title: Efficacy of different iron fortificants in wheat flour in controlling iron deficiency. Addition of microencapsulated iron to iodized salt improves the efficacy of iodine in goitrous, iron-deficient children: a randomized, double-blind, controlled trial. Clinical Safety of Iron-Fortified Formulas Haematological response to haem iron or ferrous sulphate mixed with refried black beans in moderately anaemic Guatemalan pre-school children. Leaf concentrate as an alternative to iron and folic acid supplements for anaemic adolescent girls: a randomised controlled trial in India. Oxidative Stress among Non-Anemic Adults following Flour Fortification with Iron: Baseline Data Iron-fortified rice is as efficacious as supplemental iron drops in infants and young children. Iron fortification of domestic drinking water to prevent anemia among low socioeconomic families in Brazil. Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: a double-blind randomized controlled trial. Prevention of iron deficiency by milk fortification. II. A field trial with a full-fat acidified milk. Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized ferric pyrophosphate and encapsulated ferrous fumarate in southern India. Fortification of curry powder with NaFe(111)EDTA in an iron-deficient population: report of a controlled iron-fortification trial. Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. Iron intake and iron nutritional status of infants fed iron-fortified beikost with meat. Fortification of sugar with iron sodium ethylenediaminotetraacetate (FeNaEDTA) improves iron status in semirural Guatemalan populations. Fortifying brown bread with sodium iron EDTA, ferrous fumarate, or electrolytic iron does not affect iron status in South African schoolchildren. Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. Studies of the elderly in Boston. I. The effects of iron fortification on moderately anemic peole. Dual fortification of salt with iodine and microencapsulated iron: a randomized, double-blind, controlled trial in Moroccan schoolchildren. Ferrous sulfate is more bioavailable among preschoolers than other forms of iron in a milk-based weaning food distributed by PROGRESA, a national program in Mexico. Sodium iron EDTA [NaFe(III)EDTA] as a food fortificant: erythrocyte incorporation of iron and apparent absorption of zinc, copper, calcium, and magnesium from a complementary food based on wheat and soy in healthy infants. Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Comparison of the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced elemental iron: randomized, double-blind, controlled trial in Thai women. The use of NaFeEDTA-fortified fish sauce is an effective tool for controlling iron deficiency in women of childbearing age in rural Vietnam. A preliminary simulated iron fortification trial in South Indian preschool children. Growth, Efficacy, and Safety of Feeding an Iron-Fortified Human Milk Fortifier Lack of adverse reactions to iron-fortified formula. Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren Is cooking food in iron pots an appropriate solution for the control of anaemia in developing countries? A randomised clinical trial in Benin. [Effectiveness of different iron supplementation strategies on hemoglobin and ferritin levels among schoolchildren in Teresina, Piauí State, Brazil]. Iron Fortification Reduces Blood Lead Levels in Children in Bangalore, India A randomized trial investigating an iron-rich natural mineral water as a prophylaxis against iron deficiency in pregnancy. Iron absorption by human subjects from different iron fortification compounds added to Thai fish sauce Efficacy of iron-fortified whole maize flour on iron status of schoolchildren in Kenya: a randomised controlled trial Iron-biofortified rice improves the iron stores of nonanemic Filipino women. Efficacy of iron-fortified rice in reducing anemia among schoolchildren in the Philippines. Hematologic and selenium status of low-birth-weight infants fed formulas with and without iron. Randomized, double-blind, placebo-controlled trial of an iron-fortified food product in female soldiers during military training: relations between iron status, serum hepcidin, and inflammation. The use of iron-fortified wheat flour to reduce anemia among the estate population in Sri Lanka. Effects of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on preschool children in a suburb of Chongqing, China. [Efficiency of NaFeEDTA fortified soy sauce on anemia prevention]. Effect of a beverage fortified with evaporated sugarcane juice on hemoglobin levels in preschool children. Effect of infant formula on stool characteristics of young infants. The efficacy of ferrous bisglycinate and electrolytic iron as fortificants in bread in iron-deficient school children. Iron nutritional status in preterm infants fed formulas fortified with iron Effect of iron fortification of nursery complementary food on iron status of infants in the DPRKorea. Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial NaFeEDTA fortified soy sauce showed higher iron absorption rate in Chinese females. Repleting hemoglobin in iron deficiency anemia in young children through liquid milk fortification with bioavailable iron amino acid chelate. The effect of iron in formula milk after 6 months of age. Milk versus medicine for the treatment of iron deficiency anaemia in hospitalised infants Dual fortification of salt with iron and iodine in women and children in rural Ghana. Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal. Prevention of iron-deficiency anemia: comparison of high- and low-iron formulas in term healthy infants after six months of life. A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children [Intake of an iron-supplemented milk formula as a preventive measure to avoid low iron status in 1-3 year-olds]. A local-ingredient-based, processed flour to improve the energy, iron and zinc intakes of young children: a community-based intervention Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control Haemoglobin fortified cereal: a source of available iron to breast-fed infants. The effects of iron fortification on the gut microbiota in African children: a randomized controlled trial in Cote d'Ivoire. Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico. Iron fortification of infant milk formula: the effect on iron status and immune function. The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren. Iron-fortified formulas and gastrointestinal symptoms in infants: a controlled study, With the cooperation of The Syracuse Consortium for Pediatric Clinical Studies. Efficacy of Iron-Fortified Ultra Rice in Improving the Iron Status of Women in Mexico Meat as a First Complementary Food for Breastfed Infants: Feasibility and Impact on Zinc Intake and Status Iron, zinc, copper and selenium status of breast‐fed infants and infants fed trace element fortified milk‐based infant formula [Effect of biscuits fortified with haem iron on the intellectual status of pre-school children]. Efficacy of wheat-based biscuits fortified with microcapsules containing ferrous sulfate and potassium iodate or a new hydrogen-reduced elemental iron: a randomised, double-blind, controlled trial in Kuwaiti women. Iron supplementation of low-income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops. Chronic iron intake and diarrhoeal disease in infants. A field study in a less-developed country. Dual fortification of salt with iodine and micronized ferric pyrophosphate: a randomized, double-blind, controlled trial. Iron fortified follow on formula from 9 to 18 months improves iron status but not development or growth: a randomised trial Effect of supplementation with an iron-fortified milk on incidence of diarrhea and respiratory infection in urban-resident infants. A comparative intervention trial on fish sauce fortified with NaFe-EDTA and FeSO4+citrate in iron deficiency anemic school children in Kampot, Cambodia. Randomized Controlled Trial of Iron-Fortified Drinking Water in Preschool Children Prevention of anaemia in inner-city toddlers by the use of a follow-on formula. Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Follow‐on formula in the prevention of iron deficiency: a multicentre study Acceptability of micronutrient sprinkles: a new food-based approach for delivering iron to First Nations and Inuit children in Northern Canada. [Effect of weekly rice fortification with iron on anemia prevalence and hemoglobin concentration among children attending public daycare centers in Rio de Janeiro, Brazil]. The promotive effect of soy sauce on iron absorption in human subjects. A randomized trial of two levels of iron supplementation and developmental outcome in low birth weight infants. Zinc absorption in adult humans: the effect of iron fortification. Iron‐fortified and unfortified cow's milk: Effects on iron intakes and iron status in young children Therapeutic effects of NaFeEDTA-fortified soy sauce in anaemic children in China. Feeding iron-fortified premature formula during initial hospitalization to infants less than 1800 grams birth weight. Prevention of anaemia in inner city toddlers by an iron supplemented cows' milk formula. The haematinic effect of iron in flour. Prevention of iron deficiency and psychomotor decline in high-risk infants through use of iron-fortified infant formula: a randomized clinical trial. Interactions between Infections, Malnutrition and Ironnutritional Status in Pakistani Infants A Longitudinal Study Domestic Drinking Water—An Effective Way to Prevent Anemia among Low Socioeconomic Families in Brazil Randomized double-blind controlled trial on the effects on iron status in the first year between a no added iron and standard infant formula received for three months. Iron absorption from meat pate fortified with ferric pyrophosphate in iron-deficient women. Changing the zinc:iron ratio in a cereal-based nutritional supplement has no effect on percent absorption of iron and zinc in Sri Lankan children. Milk Fortif Ed with Iron Or Iron Supplementation to Improve Nutritional Status of Pregnant Women: An Intervention Trial from Rural Vietnam The relative bioavailability in humans of elemental iron powders for use in food fortification Iron nutrition in infancy: effect of an iron-fortified milk formula. Iron-fortified bread. A long-term controlled therapeutic community-based experiment with ferrous sulphate-enriched flour. Regular consumption of a complementary food fortified with ascorbic acid and ferrous fumarate or ferric pyrophosphate is as useful as ferrous sulfate in maintaining hemoglobin concentrations >105 g/L in young Bangladeshi children. Iron fortification of dried skim milk and maize-soy-bean-milk mixture (CSM): availability of iron in Jamaican infant. Iron-fortified bread. Ferrous Gluconate and Ferrous Sulfate Added to a Complementary Food Distributed by the Mexican Nutrition Program Oportunidades Have a Comparable Efficacy to Reduce Iron Deficiency in Toddlers Efficacy of Pandesal Baked from Wheat Flour Fortified with Iron and Vitamin A in Improving the Iron and Anthropometric Status of Anemic Schoolchildren in the Philippines Iron absorption: comparison of prediction equations and reality. Results from a feeding trial in the Philippines. Evaluation of the effectiveness of stainless steel cooking pots in reducing iron-deficiency anaemia in food aid-dependent populations. Chlorella pyrenoidosa Supplementation Reduces the Risk of Anemia, Proteinuria and Edema in Pregnant Women Food-based strategies improve iron status in toddlers: a randomized controlled trial12. Random serial sampling to evaluate efficacy of iron fortification: a randomized controlled trial of margarine fortification with ferric pyrophosphate or sodium iron edetate. In a randomized controlled trial of iron fortification, anthelmintic treatment, and intermittent preventive treatment of malaria for anemia control in Ivorian children, only anthelmintic treatment shows modest benefit. Dry cereals fortified with electrolytic iron or ferrous fumarate are equally effective in breast-fed infants.
