In the case of minerals such as iron and zinc, selecting the appropriate form of the fortificant (source of the micronutrient) requires consideration of its bioavailability, its interaction with the food matrix and its cost. Hurrell et al (6) comprehensively reviewed the efficacy and effectiveness of iron compounds used in fortification programmes. They categorized forms of iron currently being used on the basis of bioavailability and stability and related this to the amount of the vehicle being consumed.…”

“…These authors presented strong evidence that reduced iron and other forms of iron with low bioavailability are not, and cannot be, efficacious. Hurrell et al (6) predicted that only nine of seventy-eight national programmes they reviewed 'could be expected to have positive impact on iron status'; none of these nine used reduced iron. Thus the absence of impact noted in the study from Brazil (1) is consistent with this prediction.…”