abstract: OBJECTIVE To observe the different impacts of electrolytic iron , FeSO4 , and NaFeEDTA on body iron store of anemic school students . METHODS Four hundreds anemic students at the age of 11 - 18 years were divided into four groups . Of which , three consumed different iron fortificants from wheat flour as food vehicle for six months and one consumed non-fortified flour ( control ) . The fortification level of electrolytic iron , FeSO4 , and NaFeEDTA was 60 mg Fe/kg , 30 mg Fe/kg , and 20 mg Fe/kg , respectively . Blood sample s were collected at 0 , 2 , 4 , and 6 months and hemoglobin ( Hb ) , serum ferritin ( SF ) , and transferrin receptor ( TfR ) were measured . RESULTS The hemoglobin levels in three intervention groups increased , the increments of Hb in the NaFeEDTA group were significantly higher than that in the other groups . SF and TfR levels increased in the tested groups and body iron store in the NaFeEDTA group was higher than that in the other groups . These parameters did not show any significant changes in the control group . CONCLUSION NaFeEDTA and FeSO4 fortified wheat flour has positive impacts on iron status in anemic students and NaFeEDTA is more effective than FeSO4 , while electrolytic iron is less effective in improving iron store in anemic students OBJECTIVE In many developing countries , children are at high risk for both goiter and anemia . Iron ( Fe ) deficiency adversely effects thyroid metabolism and reduces efficacy of iodine prophylaxis in areas of endemic goiter . The study aim was to determine if co-fortification of iodized salt with Fe would improve efficacy of the iodine in goitrous children with a high prevalence of anemia . DESIGN AND METHODS In a 9-month , r and omized , double-blind trial , 6 - 15 year-old children ( n=377 ) were given iodized salt ( 25 microg iodine/g salt ) or dual-fortified salt with iodine ( 25 microg iodine/g salt ) and Fe ( 1 mg Fe/g salt , as ferrous sulfate microencapsulated with partially hydrogenated vegetable oil ) . RESULTS In the dual-fortified salt group , hemoglobin and Fe status improved significantly compared with the iodized salt group ( P<0.05 ) . At 40 weeks , the mean decrease in thyroid volume measured by ultrasound in the dual-fortified salt group ( -38 % ) was twice that of the iodized salt group ( -18 % ) ( P<0.01 ) . Compared with the iodized salt group , serum thyroxine was significantly increased ( P<0.05 ) and the prevalence of hypothyroidism and goiter decreased ( P<0.01 ) in the dual-fortified salt group . CONCLUSION Addition of encapsulated Fe to iodized salt improves the efficacy of iodine in goitrous children with a high prevalence of anemia Background . Iron-fortified formulas are recommended throughout infancy and are frequently used beyond , yet safety aspects have been inadequately studied . Iron could theoretically increase pro-oxidant stress , with potential adverse effects , including infection risk , and some clinicians suspect that iron-fortified formulas induce gastrointestinal disturbance . Objective . A planned component of a large intervention trial has been to test the hypothesis that infants receiving iron-fortified formula  do not have a higher incidence of infections ( primary outcome ) or gastrointestinal problems ( secondary outcome ) than infants on low iron-formulas or cow 's milk . Methods . Children ( n = 493 ) 9 months old receiving cow 's milk were recruited in 3 UK centers and r and omized to : 1 ) cow 's milk as before , 2 ) formula containing .9 mg/L of iron  , or 3 ) an  otherwise identical formula but  containing 12 mg/L of iron . Children were followed at 3 monthly intervals and the episodes of infections , diarrhea and constipation , and general morbidity to 18 months old were recorded . Hematologic indices of iron status were determined at 18 months old . Results . Serum ferritin concentrations were increased in infants receiving iron-fortified formula but there were no intergroup differences in incidence of infection , gastrointestinal problems , or in general morbidity or weight gain . Conclusions . We were unable to identify adverse health effects in older infants and toddlers consuming a high iron-containing formula ( 12 mg/L ) even when used in population s with a low incidence of iron deficiency OBJECTIVE Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets . For this purpose , a new haem iron preparation was developed . The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate ( FeSO4 ) . DESIGN In a masked , stratified-r and omised intervention trial , children received five 156-g cans of refried black beans per week for 10 consecutive weeks . The beans-only ( control ) , FeSO4 and haem iron groups were offered a cumulative dose of 155 mg , 1625 mg and 1700 mg of iron from the bean intervention , respectively . Haemoglobin ( Hb ) and ferritin concentrations were determined at baseline and after 5 and 10 weeks . Compliance was examined weekly . SETTING A low-income community in Guatemala City . SUBJECTS One hundred and ten children aged 12 - 36 months with initial Hb values between 100 and 115 g l(-1 ) . RESULTS The cumulative intake of beans was approximately 80 % of that offered , signifying an additional approximately 1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks . Hb concentrations increased by the order of 7.3 - 11.4 g l(-1 ) during the intervention , but without significant differences across treatments . Average ferritin concentrations were unaffected by treatment assignment . However , post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group ( 13.1+/-7.7 g l(-1 ) ) to be significantly greater than the respective increases ( 6.8+/-11.2 and 6.4+/-8.5 g l(-1 ) ) in the inorganic iron and beans-only groups . CONCLUSIONS Canned refried beans are a c and i date vehicle for fortificant iron . Given the improved colour and organoleptic properties imparted by haem iron added to refried beans , its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4 OBJECTIVE Despite public health campaigns based on Fe and folic acid supplements , Fe-deficiency anaemia remains highly prevalent among women in India . We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating  anaemia in adolescent girls . DESIGN R and omised controlled two-arm trial over 3 months : one group received daily Fe and folic acid ( IFA ; 60 mg Fe , 500 microg folic acid ) ; the other daily leaf concentrate ( LC ; 5 mg Fe , 13 microg folic acid ) . Hb concentration , mean cell volume , serum Fe , serum ferritin and total Fe-binding capacity were measured pre- and post-intervention . SETTING Jaipur , India . SUBJECTS One hundred and two adolescent girls aged 14 - 18 years . RESULTS Of the 102 girls r and omized to the two arms of the trial , four ( 3.9 % ) were severely anaemic  ( Hb < 7 g/dl ) , twenty-eight ( 27.5 % ) were moderately anaemic ( Hb > or = 7 g/dl , < 10 g/dl ) and seventy ( 68.6 % ) were mildly anaemic ( Hb > or = 10 g/dl , < 12 g/dl ) . In the IFA group , eleven girls ( 20.4 % ) withdrew due to side-effects , compared with one girl ( 2.1 % ) in the LC group ( P = 0.005 ) . Total losses to follow-up were 14/54 in the IFA group and 2/48 in the LC group . At the end of the trial , none of the eighty-six remaining girls were severely anaemic , nine ( 10.5 % ) were moderately anaemic and twenty-six ( 30.2 % ) were mildly anaemic ; fifty-one ( 59.3 % ) had normal Hb levels ( > or = 12 g/dl ) . After adjustment for baseline values , LC was as effective as IFA in improving serum Fe parameters and treating anaemia . CONCLUSIONS Leaf concentrate is an effective , and more palatable , alternative to Fe and folic acid supplements for treating anaemia in adolescent girls Background : It has been suggested that food fortification might be an inexpensive , simple and effective way to control and prevent iron deficiency and its related anemia in many countries . Despite the advantages of this approach and the fact that it has been implemented in some provinces in Iran for more than 6 years , many scientists in the country worry about the negative aspects of the extra iron distributed among non-anemic persons in the community . Objective : This study was design ed to assess the effect of the flour fortification program on oxidative stress biomarkers and iron status among non-anemic 40- to 65-year-old adults . Study Design : This study had a special design that was implemented in 3 different parts . The main and first part was a field study . We r and omized 2 cities in 1 province . In each city , 200 volunteers ( 100 men and 100 women ) were selected using a multi-stage stratified method . Examination and interview ( filling out data collection forms ) were the methods of data gathering . In each of the 3 phases , demographic , anthropometric , blood pressure , micro- and macronutrient intakes , physical activities , and some oxidative stress biomarkers were the main data that were gathered . The results of this study can help health policy makers in design ing future interventions in the country based on food fortification How to improve iron status among infants and young children is of continued concern in low- to middle-income countries , including Brazil . In a double blind , 5-mo , home-based , r and omized trial in Brazil , we gave one group of mildly anemic 6- to 24-mo-old children ( n = 175 )  rice fortified with micronized ferric pyrophosphate using the Ultra Rice technology and a placebo solution ( URG ) and another group identical nonfortified rice and iron drops . We instructed parents on the correct dosage of iron drops and to feed their children rice as they normally would . We measured serum ferritin ( SF ) and hemoglobin ( Hb ) concentrations at baseline and at 5 mo . At baseline , the prevalences of iron deficiency and anemia in the total sample were 73.1 and 100 % , respectively . At 5 mo , SF and Hb increased in both groups , although the change in the URG was larger ( P < 0.01 ) . Adult participants were unable to distinguish cooked fortified rice from unfortified rice in terms of smell , color , or taste . As rice is normally consumed at home , MPF-fortified rice increased iron stores and reduced anemia in a group of mildly anemic children 6 - 24 mo old . In population s where young children are routinely fed approximately 100 g of cooked rice daily , fortifying it with iron may improve iron status at least as well as providing free iron drops Iron deficiency anaemia is a most common micronutrient deficiency affecting mostly the low socioeconomic population s of the developing world . The objective of this study was to evaluate the feasibility of iron fortification of household drinking water to prevent iron deficiency anaemia among members of the low socioeconomic families of Southern Brazil . A total of 21 low socioeconomic families representing 88 subjects including 1 - 6 years old children whose haemoglobin level was between 10 and 12 g/dl were selected to participate in this study . Nine families in the control group were supplied with placebo solution and 12 families in the experimental group were supplied iron solution with ascorbic acid to be added to their domestic drinking water over a period of 4 months . The feasibility and acceptability of iron fortified drinking water was assessed through home visits and question naires . Blood sample s were collected at the beginning and after 4 months of the study for the determination of haemoglobin and serum ferritin levels . The results of this study indicated that iron fortified drinking water was well received by the low socioeconomic families and that it was effective in improving the haemoglobin and serum ferritin levels . It can be concluded from this study that iron fortification of household drinking water is a simple and effective alternative for developing countries along with other technological approaches to iron fortification of foods BACKGROUND Iron fortification of rice could be an effective strategy for reducing iron deficiency anemia in South Asia . OBJECTIVE We aim ed to determine whether extruded rice grains fortified with micronized ground ferric pyrophosphate ( MGFP ) would increase body iron stores in children . DESIGN In a double-blind , 7-mo , school-based feeding trial in Bangalore , India , iron-depleted , 6 - 13-y-old children ( n = 184 ) were r and omly assigned to receive either a rice-based lunch meal fortified with 20 mg Fe as MGFP or an identical but unfortified control meal . The meals were consumed under direct supervision , and daily leftovers were weighed . All children were dewormed at baseline and at 3.5 mo . Iron status and hemoglobin were measured at baseline , 3.5 mo , and 7 mo . RESULTS At baseline , the prevalences of iron deficiency and iron deficiency anemia in the total sample were 78 % and 29 % , respectively . After 7 mo of feeding , there was a significant increase in body iron stores in both study groups ( P < 0.001 ) , with a greater increase in the iron group than in the control group ( P < 0.05 ) . There was a significant time x treatment interaction for iron deficiency , which fell from 78 % to 25 % in the dewormed iron group and from 79 % to 49 % in the dewormed control group . Iron deficiency anemia decreased from 30 % to 15 % ( NS ) in the iron group but remained virtually unchanged in the control group ( 28 % and 27 % ) . In sensory tests , the MGFP-fortified rice ( fortified at 3 and 5 mg Fe/100 g ) was indistinguishable from natural rice , in both cooked and uncooked form . CONCLUSIONS Extruded rice fortified with MGFP has excellent sensory characteristics . Fed in a school lunch meal , it increases iron stores and reduces the prevalence of iron deficiency in Indian children In a longitudinal study from age 3 to 15 mo , 276 term , healthy , spontaneously weaned infants received a full-fat acidified milk fortified with 15 mg of elemental Fe as ferrous sulfate and 100 mg of ascorbic acid/100 g of powder and  278 control infants received milk without additives . At ages 9 and 15 mo significant differences were encountered in all measures of Fe nutriture in favor of the fortified group ( p less than 0.001 ) . Anemia ( Hg less than 110 g/L ) was present in 25.7 % of unfortified infants compared with only 2.5 % in those fortified at age 15 mo . Saturation of transferrin less than 9 % was present in 33.8 % and serum ferritin less than 10 micrograms/L in 39.1 % of the nonfortified infants . The figures for the fortified group were 7 and 8.5 % respectively . The efficiency of the fortified acidified milk in eradicating Fe deficiency in the infants while discouraging use by other family members make this milk a useful targeted product in programs of supplementary food distribution in the underdeveloped world BACKGROUND Dual fortification of salt with iodine and iron could be a sustainable approach to combating iodine and iron deficiencies . OBJECTIVE We compared the efficacy of dual-fortified salt ( DFS ) made by using 2 proposed contrasting formulas-one fortifying with iron as micronized ground ferric pyrophosphate ( MGFePP ) and the other with iron as encapsulated ferrous fumarate (EFF)-with the efficacy of iodized salt ( IS ) in schoolchildren in rural southern India . DESIGN After stability and acceptability testing , a double-blind , household-based intervention was conducted in 5 - 15-y-old children ( n = 458 ) r and omly assigned into 3 groups to receive IS or DFS with iron as MGFePP or EFF , both at 2 mg/g salt . We measured hemoglobin , iron status , and urinary iodine at baseline , 5 mo , and 10 mo . RESULTS Median serum ferritin and calculated median body iron improved significantly in the 2 groups receiving iron . After 10 mo , the prevalence of anemia decreased from 16.8 % to 7.7 % in the MGFePP group ( P < 0.05 ) and from 15.1 % to 5.0 % in the EFF group ( P < 0.01 ) . The median urinary iodine concentration increased significantly in the IS and EFF groups ( P < 0.001 ) but not in the MGFePP group . Losses of iodine in salt with 1.8 % moisture were high for MGFePP , whereas the EFF segregated in salt with 0.5 % moisture and caused color changes in some local foods . CONCLUSIONS Both DFSs were efficacious in reducing the prevalence of anemia and iron deficiency in school-age children . Local salt characteristics should be taken into consideration when choosing an iron fortificant for DFS to achieve optimal iodine stability and color A targeted , double-blind controlled iron fortification trial using Fe(111)-EDTA in masala ( curry powder ) was directed towards an Fe-deficient Indian population for 2 y. The Fe status of the fortified group improved more than that of control subjects . Improvement reached significance over control subjects for females in hemoglobin ( p = 0.0005 ) , ferritin ( p = 0.0002 ) , and body Fe stores ( p = 0.001 ) and for males in ferritin ( p = 0.04 ) . The prevalence of Fe-deficiency anemia ( IDA ) decreased from 22 to 5 % in fortified females . Premenopausal women , multipara women , and women with prolonged menstruation or initial IDA benefitted most from fortification . The mean increase in body Fe stores in females with initial IDA was 9.0 + /- 1.3 mmol , representing an increased absorption of 12 mumol/d . Fortified subjects with normal Fe status did not accumulate excessive body Fe and there was no alteration in serum Zn concentrations . Targeted fortification is a safe and effective means of combatting Fe deficiency BACKGROUND Fish sauce is consumed daily by a large proportion of the Vietnamese population and could therefore be a potentially useful food vehicle for iron-fortification programs . OBJECTIVE We evaluated the efficacy of iron-fortified fish sauce in improving the iron status of anemic women . DESIGN In a r and omized , double-masked study of 152 anemic ( hemoglobin concentration of 81 - 119 g/L ) women , a meal based on noodles or rice was served 6 d/wk with 10 mL fish sauce containing either 10 mg Fe as NaFeEDTA ( iron-fortified group ) or no added iron ( control group ) . Concentrations of hemoglobin , serum ferritin ( SF ) , and serum transferrin receptor ( TfR ) were measured at baseline and after 3 and 6 mo . RESULTS After 6 mo , hemoglobin and SF concentrations were higher and TfR concentrations were lower in the iron-fortified group than in the control group [ hemoglobin : 116.3 + /- 8.7 ( + /- SD ) compared with 107.6 + /- 11.0 g/L ( P < 0.0001 ) ; SF : 30.9 ( 95 % CI : 23.4 , 40.6 ) compared with 14.6 ( 11.3 , 19.0 ) micro g/L ( P = 0.0002 ) ; TfR : 7.2 ( 6.4 , 7.9 ) compared with 9.0 ( 8.1 , 9.9 ) mg/L ( P = 0.002 ) ] . The prevalence of iron deficiency ( SF < 12 micro g/L or TfR > 8.5 mg/L ) and iron deficiency anemia ( iron deficiency with hemoglobin < 120 g/L ) was lower in the iron-fortified group than in the control group [ 32.8 % compared with 62.5 % ( P = 0.0005 ) and 20.3 % compared with 58.3 % ( P < 0.0001 ) , respectively ] . CONCLUSIONS Regular consumption of iron-fortified fish sauce significantly reduced the prevalence of iron  deficiency anemia in Vietnamese women during the 6-mo intervention . Fortifying fish sauce with iron by using a water-soluble , highly bioavailable compound ( NaFeEDTA ) is a promising strategy for combating iron deficiency anemia in Vietnam BACKGROUND According to our current underst and ing , iron absorption with weekly iron supplements is not higher than that with daily supplements ( ie , there is no mucosal block ) . However , community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one . Furthermore , when differences in absorption are found , they are commonly smaller than would be expected on the basis of differences in the amount of iron provided . The possibility of differential compliance between the regimens needs to be evaluated to explain these findings . OBJECTIVE Taking compliance into account , we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy . DESIGN In Bangladesh , 50 antenatal centers were r and omly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d . Compliance was monitored by using a pill bottle equipped with an electronic counting device .  Hemoglobin concentrations were measured at baseline and after 4 , 8 , and 12 wk of supplementation . RESULTS There was no differential effect per iron tablet between weekly and daily regimens . A 12-wk daily regimen ( 68 % compliance ) produced a small but significantly greater hemoglobin response than did the weekly regimen ( 104 % compliance ) . The first 20 tablets consumed produced most of the effect ; after 40 tablets , there was no further response . CONCLUSIONS There was no evidence of a mucosal block in the daily regimen . Over 12 wk , 50 % of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect . The weekly regimen provided a large part of this amount , explaining the limited difference in effect . It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary To evaluate the effect of introducing complementary foods before 6 mo of age , we r and omly assigned 164 infants who had been exclusively breast-fed for 4 mo to continue being exclusively breast-fed until 6 mo ( EBF group ) or to receive iron-fortified foods in addition to breast milk from 4 to 6 mo ( BF+SF group ) . At 6 mo , the BF+SF group had higher mean iron intake ( 4 mg/d compared with 0.2 mg/d in EBF infants ) and higher hemoglobin , hematocrit , and ferritin values than the EBF group ( P < 0.05 ) . The percentage with low hemoglobin ( < 103 g/L ) did not differ significantly between groups , but fewer infants in the BF+SF group had a low hematocrit ( < 0.33 ; 21.4 % compared with 32.0 % , respectively ; P < 0.05 ) . The percentage of infants with ferritin concentrations < 12 microg/L at 6 mo was lower than the percentage with low hemoglobin or hematocrit , raising questions about the validity of the cutoffs at this age . Infants at greatest risk for anemia and low ferritin were those with birth weights < 2500 g ; no infant with a birth weight > 3000 g had a low ferritin value at 6 mo . We conclude that the risk of iron deficiency is low among infants with birth weights > 3000 g who are exclusively breast-fed for 6 mo . Iron drops are recommended for low-birth-weight infants ; for breast-fed infants with birth weights between 2500 and 3000 g , further research is needed to determine whether iron drops are more effective than complementary foods for preventing iron deficiency before 6 mo We compared iron intake and iron nutritional status of two groups of healthy term infants who received meat-containing baby foods fortified with ferrous sulphate ( 2 mg Fe/100 g ) . One group received an Fe-fortified formula ( 1.6 mg Fe/100 kcal ) and the other a nonfortified formula . Fe intake of the group fed the nonfortified formula was significantly lower ( p less than 0.0001 ) . These infants received Fe mainly from fortification Fe with beikost ( 75 - 86 % ) and less than 10 % met the recommended intake of 1 mg.kg-1.d-1 ; whereas 80 - 85 % of the infants fed the Fe-fortified formula did . Hb , Hct , FEP , and ferritin were similar in both groups with the exception of lower ferritin values at age 365 d ( p less than 0.05 ) in the group fed the nonfortified formula . No infant had hemoglobin less than 100 g/L. We conclude that regular consumption of commercially prepared Fe-fortified beikost with meat prevents most healthy term infants from Fe deficiency even if Fe intake is substantially below the recommended intake A 32-mo-long , double-blind field study involving one highl and control community receiving only vitamin A-fortified sugar and three vitamin A- and FeNaEDTA-sugar-fortified communities , two in the lowl and s and one in the highl and s of Guatemala , was undertaken to test the effectiveness of this approach in controlling iron deficiency .  The communities ' population ranged between 1200 and 17000 .  Sugar fortified with 1 g FeNaEDTA and 15 mg retinol as retinyl palmitate/kg was stable , did not segregate , and was well accepted by the communities . The impact of fortification on iron nutrition was estimated at 8 , 20 , and 32 mo of intervention . All pregnant women and subjects with severe anemia received supplements or treatment and were excluded from the analysis . Iron stores in the fortified communities increased significantly except for women 18 - 48 y of age in one lowl and community and > 49 y in the highl and community . Iron stores in the control community remained unchanged except for a rise among adult males The choice of iron fortificant usually represents a balance between bioavailability of the compound and its tendency to cause organoleptic problems . The aim of this study was to evaluate the efficacy of sodium iron EDTA ( NaFeEDTA ) and ferrous fumarate at levels compatible with South African brown bread ( 10 mg/kg flour for NaFeEDTA and 20 mg/kg flour for ferrous fumarate ) in a r and omized controlled trial ; electrolytic iron was evaluated at the level currently used in South Africa ( 35 mg/kg flour ) . Schoolchildren ( n = 361 ) , aged 6 - 11 y , from a low socioeconomic community with hemoglobin ( Hb ) < or = 125 g/L were r and omly assigned to 1 of 4 groups that received 4 slices of brown bread supplying either : 1 ) no fortification iron 2 ) 2.35 mg iron as NaFeEDTA ; 3 ) 4.70 mg iron as ferrous fumarate ; and 4 ) 8.30 mg iron as electrolytic iron per intervention day . These amounts simulated a bread intake of 6 slices per day over the 34-wk study period at fortification levels of 0 , 10 , 20 , and 35 mg/kg flour , respectively . Hb concentration and iron status were assessed at baseline and after 34 wk of intervention . The iron interventions did not affect Hb concentration , transferrin saturation , or serum ferritin , iron , or transferrin receptor concentrations relative to the control group . Our results suggest that electrolytic iron at the level currently used in South Africa is not effective in improving iron or Hb status . Neither do NaFeEDTA or ferrous fumarate appear to be suitable alternatives for the fortification of wheat flour when included at levels that do not cause color changes BACKGROUND Iron deficiency anemia is the most prevalent nutrition problem in young children . One possible strategy to prevent iron deficiency anemia in this population group is the fortification of affordable food . OBJECTIVE This study was design ed to assess whether iron-fortified c and ies can improve iron status and are acceptable to children aged 4 - 6 y. DESIGN A double-blind , placebo-controlled intervention study was conducted in Jakarta , INDONESIA : The children were r and omly assigned to 1 of 2 treatment groups : a fortified group ( n = 57 ) and a placebo group ( n = 60 ) . Every week for 12 wk , 30 g ( 10 pieces ) c and y was given to the children . The c and y given to the fortified group contained 1 mg elemental Fe/g and very small amounts of other vitamins and minerals . RESULTS The hemoglobin concentration of the fortified group increased by 10.2 g/L ( 95 % CI : 8.3 , 12 g/L ) whereas that of the placebo group increased by 4.0 g/L ( 2.0 , 6.0 g/L ; P < 0.001 ) . Anemia prevalence decreased from 50.9 % at the start of the intervention to 8.8 % after 12 wk of intervention in the fortified group ( P < 0.001 ) and from 43.3 % to 26.7 % in the placebo group ( P < 0.05 ) . After 12 wk of intervention , the serum ferritin concentration was 71 % higher than at baseline in the fortified group and 28 % higher in the placebo group ( P < 0.001 ) . Acceptability of the iron-fortified c and ies was good . The per capita cost of the supplement was approximately US$ 0.96 - 1.20 for the 12 wk of intervention . CONCLUSION Iron-fortified c and ies were effective for improving the iron status  of young children and might be an affordable way to combat iron deficiency in children of low-to-middle income groups It has been reported that large numbers of elderly Americans are moderately anemic because of iron deficiency anemia . In the present study , information has been obtained concerning blood composition , health , and nutritional habits of 779 people over 60 years of age , institutionalized or free-living in the Boston area . This paper presents the results of their blood examinations . Two hundred twenty-one of the free-living people examined who showed hemoglobin levels between 9 and 12.9 g/dl agreed to participate in an iron fortification study .  Two-thirds of them received iron-fortified grain products daily for 6 to 8 months . The rest received the same foods without added iron . At the end of the experimental period a marked increase in hemoglobin levels averaging 1.4 g/dl was observed in both groups . This appeared to be attributable to an undefined intervention effect ; no measurable effects attributable to the iron fortification were observed . Three months of daily ferrous sulfate administration to those whose hemoglobin levels remained below 13 g/dl was without effect . Examination of the data obtained suggests that the cause of the moderately low hemoglobin levels initially observed was not occult bleeding or folic acid or iron deficiency BACKGROUND In many developing countries , children are at high risk of both goiter and iron deficiency anemia . OBJECTIVE In a series of studies in northern Morocco , we developed and tested a dual-fortified salt ( DFS ) containing iodine and microencapsulated iron . DESIGN To establish the DFS fortification concentration , we measured salt intake by 3-d weighed food records and estimated iron bioavailability from the local diet by using published algorithms . We then formulated a DFS containing 25 micro g iodine/g salt ( as potassium iodide ) and 1 mg iron/g salt ( as ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil ) . After storage and acceptability trials , we compared the efficacy of the DFS to that of iodized salt in a 9-mo , r and omized , double-blind trial in iodine-deficient , 6 - 15-y-old children ( n = 377 ) . RESULTS Mean salt intake in school-age children was 7 - 12 g/d , and estimated iron bioavailability from the local diet was 0.4 - 4.3 % . After storage for 20 wk , the DFS and iodized salt were not significantly different in iodine content , and color stability was acceptable when the compounds were added to local meals . During the efficacy trial , urinary iodine concentrations and thyroid volumes improved significantly ( P < 0.001 and < 0.05 , respectively ) from baseline in both groups . At 40 wk , mean hemoglobin concentrations in the DFS group had increased by 14 g/L ( P < 0.01 ) , and serum ferritin , transferrin receptor , and zinc protoporphyrin concentrations were significantly better ( P < 0.05 ) in the DFS group than in the iodized salt group . The prevalence of iron deficiency anemia in the DFS group decreased from 35 % at baseline to 8 % at 40 wk ( P < 0.001 ) . CONCLUSION A DFS containing iodine and encapsulated iron can be an effective fortification strategy After 1 y of distributing a milk-based fortified weaning food provided by the Mexican social program PROGRESA , positive effects on physical growth , prevalence of anemia , and several vitamin deficiencies were observed . There was no effect on iron status , which we hypothesized was related to the poor bioavailability of the reduced iron used as a fortificant in PROGRESA . The objective of this study was to compare the iron bioavailability from different iron sources added as fortificants to the weaning food . Children ( n = 54 ) aged 2 - 4 y were r and omly assigned to receive 44 g of the weaning food fortified with ferrous sulfate , ferrous fumarate , or reduced iron + Na(2)EDTA .  Iron absorption was measured using an established double-tracer isotopic methodology . Iron absorption from ferrous sulfate ( 7.9 + /- 9.8 % ) was greater than from either ferrous fumarate ( 2.43 + /- 2.3 % ) or reduced iron + Na(2)EDTA ( 1.4 + /- 1.3 % ) ( P < 0.01 ) . The absorption of log-(58)Fe sulfate given with the iron source correlated with serum ferritin ( s-ferritin ) concentration ( n = 13 , r = 0.63 , P = 0.01 ) and log-(57)Fe absorption ( reference dose ) ( n = 14 , r = -0.52 , P = 0.02 ) . Absorption from ferrous fumarate and reduced iron + Na2EDTA did not correlate with s-ferritin or absorption of (57)Fe . The recommended daily portion of the fortified complementary food provides an average of 0.256 , 0.096 , 0.046 mmol ( 1.44 , 0.54 , and 0.26 mg ) of absorbed iron , if fortified with sulfate , fumarate and reduced iron + Na(2)EDTA , respectively . Ferrous sulfate was more bioavailable than either ferrous fumarate or reduced iron + Na(2)EDTA when added to the milk-based fortified food and more readily met the average daily iron requirements for children 2 - 3 y of age BACKGROUND Phytic acid is a strong inhibitor of iron absorption from fortified foods . In adults , this inhibitory effect can be overcome by adding ascorbic acid with the iron fortificant or by using a " protected " iron compound such as NaFeEDTA . In addition , the use of NaFeEDTA as an iron fortificant has been reported to increase zinc absorption in adult women . No information is available on iron bioavailability from NaFeEDTA or the influence of NaFeEDTA on minerals and trace elements in infants . OBJECTIVE We aim ed to compare iron bioavailability from a complementary food based on wheat and soy fortified with either NaFeEDTA or ferrous sulfate plus ascorbic acid . The apparent absorption of zinc , copper , calcium , and magnesium was evaluated in parallel . DESIGN Stable-isotope techniques were used in a crossover design to evaluate erythrocyte incorporation of iron 14 d after administration of labeled test meals and the apparent absorption of zinc , copper , calcium , and magnesium on the basis of fecal monitoring in 11 infants . RESULTS Geometric mean erythrocyte incorporation of iron was 3.7 % ( NaFeEDTA ) and 4.9 % ( ferrous sulfate plus ascorbic acid ) ( P = 0.08 ) . No significant differences in the apparent absorption of zinc , copper , calcium , or magnesium were observed between test meals ( n = 10 ) . CONCLUSIONS Iron bioavailability from a high-phytate , cereal-based complementary food fortified with either NaFeEDTA or ferrous sulfate plus ascorbic acid was not significantly different . NaFeEDTA did not influence the apparent absorption of zinc , copper , calcium , or magnesium .  NaFeEDTA does not provide any nutritional benefit compared with the combination of a highly bioavailable iron compound and ascorbic acid BACKGROUND Micronutrient deficiencies are common during infancy , and optimal approaches for their prevention need to be identified . OBJECTIVE The objective was to compare the efficacy and acceptability of Sprinkles ( SP ) , crushable Nutritabs ( NT ) , and fat-based Nutributter ( NB ; 108 kcal/d ) , which provide 6 , 16 , and 19 vitamins and minerals , respectively , when used for home fortification of complementary foods . DESIGN Ghanaian infants were r and omly assigned to receive SP ( n = 105 ) , NT ( n = 105 ) , or NB ( n = 103 ) daily from 6 to 12 mo of age . We assessed dietary intake , morbidity , and compliance weekly . Hemoglobin and plasma ferritin , TfR , C-reactive protein , and zinc were measured at 6 and 12 mo . We used an exit interview to assess acceptability . A r and omly selected control group of infants who received no intervention ( NI ; n = 96 ) were assessed at 12 mo . RESULTS All supplements were well accepted , and the mean percentage of days that supplements were consumed ( 87 % ) did not differ between groups . At 12 mo , all 3 intervention groups had significantly higher ferritin and lower TfR concentrations than did the NI control group . Mean ( + /- SD ) hemoglobin was significantly higher in NT ( 112 + /- 14 g/L ) and NB ( 114 + /- 14 g/L ) but not in SP ( 110 + /- 14 g/L ) infants than in NI infants ( 106 + /- 14 g/L ) . The prevalence of iron deficiency anemia was 31 % in the NI control group compared with 10 % in the intervention groups combined ( P < 0.0001 ) . CONCLUSION All 3 options for home fortification of complementary foods are effective for reducing the prevalence of iron deficiency in such population BACKGROUND Although elemental iron powders are widely used to fortify cereal products , little data exist on their efficacy in humans . OBJECTIVE We compared the efficacy of wheat-based snacks fortified with ferrous sulfate , electrolytic iron , or hydrogen-reduced iron in Thai women with low iron stores . DESIGN A double-blind intervention was conducted in 18 - 50-y-old women ( n = 330 ) r and omly assigned into 4 groups to receive either no fortification iron or 12 mg Fe/d for 6 d/wk for 35 wk as ferrous sulfate , electrolytic iron , or hydrogen-reduced iron in a baked , wheat-flour-based snack . Snacks were not consumed with meals , and consumption was monitored . At baseline , 20 wk , and 35 wk , hemoglobin status and iron were measured and the groups were compared . RESULTS Between baseline and 35 wk , geometric mean serum ferritin ( SF ) increased significantly in all 3 groups receiving iron ( P < 0.01 ) , and geometric mean serum transferrin receptor ( TfR ) decreased significantly in the groups receiving ferrous sulfate and electrolytic iron ( P < 0.05 ) . Calculated mean ( + /-SD ) body iron stores increased from 1.5 + /- 2.8 to 5.4 + /- 2.9 mg/kg in the ferrous sulfate group , from 1.5 + /- 3.5 to 4.4 + /- 3.6 mg/kg in the electrolytic iron group , and from 1.3 + /- 3.2 to 3.2 + /- 4.3 mg/kg in the hydrogen-reduced iron group ( P < 0.01 for all 3 groups ) but did not change significantly in the control group . CONCLUSIONS Ferrous sulfate , electrolytic iron , and hydrogen-reduced iron , fortified into wheat-based snacks , significantly improved iron status . On the basis of the change in body iron stores during the 35-wk study , the relative efficacy of the electrolytic and hydrogen-reduced iron compared with ferrous sulfate was 77 % and 49 % , respectively One cost-effective strategy for controlling iron deficiency is the fortification of staple foods or condiments with iron . We evaluated the effectiveness of fortifying fish sauce with NaFeEDTA for improving iron status in women of childbearing age in Vietnam in a double-blind intervention with r and omization by village . All families in the selected villages were supplied with fish sauce that was either unfortified ( Group C , 10 villages ) or fortified with NaFeEDTA [ 9 mmol ( 500 mg ) Fe/L , Group F , 11 villages ] for 18 mo . The effect of fortification was assessed in the 576 women ( n = 288/group ) by measuring hemoglobin and serum ferritin ( SF ) at 6 , 12 , and 18 mo . Analysis of the group x time interaction using a repeated- measures test for each response demonstrated a significant effect of fortification on hemoglobin ( P = 0.039 ) and log SF ( P < 0.0001 ) in Group F with no significant changes in Group C. The prevalence of iron deficiency ( SF < 12 microg/L ) decreased from 22.3 to 4.0 % and the prevalence of anemia ( hemoglobin < 120 g/L ) from 24.7 to 8.5 % in Group F with no significant changes in Group C. NaFeEDTA fortification of fish sauce is an effective method for reducing the prevalence of iron deficiency in women in Vietnam 1 . The effect of fortification of food with iron to provide 10 mg elemental Fe/child per d was studied in preschool children maintained on a cereal diet , over a 5-month period . 2 . The absorption of 5 mg Fe as ferrous sulphate mixed in one meal was 3.3 % of the test dose and when 3.3 mg was given with each of three meals over a 2 d period the corresponding value was 4.8 % . 3 . The mean absorption of a test dose of ferrous ascorbate  studied in twenty-four children midway through the trial was 42 % . 4 . The only beneficial effect of Fe fortification in this time-period in the experimental group was the prevention of the decrease in packed cell volume which occurred in the control groups Objective . Survival rates for preterm infants who weigh between 501 and 1500 g at birth have continued to improve over time . In response to this continuing decrease in birth weight of surviving preterm infants , Enfamil Human Milk Fortifier has recently been reformulated to meet the nutritional requirements of these smaller , more rapidly growing infants . It now provides an increased protein level of 1.1 g/58 kJ , a decreased carbohydrate level of 0.2 g/58 kJ , and a combined linoleic and α-linolenic fatty acid content of 157 mg/58 kJ. As these very small preterm infants have an increased requirement for dietary iron , the fortifier has been supplemented with 1.44 mg/58 kJ of iron , an amount of iron similar to that provided in a typical iron-fortified term infant formula . An iron-fortified product obviates the need for administration of an iron supplement , a hyperosmolar-inducing intervention . The purpose of this prospect i ve , double-blind , r and omized , controlled study was to evaluate growth , safety , and efficacy in a population of very low birth weight ( VLBW ) preterm infants who received human milk fortified with either the reformulated iron-fortified powdered human milk fortifier test product ( HMF-T ) or a powdered commercially available human milk fortifier control product ( HMF-C ) .  Methods . Infants who weighed ≤1500 g , had a gestational age ≤33 weeks postmenstrual age , and had an enteral intake of at least 100 mL/kg per day of unfortified human milk were stratified by gender and birth weight and r and omized to receive HMF-T or HMF-C product from study day 1 to study day 28 , hospital discharge , or the termination of human milk feedings , whichever came first . Unless medically indicated , investigators were not to administer iron supplements from study days 1 to 14 . Infants were assessed serially for growth ; enteral and parenteral intake ; serum chemistry and hematologic values ; clinical histories , including the administration of blood transfusions ; feeding tolerance ; respiratory outcomes ; and morbidities , including adverse events . Results . Of the 181 participating infants in this study , 96 received HMF-T and 85 received HMF-C. At r and omization , there were no significant differences in infant characteristics between the fortifier groups . The percentage of participants who remained in the study for 28 days was similar between fortifier groups ( 57 % HMF-T , 46 % HMF-C ) . For both fortifier groups , the most frequent reasons for discontinuing the study before study day 28 were unavailability of human milk and hospital discharge . Rate of weight gain was similar between the fortifier groups ( 17.5 ± 0.53 g/kg per day for HMF-T and 17.3 ± 0.59 g/kg per day for HMF-C  ) . Mean achieved weight , length , and head circumference were comparable between groups across the 28-day study period . Total protein intake from enteral and parenteral nutrition was significantly greater for the HMF-T fortifier group ; however , this difference did not result in any difference in growth between the 2 fortifier groups . An analysis of the growth and energy intake data of a subset of the intent-to-treat population who adhered more strictly to the study feeding protocol yielded results similar to those seen for the intent-to-treat population . There were no clinical ly significant differences in the results of laboratory studies between the groups at study days 0 , 14 , and 28 . Anemia of prematurity was prevalent in both study groups ; by study day 28 , median hematocrit levels were 27.0 % ( interquartile range [ IQR ] : 24.0%–29.6 % ) for the HMF-T group and 26.0 % ( IQR : 24.0%–31.0 % ) for the HMF-C group . Median ferritin levels were 77.0 ng/mL ( IQR : 37 - 155 ng/ml ) for HMF-T and 92.0 ng/mL ( IQR : 33 - 110 ng/mL ) for HMF-C. There were no significant differences between the study fortifier groups in regard to the receipt of medically indicated iron supplements on or before study day 14 or in the administration of blood transfusions before study day 0 or from study days 0 through 14 . However , from study day 15 to study day 28 , fewer HMF-T infants ( n = 12 ) required a blood transfusion than did HMF-C infants ( n = 20 ) . Although the higher levels of iron in the HMF-T fortifier ( 1.44 mg vs 0.35 mg for HMF-C per 4 packets of powdered fortifier ) did not prevent anemia per se , it did reduce the frequency of one of the most serious outcomes of anemia : the need for a blood transfusion . There was no statistically significant difference between fortifier groups in regard to feeding tolerance . Rates of suspected sepsis ( 26 % HMF-T vs 31 % HMF-C ) and confirmed sepsis ( 5 % HMF-T , 7 % HMF-C ) were low as were the rates of suspected necrotizing enterocolitis ( NEC ; 6 % HMF-T and 5 % HMF-C ) and confirmed Bell 's stage 2 or more NEC ( 1 % HMF-T and 1 % HMF-C ) . There were no statistically significant differences between the study fortifier groups in regard to the incidence of confirmed and suspected sepsis and NEC . Conclusion . Both human milk fortifiers studied are safe , are well tolerated , and facilitate comparable good growth ; however , using the iron-fortified product may reduce the need for blood transfusions in VLBW infants . The similar low rates of suspected and confirmed NEC and sepsis seen in both fortifier groups in this study refutes the premise that the inclusion of iron in fortifiers will increase the incidence of sepsis and NEC . Indeed , the incidence for NEC and sepsis for both groups in this study was lower than is reported for VLBW infants and similar to that seen for infants who are fed human milk Some physicians are reluctant to recommend feeding of iron-fortified formulas to infants because of a fear of adverse reactions . In crossover studies , parents ' records were compared with regard to their  infant 's  behavior ( fussiness , cramps , regurgitation , flatus , colic ) and stool characteristics during periods when iron-fortified formulas were fed and periods when non-iron-fortified formulas were fed . No statistically significant feeding-related difference was noted except for stool color The effect of iron fortification is generally assumed to be less than iron supplementation ; however , the magnitude of difference in effects is not known . The present study aims to compare the efficacy of these two strategies on anaemia and iron status . After screening on low Hb , 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a r and omized , placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group , with children in all groups having been dewormed .  Blood sample s were collected before and after intervention for haemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) , C-reactive protein ( CRP ) , and haemoglobinopathies analysis . Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration , SF , TfR , body iron , and anaemic status as outcome variables . The improvement of haemoglobin , SF , and body iron level in the group receiving iron fortification was 42 % ( 2.6 g/L versus 6.2 g/L ) , 20 % ( 23.5 μg/L versus 117.3 μg/L ) , and 31.3 % ( 1.4 mg/kg versus 4.4 mg/kg ) of that in the iron supplementation group . The prevalence of anaemia dropped to 15.1 % in the control group , with an additional reduction of anaemia of 8.5 % in the iron supplementation group . The additional reduction due to iron fortification was 5.4 % , which amounts to well over 50 % of the impact of supplementation . In conclusion , the efficacy of iron fortification based on reduction of prevalence of anaemia , and on the change in haemoglobin level , is about half of the maximum impact of supplementation in case of optimal compliance . Thus , in a population of anaemic children with mild iron deficiency , iron fortification should be the preferred strategy to combat anaemia OBJECTIVE To evaluate the effect of two types of iron pots on haemoglobin ( Hb ) and serum ferritin ( SF ) concentrations in young children ( 6 - 24 months ) , adolescent girls ( 11 - 15 years ) and women of reproductive age ( 15 - 44 years ) , whose households were provided with  iron pots  for cooking food over a period of 6 months , compared with controls . DESIGN AND METHODS We r and omly assigned 161 households including 339 individuals from the three subgroups to cast iron pots , blue steel pots or oral iron supplements ( control ) . In the control group , children received micronutrient Sprinkles , and adolescent girls and women received iron tablets daily for 6 months . We measured Hb , SF and C-reactive protein concentrations at baseline and 6 months , and compared groups using regression models . RESULTS Anaemia prevalence ( Hb < 110 g l(-1 ) in infants , Hb < 120 g l(-1 ) in girls or women ) was 47 % ( cast iron group ) , 50 % ( blue steel group ) and 50 % ( control ) at baseline . At 6 months , there were no significant differences in Hb concentrations among groups ; however , differences in SF concentrations were significant ( P < 0.0001)--the control group had higher SF concentrations compared with the groups using iron pots . Also , differences in the prevalence of iron-deficiency anaemia ( IDA ; anaemia plus SF < 15 microg l(-1 ) ) were almost significant between cast iron and control groups ( P = 0.08 ) , and blue steel and control groups ( P = 0.05 ) . CONCLUSION There is no evidence that iron cooking pots are effective against IDA . Further research is warranted to determine whether the iron leached from the pots is bioavailable This study evaluated the effectiveness of supplementation with ferrous sulfate and iron bis-glycinate chelate on hemoglobin and serum ferritin levels among schoolchildren ( 7 - 11 years ) of both sexes . A r and omized community-based trial including 138 anemic children ( hemoglobin < 11.5 g/dL ) was conducted in Teresina , Piauí State , Brazil . Children were assigned to two treatment groups on an individual basis . One group ( n = 71 ) received 40 mg iron as ferrous sulfate once weekly and the other group ( n = 67 ) received 3.8 mg of iron bis-glycinate chelate-enriched cookies , 3x/week , for 8 weeks . The interventions showed a significant increase ( p < 0.01 ) in hemoglobin levels ( 1.1g/dL ) for children who received ferrous sulfate and 0.9 g/dl in those who received iron bis-glycinate chelate , although not significant in the inter-group comparison ( p > 0.05 ) . No effect was observed on body iron for either intervention ( p > 0.05 ) . Children with depleted iron stores ( < 15 ng/mL ) at the beginning of interventions showed increased serum ferritin concentrations after 8 weeks ( p < 0.01 ) , although no difference between treatments ( p > 0.05 ) was observed . The results confirm the effectiveness of the iron supplementation interventions and corroborate the use of iron salts or ferrous bisglycinate chelate on a weekly basis to overcome iron deficiency and anemia OBJECTIVE . Chronic lead poisoning and iron deficiency are concentrated in urban children from lower socioeconomic strata , and both impair neurocognitive development . Our study objective was to determine if iron fortification reduces blood lead levels in urban , lead-exposed , iron-deficient children in Bangalore , India . DESIGN , SETTING , AND PARTICIPANTS . A r and omized , double-blind , controlled school-based feeding trial was done in 5- to 13-year-old iron-deficient children ( n = 186 ) . At baseline , a high prevalence of lead poisoning was found in the younger children . Subsequently , all 5- to 9-year-old children participating in the trial ( n = 134 ) were followed to determine if iron fortification would affect their blood lead levels . INTERVENTION . Children were dewormed and fed 6 days/week for 16 weeks either an iron-fortified rice meal ( ∼15 mg of iron per day as ferric pyrophosphate ) or an identical control meal without added iron . Feeding was directly supervised and compliance monitored . OUTCOME MEASURES . Hemoglobin , serum ferritin , C-reactive protein , transferrin receptor , zinc protoporphyrin , and blood lead concentrations were measured . RESULTS . The prevalence of iron deficiency was significantly reduced in the iron group ( from 70 % to 28 % ) compared with the control group ( 76 % to 55 % ) . There was a significant decrease in median blood lead concentration in the iron group compared with the control group . The prevalence of blood lead levels ≥10 μg/dL was significantly reduced in the iron group ( from 65 % to 29 % ) compared with the control group ( 68 % to 55 % ) . CONCLUSIONS . Our findings suggest providing iron in a fortified food to lead-exposed children may reduce chronic lead intoxication . Iron fortification may be an effective and sustainable strategy to accompany environmental lead abatement Spatone Iron-Plus is a naturally occurring mineral water from Trefriw Wells Spa in Conwy County , North Wales , UK . It contains approximately 0.20 mg of iron per millilitre as ferrous sulphate and has been shown to provide iron in a highly bio-available form . A 24 ml sachet contains approximately 5 mg of iron . Iron deficiency is common in the obstetric population . However , compliance with traditional iron supplements is poor because of gastrointestinal side-effects . We design ed a r and omized , double-blind , placebo-controlled trial . A total of 102 low-risk antenatal patients , who were noncompliant with routinely prescribed ferrous sulphate tablets  , were r and omized to receive 48 ml of Spatone water or placebo . The study was conducted between 22 and 28 weeks gestation . Primary outcome measures were compliance , gastrointestinal side-effects and changes in ferritin levels during the trial period . Compliance in the intervention group was 57 % compared with 67 % in the control group , P = 0.22 . Dyspepsia scores , as determined by a recognized and well-vali date d question naire , did not differ between the two groups . During the trial period , mean ferritin levels fell by 24 % in the Spatone Iron-Plus group compared with a mean fall of 51 % in ferritin levels among the control group , P = 0.016 Objectives : ( a ) To measure iron absorption by human subjects from citric acid stabilized fish sauce fortified with ferrous sulfate , ferric ammonium citrate or ferrous lactate and ( b ) to identify the effect of added citric acid ( 3 g/l ) on iron absorption from ferrous sulfate fortified fish sauce . Design : Iron absorption from the intrinsically labeled compounds was determined via erythrocyte incorporation of isotopic labels ( 57Fe and 58Fe ) using a r and omized crossover design . In three separate absorption studies , 10 adult women each consumed a basic test meal of rice and vegetable soup seasoned with isotopically labeled , iron fortified fish sauce . Results : Iron absorption was significantly lower from ferrous lactate and from ferric ammonium citrate fortified fish sauce than from ferrous sulfate fortified fish sauce  . Fractional iron absorption ( geometric mean ; −1s.d . , + 1s.d . ) was 8.7(3.6 ; 21.4)% for ferrous lactate compared to 13.0(5.4 ; 31.4)% from ferrous sulfate , P=0.003 ( study 1 ) and 6.0(2.5 ; 14.3)% from ferric ammonium citrate relative to 11.7(4.4 ; 30.7)% from ferrous sulfate , P<0.001 , in study 2 . Citric acid added at a molar ratio of ∼2.5 to iron had no effect on iron absorption from ferrous sulfate ( study 3 ) . Iron absorption in the presence of citric acid was 14.1(6.4 ; 30.8)% compared to 12.0(5.8 ; 24.7)% in its absence ( P=0.26 ) . Conclusions : Iron absorption was 50–100 % higher from ferrous sulphate fortified fish sauce than from fish sauce fortified with ferric ammonium citrate or ferrous lactate . In the presence of citric acid as a chelator , ferrous sulfate would appear to be a useful fortificant for fish sauce . Sponsorship : International Atomic Energy Agency ( IAEA ) , Vienna , BACKGROUND Sodium iron edetic acid ( NaFeEDTA ) might be a more bioavailable source of iron than electrolytic iron , when added to maize flour . We aim ed to assess the effect , on children 's iron status , of consumption of whole maize flour fortified with iron as NaFeEDTA or electrolytic iron . METHODS 516 children , aged 3 - 8 years , from four schools in Marafa , Kenya , were r and omly assigned to four groups . All were given the same amount of porridge five times a week . The porridge for one group was made from unfortified whole maize flour ; for the other three groups it was fortified with either high-dose NaFeEDTA ( 56 mg/kg ) , low-dose NaFeEDTA ( 28 mg/kg ) , or electrolytic iron ( 56 mg/kg ) . Concentrations of haemoglobin , plasma ferritin , and transferrin receptor were analysed in sample s taken at baseline and at the end of the 5-month intervention . The primary outcome was iron-deficiency anaemia . We analysed data on an intention-to-treat basis . This trial is registered with Clinical Trials.gov , number NCT00386074 . FINDINGS The prevalence of iron-deficiency anaemia in children given unfortified flour was 10 % . Compared with placebo , the prevalence of iron-deficiency anaemia in children given flour fortified with high-dose NaFeEDTA , low-dose NaFeEDTA , and electrolytic iron changed by -89 % ( 95 % CI -97 % to -49 % ) , -48 % ( -77 % to 20 % ) , and 59 % ( -18 % to 209 % ) , respectively . Consumption of high-dose NaFeEDTA improved all measured iron-status indicators . Low-dose NaFeEDTA decreased the prevalence of iron deficiency but did not noticeably change the prevalence of anaemia . Electrolytic iron did not improve any of these iron-status indicators .  Children who were iron-deficient at baseline benefited more from high-dose and low-dose NaFeEDTA than those with sufficient iron at baseline . INTERPRETATION Consumption of whole maize flour fortified with NaFeEDTA caused modest , dose-dependent improvements in children 's iron status . Fortification with electrolytic iron did not improve their iron status . Therefore , in high-phytate flours , NaFeEDTA is more suitable than electrolytic iron for supplementation of iron in the diet Iron deficiency is endemic in much of the world , and food system-based approaches to eradication may be viable with new plant breeding approaches to increase the micronutrient content in staple crops . It is thought that conventional plant breeding approaches provide varieties of rice that have 400 - 500 % higher iron contents than varieties commonly consumed in much of Asia . The efficacy of consuming high-iron rice was tested during a 9-mo feeding trial with a double-blind dietary intervention in 192 religious sisters living in 10 convents around metro Manila , the Philippines . Subjects were r and omly assigned to consume either high-iron rice ( 3.21 mg/kg Fe ) or a local variety of control rice ( 0.57 mg/kg Fe ) , and daily food consumption was monitored . The high-iron rice contributed 1.79 mg Fe/d to the diet in contrast to 0.37 mg Fe/d from the control rice . The 17 % difference in total dietary iron consumption compared with controls ( 10.16 + /- 1.06 vs. 8.44 + /- 1.82 mg/d ) result ed in a modest increase in serum ferritin ( P = 0.10 ) and total body iron ( P = 0.06 ) and no increase in hemoglobin ( P = 0.59 ) . However , the response was greater in nonanemic subjects for ferritin ( P = 0.02 ) and body iron ( P = 0.05 ) , representing a 20 % increase after controlling for baseline values and daily rice consumption . The greatest improvements in iron status were seen in those nonanemic women who had the lowest baseline iron status and in those who consumed the most iron from rice . Consumption of biofortified rice , without any other changes in diet , is efficacious in improving iron stores of women with iron-poor diets in the developing world BACKGROUND Iron deficiency anemia ( IDA ) in the Philippines is a serious public health problem . Fortifying rice offers a great opportunity to control IDA . However , information on other types of fortificants that can be used is scarce . OBJECTIVE To compare the effects of two types of iron fortificants in rice in improving the hematological status of schoolchildren . DESIGN 180 r and omly selected 6-to 9-year-old anemic children were r and omly allocated to three groups in a double-blinded manner : One group received iron-enriched rice ( IER ) with extruded iron premix rice ( IPR ) using ferrous sulfate as fortificant ( ExFeSO4 ) ; the second group received IER with extruded IPR using micronized dispersible ferric pyrophosphate ( ExFeP80 ) ; and the third group received non-fortified rice ( Control ) . These were administered daily for 5 days a week for 6 months . Blood sample s were collected at baseline after 3 and 6 months . RESULTS At baseline , one child in the ExFeP80 group was suffering from IDA ; at 3 months , no IDA was found in any groups ; while at 6 months , one child in the ExFeP80 developed IDA . The baseline prevalence of anemia in all groups , which was 100 % , was significantly reduced to 51 % , 54 % , and 63 % in the ExFeSO4 , ExFeP80 and Control groups respectively . After 6 months , further significant reductions were observed in the ExFeSO4 ( 38 % ) and ExFeP80 ( 33 % ) but remained at 63 % in the Control group . Greater , significant increases were also observed in plasma ferritin in the fortified groups than in the Control group from baseline to 6 months . The predictors of change in hemoglobin ( Hb ) and plasma ferritin were group allocation and basal values . CONCLUSION The consumption of rice fortified with FeP80 using extrusion technology has similar effects as that of FeSO4 in reducing the prevalence of IDA among schoolchildren Preterm infants with birth weights between 1,001 and 1,600 gm were r and omly assigned at one week of age to three groups and fed a st and ard milk-based formula , the same formula with iron , or a soy-based formula with iron .  Hematologic values and selenium status were then studied prospect ively for five weeks . Rates of decline in hematocrit and hemoglobin did not differ significantly among the three groups and did not correlate with red cell selenium values or glutathione peroxidase activity . Attainment of vitamin E sufficiency was variable among the infants , with no significant intergroup differences . Plasma selenium concentrations did not change significantly , but plasma glutathione peroxidase activity declined consistently in all three groups . Under the conditions of this study , iron at a concentration of 12 mg/L of infant formula did not accelerate hemolysis ; nor was there evidence of a direct association between selenium values and early anemia of prematurity BACKGROUND Iron status de grade s in female soldiers during military training . Inflammation-mediated up-regulation of hepcidin , a key mediator of iron homeostasis , may be a contributing factor . OBJECTIVE We measured the efficacy of an iron-fortified food product for maintaining iron status in female soldiers during basic combat training ( BCT ) and examined relations between iron status , serum hepcidin concentrations , and inflammation . DESIGN A r and omized , double-blind , placebo-controlled trial was conducted . Volunteers received an iron-fortified food product ( total dose = 56 mg Fe/d ) or a placebo twice daily during the 9-wk BCT course . Iron-status indicators , serum hepcidin concentrations , and markers of inflammation were measured pre- and post-BCT . RESULTS BCT affected iron status ; serum ferritin concentrations decreased ( P < or = 0.05 ) , and concentrations of soluble transferrin receptor ( sTfR ) and hemoglobin and the red cell distribution width increased ( P < or = 0.05 ) . Consumption of the iron-fortified food product attenuated declines in iron status in iron-deficient anemic soldiers ; a group-by-time interaction was observed for hemoglobin and sTfR concentrations ( P < or = 0.05 ) . Serum hepcidin concentrations were not affected by BCT ; however , hepcidin concentrations were lower in iron-deficient anemic soldiers than in those with normal iron status ( P < or = 0.05 ) and were positively associated with serum ferritin ( P < or = 0.05 ) and C-reactive protein ( P < or = 0.05 ) concentrations pre- and post-BCT . CONCLUSIONS Twice-daily consumption of an iron-fortified food product improved iron status in iron-deficient anemic soldiers but not in iron-normal or iron-deficient nonanemic soldiers . Serum hepcidin concentrations were not affected by training but were associated with iron status and inflammation pre- and post-BCT . This trial was registered at clinical trials.gov as NCT01100905 The use of flour fortified with 66 mg/kg of electrolytic or reduced iron to reduce the prevalence of anemia was determined in a two-year , double-blind , controlled trial . The trial was conducted in Sri Lanka among preschoolers between 9 and 71 months old , primary schoolers 6 to 11 years old , and nonpregnant women . At baseline , 18.4 % of the preschoolers had low hemoglobin ( Hb ) concentrations .  Neither electrolytic nor reduced iron had an effect on Hb concentration among preschoolers . Only 7 % of the primary schoolers were anemic at the start of the trial and , again , fortification had no effect on Hb concentration . Twenty-nine percent of women had a low Hb at outset and there was no evidence that fortification had an effect on Hb in this group . The findings from this study suggest that fortification of flour with electrolytic iron or reduced iron was not beneficial in reducing anemia in this population . This was probably due to the low prevalence of anemia and low bioavailability of the fortificant iron . Fortification with either iron fortificant was acceptable Preschool children in developing countries are likely to have multiple , concurrent micronutrient deficiencies . This study was design ed to evaluate the effectiveness of different combinations of nutritional fortified diet to improve the blood levels of iron , vitamin A and other essential micronutrients in the preschool population of Banan District of Chongqing , China . From December 2005 to June 2006 , a total of 226 2 - 6 y old preschool children were recruited from three nurseries in the area , and they were r and omly assigned to three different fortified diet groups for 6 mo . Group I was fortified with vitamin A ; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron , thiamine , riboflavin , folic acid , niacinamide , zinc and calcium , respectively . Subjects ' weight and height were measured for assessing the children 's growth and development . Blood sample s were taken at the beginning and the end of the 6-mo study period for measuring serum levels of micronutrients . Group III with the multiple micronutrient fortified diet was the most effective to improve the serum level of retinol from [ media ( P25 , P75 ) : 1.06 ( 0.89 , 1.32 ) ] micromol/L to 1.29 ( 1.04 , 1.39 ) micromol/L ( p<0.05 ) and retinol binding protein from 17.0 ( 12.6 , 25.6 ) mg/L to 31.6 ( 24.4 , 44.0 ) mg/L ( p<0.05 ) and to mobilize the stored iron in the liver ( p<0.05 ) . In addition , the three groups ' hemoglobin levels were elevated from 117.0 ( 109.0 , 124.1 ) g/L , 114.0 ( 109.2 , 119.7 ) g/L and 115.0 ( 109.5 , 122.7 ) g/L to 125.7 ( 119.2 , 133.1 ) g/L , 126.5 ( 122.2 , 135.9 ) g/L and 125.1 ( 119.8 , 131.6 ) g/L over the 6 mo of intervention period , but there were no difference among the three groups ( p>0.05 ) . Nevertheless , unexpected results were obtained when comparing the effects on growth status among the different supplement groups . Our study has demonstrated that a multiple micronutrient fortified diet for 6 mo is more effective to improve the levels of hemoglobin , serum retinol , and RBP as well as to facilitate the mobilization of iron storage in preschool children OBJECTIVE Study the efficiency of the NaFeEDTA fortified soy sauce on anemia prevention among the children from iron deficiency anemia ( IDA ) prevalence region . METHODS A double blind controlled r and om intervention in Bijie , Guizhou was conducted for 18 months . The finger hemoglobin ( Hb ) was detected at baseline and after 6 , 12 , 18 months intervention . Anthropometrics were also taken at baseline and after 12 months intervention . RESULTS The Hb level increased significantly in the intervention group [ ( 111.08 + /- 11.31 ) g/L at baseline and ( 122.99 + /- 8.43 ) g/L after 12 months ] , the anemia prevalence decreased markedly ( 58.0 % at baseline , 17.6 % after 12 months ) . After 12 months intervention , a significantly gain of the weight for age Z-score ( WAZ ) was observed in the intervention group . The abdomen and triceps skin folders were thicker in the intervention group , and the intervention group had greater gains of the abdomen and triceps skin folders than those in the control group . CONCLUSION The soy sauce fortified with NaFeEDTA can increase the Hb level and decrease the prevalence of anemia in the children , and the NaFeEDTA fortified soy sauce can enhance the weight gain and the pull up of the subcutaneous fat . It is suggested that using NaFeEDTA fortified soy sauce in high IDA prevalence population was an efficient way for IDA preventing The study objective was to measure the effect of consumption of a beverage mixed with a high-iron sweetener ( evaporated sugarcane juice known as rapadura ) on hemoglobin levels in preschool children , and to compare it with the effect of consuming the same beverage sweetened with refined sugar . Research consisted of a 12-week r and omized , controlled double-blind trial conducted in 2007 at a state-run school in Sobral , Brazil , among children aged 2 - 3 years . The study sample was divided into two groups-one consuming cashew juice mixed with 25 g of rapadura and 40 mg of ascorbic acid ( per 200-mL serving ) , and another consuming the same quantity of juice and ascorbic acid sweetened with 25 g of st and ard refined sugar . A significant statistical increase in hemoglobin was observed in the group consuming the rapadura-fortified beverage . It was therefore concluded that consumption of rapadura increased hemoglobin and thus reduced iron deficiency anemia in preschool children BACKGROUND Many infants are switched between multiple formula preparations early in life because of perceived abnormalities in stooling pattern as well as gastrointestinal symptoms . OBJECTIVE To investigate the relationship between the type of formula consumed and the stooling characteristics and gastrointestinal  symptoms of young infants . METHODS Healthy 1-month-old infants were fed one of four commercial formula preparations ( Enfamil , Enfamil with Iron , ProSobee , and Nutramigen ) for 12 to 14 days in a prospect i ve double-blinded ( parent/physician ) fashion . Parents completed a daily diary of stool characteristics as well as severity of spitting , gas , and crying for the last 7 days of the study period . A breast-fed infant group was studied as well . RESULTS Two hundred eighty five infants were enrolled and 238 completed the study . Infants receiving breast milk or Nutramigen had twice as many stools as other formula groups ( P < .001 ) . Infants receiving ProSobee had hard/firm stools more often than breast-fed or other formula-fed groups ( P < .00001 ) . Watery stools were more common in infants fed Nutramigen than other formula groups ( P < .04 ) . Green stools were more common in 12 mg/L iron preparations ( Enfamil with iron , ProSobee , Nutramigen ) than in those with 1 mg/L ( Enfamil , breast milk ) ( P < .00001 ) . Spitting , gassiness , and crying were of equal severity in all formula groups . CONCLUSIONS The interpretation of stool frequency , color , and consistency must take into account the infant 's formula type as significant variations in normal infants occur . Parental education on the range of infant stooling characteristics as well as the common occurrence of spitting , gas , and crying may alleviate concern for formula intolerance and underlying gastrointestinal disease Food fortification is an important long-term strategy for addressing micronutrient deficiencies . Finding the ideal Fe fortification compound , however , remains a challenge . In the present study the effect of ferrous bisglycinate as fortificant in brown bread was compared with that of electrolytic Fe among Fe-deficient school children in a r and omised controlled trial . Children ( n 160 ) , aged 6 - 11 years , with serum ferritin < 20 microg/l , were r and omly assigned to one of three treatment categories : ( i ) st and ard unfortified bread ; ( ii ) bread with electrolytic Fe as fortificant ; and ( iii ) bread with ferrous bisglycinate as fortificant . Each child received four slices of bread ( 120 g ) on school days , which supplied an average of 3.66 mg elemental Fe per intervention day for 137 d ( 2.52 mg/d for 75 d and 5.04 mg/d for 62 d ) over a period of 7.5 months . Hb , serum ferritin , serum Fe and transferrin saturation were measured at baseline and at the end of the intervention . Significant treatment effects were observed for Hb ( P = 0.013 ) , serum Fe ( P = 0.041 ) and transferrin saturation ( P = 0.042 ) in the ferrous bisglycinate group , but not in the electrolytic Fe group . There were no significant intervention effects for serum ferritin in either treatment group . Overall , ferrous bisglycinate as Fe fortificant in brown bread performed better than electrolytic Fe in a group of Fe-deficient school children over a period of 7.5 months AIMS To prospect ively evaluate the iron nutritional status of preterm infants fed either a term ( 0.5 mg/dl iron ) or preterm ( 0.9 mg/dl ) formulas fortified with iron after hospital discharge . METHODS Healthy low birthweight preterm infants were r and omly assigned into three groups at the time of hospital discharge . Group A were fed an iron fortified preterm formula ( 0.9 mg/dl iron ) until 6 months corrected age ; group B , a fortified term formula ( 0.5 mg/l iron ) until 6 months corrected age group C , the preterm formula between hospital discharge and term , then the term formula until 6 months corrected age . RESULTS Seventy eight infants were followed up to 6 months corrected age . Iron intake from formula differed significantly between the groups ( A , 1.17 mg/kg/day ( SD 0.32 ) > C , 0.86 mg/kg/day ( SD 0.40 ) = B , 0.81 mg/kg/day ( SD 0.23 ) ; p < 0.0001 ) . Haemoglobin concentrations were similar to those of iron sufficient preterm infants of the same postnatal age , and term infants of the same postmenstrual age ( after 3 months of age ) . There were no significant differences in haemoglobin concentration ( p = 0.391 ) , plasma ferritin ( A vs B , p = 0.322 ) , or in the incidence of iron deficiency ( A vsB , p = 0.534 ) . CONCLUSIONS Iron fortified formulas containing between 0.5 and 0.9 mg/dl iron seem to meet the iron nutritional needs of preterm infants after hospital discharge The aim of this study was to determine the iron status of infants who consumed porridge cooked in water with added ferrous sulphate .  A total of 234 infants , aged 6 - 12 months , were recruited from 36 nurseries in the Democratic Peoples Republic of Korea ( DPRK North Korea ) and r and omly divided into iron ( Fe ) and placebo groups . At baseline , almost half the children had Hb<110 g/L and no significant differences between the two groups were found with regard to hemoglobin concentration and anemia prevalence . The Fe group received rice porridge fortified with 10 mg of iron ( as ferrous sulfate ) per day , added to the water in which the rice was cooked and the placebo group non-fortified cereal for 6 months . After which , the hemoglobin ( Hb ) , serum ferritin ( SF ) and packed cell volume ( PCV ) were measured and it was found that the proportion of children with anemia ( Hb<110 g/L ) was lower ( 24.3 % v 48.1 % p<0.01 ) , the Hb levels ( 117.6 g/L v 109.8 g/L p<0.001 ) and serum ferritin were higher ( 40.7 v 26.8 mcg/L p<0.001 ) ; and iron deficiency anemia ( Hb<110 g/L , SF<12 mcg/L ) was lower in the Fe group ( 3 % v 22 % p<0.001 ) when compared to the placebo group . Ferrous sulphate , added to the water in which rice was cooked , lowered the prevalence of iron deficiency anemia of infants in the DPRK with no adverse reactions . This simple fortification would be suitable as a nationwide program in the DPRK and other countries with large infant nurseries The objective of this research was to study the effectiveness of NaFeEDTA-fortified soy sauce for controlling iron deficiency in a high-risk population . This was an 18-month , r and omized , placebo-controlled intervention trial in 14,000 residents aged three years or older in Bijie City , Guizhou Province , China , using sodium-iron ethylene diamine tetraacetate (NaFeEDTA)-fortified soy sauce ( 29.6 mg Fe/100 ml ) . The study data included measurements of food consumption , hemoglobin , serum ferritin , and serum retinol . The results showed that the diet consisted primarily of cereals , fruits , and vegetables , with very little meat . Food consumption remained unchanged during the study period and was similar in the fortified and control groups . The average daily  soy sauce  consumption of the group consuming the fortified product was 16.4 ml per person , which provided 4.9 mg of iron from NaFeEDTA . At the end of the trial , all age and sex subgroups receiving NaFeEDTA had significantly higher hemoglobin levels , a lower prevalence of anemia , and higher plasma ferritin levels than the controls . The effects became statistically significant after six months of intervention and were maintained throughout the study period . We conclude that NaFeEDTA-fortified soy sauce was highly effective in controlling iron deficiency and reducing the prevalence of iron-deficiency anemia in men , women , and children . NaFeEDTA-fortified soy sauce is affordable and was well accepted by the study population OBJECTIVE NaFeEDTA was considered as a promising iron fortificant for controlling iron deficiency anemia .  Soy sauce is a suitable food carrier for iron fortification and is a popular condiment in China .  Iron absorption rates of NaFeEDTA and FeSO4 were observed and compared in adult female subjects . METHODS The stable isotope tracer method was used in Chinese females consuming a typical Chinese diet . Ten healthy young Chinese women were selected as subjects in the 15-day study . A plant-based diet was used based on the dietary pattern of adult women in the 1992 National Nutrition Survey . Six milligram of 54Fe in 54FeSO4 soy sauce and 3 mg 58Fe in Na58FeEDTA soy sauce were given to the same subjects in two days . Food sample s and fecal sample s were collected and analyzed . RESULTS Iron absorption rates of NaFeEDTA and FeSO4 were 10.51 % + /- 2.83 and 4.73 % + /- 2.15 respectively . The 58Fe ( NaFeEDTA ) absorption was significantly higher than that of 54Fe ( FeSO4 ) ( P < 0.01 ) . The iron absorption rate from NaFeEDTA was 1.2 times higher than that from FeSO4 in Chinese adult women consuming a typical Chinese diet . CONCLUSION The higher absorption rate of NaFeEDTA suggested that NaFeEDTA would be a better iron fortificant used in soy sauce for the controlling of iron deficiency anemia in China OBJECTIVE To determine if repletion of hemoglobin was achievable in young children presenting both severe ( < or = 9.4 g hemoglobin/dL blood ) and less severe iron deficiency anemia ( 9.5 to 11.0 g hemoglobin/dL blood ) through fortification of liquid 3.3 % butterfat milk with a bioavailable ferrous iron amino acid chelate ( Ferrochel ) at 3 mg iron/liter/day . METHODS A group of 185 children were selected from Tupã , Brazil who presented the above two stages of iron deficiency anemia plus normalcy . Initially , 54 % had severe iron deficiency anemia , 33 % were less severely anemic and 13 % had normal hemoglobin concentrations . They received iron-fortified milk for a mean of 222+/-2 days . Hemoglobin concentrations were measured initially , at 133+/-13 days , and at 222+/-2 days . RESULTS By mean 222 days , 57 % of the childrens ' hemoglobins were normal . Highest rates of repletion were in the initially severe anemic group . Repeated measures ANOVAs demonstrated that hemoglobins at 0 , 133 and 222 days for the total group , as well as for the severe and less severe iron deficiency anemic groups , represented statistically different population s at alpha=0.0005 . Children with initially normal hemoglobin concentrations showed no change at 0 , 133 and 222 days ( alpha=0.10 ) , suggesting the possibility of absorptive regulation of this form of iron . CONCLUSIONS Low hemoglobin concentrations in young children can be increased through daily consumption of fluid milk fortified with 3 mg ferrous amino acid chelate ( Ferrochel ) Ninety two normal birthweight infants aged 6 months entered a double blind controlled trial which compared a follow on formula milk with no added iron against the same formula milk containing 1.2 mg of iron per 100 ml . There was no significant difference in the social class or demographic characteristics of the two treatment groups or in the proportion of each group completing the trial . There was no difference between the two groups in the quantity of milk taken but the amounts taken lessened between 6 and 18 months of age . There was no difference between the two groups with respect to mean haemoglobin and median serum ferritin at 6 , 9 , 12 , 15 , and 18 months of age . Very few infants developed iron deficiency anaemia in either group but there was a tendency for serum ferritin levels to fall between 6 and 18 months of age in both groups . The results suggest that iron added to follow on milk was not an important source of dietary iron in the infants studied Aims : To compare iron fortified follow-on milk ( iron follow-on ) , iron fortified partially modified cows ’ milk ( iron milk ) , and iron medicine for the treatment of iron deficiency anaemia ( IDA ) in hospitalised infants . Methods : In a r and omised controlled trial , infants aged 9–23 months with IDA and who were hospitalised with an acute illness received iron follow-on ( 12 mg/l ferrous iron ) , iron milk ( 12.9 mg/l ferrous iron ) , or iron medicine ( ferrous gluconate at 3 mg/kg of elemental iron once daily ) . All interventions were given for three months . Changes in measures of iron status three months after hospital discharge were determined . Results : A total of 234 infants were r and omised .  Iron status was measured at follow up in 59 ( 70 % ) iron medicine , 49 ( 66 % ) iron follow-on , and 54 ( 70 % ) iron milk treated infants . There was a significant ( mean , 95 % CI ) increase in haemoglobin ( 15 g/l , 13 to 16 ) and iron saturation ( 9 % , 8 to 10 ) and decrease in ferritin ( −53 μg/l , −74 to −31 ) in all three groups . Mean cell volume increased in iron follow-on ( 2 fl , 1 to 3 ) and iron milk ( 1 fl , 0.1 to 3 ) treated infants , but not in the iron medicine group ( 1 fl , −1 to 2 ) . The proportion with IDA decreased in all three groups : iron medicine 93 % to 7 % , iron follow-on 83 % to 8 % , and iron milk 96 % to 30 % . Adverse effects , primarily gastrointestinal , occurred in 23 % of the iron medicine , 14 % of the iron follow-on , and 13 % of the iron milk group . Conclusions : Iron fortified follow-on milk , iron fortified partially modified cows ’ milk , and iron medicine all effectively treat IDA in infancy OBJECTIVE To test the efficacy of double-fortified salt ( DFS ) on the  anaemia and iodine deficiency ( ID ) status of women and their children . DESIGN Double-blind r and omised controlled trial . SETTING Sekyere West District of Ghana . SUBJECTS In this eight-month trial , mildly anaemic or non-anaemic , non-pregnant , non-lactating women were r and omised into three groups receiving : DFS plus weekly placebo ( n = 61 ) ; iodised salt plus weekly 70 mg iron supplement ( n = 65 ) ; or iodised salt ( IS ) plus weekly placebo ( control group , n = 58 ) . Correspondingly , their mildly anaemic and non-anaemic children aged 1 - 5 years were r and omised into two groups receiving either the DFS ( n = 23 ) or IS alone ( control group , n = 59 ) . RESULTS At the end of the intervention , prevalence of anaemia in women remained unchanged in the DFS or IS plus weekly iron supplement group , but significantly increased by 19.5 % in the control group ( P = 0.039 ) . In children , prevalence of anaemia in the DFS group significantly decreased by 21.7 % ( P = 0.025 ) while no change was observed in the control group . ID decreased significantly in all groups of women ( P < 0.001 ) and children ( P < 0.05 ) , with no difference among groups of women and children . CONCLUSION While the use of DFS prevented anaemia in women , it had a significant role in both the prevention and treatment of anaemia in children . Both the DFS and IS significantly reduced ID in women and children to a similar degree BACKGROUND Although uncommon , iron deficiency ( ID ) occurs in breastfed infants . The regular provision of iron may prevent ID . OBJECTIVE The objective was to test the feasibility and effectiveness of 2 modalities of providing iron ( medicinal iron or iron-fortified cereal ) to breastfed infants . The study tested the hypothesis that regular provision of iron improves iron status of breastfed infants without adverse effects . DESIGN In this prospect i ve , r and omized , open-label trial , breastfed infants received on a regular basis either medicinal iron ( n = 48 ) or an iron-fortified fruit-cereal combination ( n = 45 ) from 4 to 9 mo or no intervention ( control group ; n = 59 ) . The interventions provided 7.0 - 7.5 mg ferrous sulfate/d . Infants were enrolled at 1 mo and were followed to 2 y. Iron-status indicators were determined periodically , stool characteristics were recorded , and growth was monitored . RESULTS The regular provision of iron led to improved iron status during and for some months after the intervention . Both sources of iron were about equally effective . Iron affected stool color but had no effect on feeding-related behavior . However , medicinal iron was associated with a small but significant reduction in length gain and a trend toward reduced weight gain . ID anemia was observed in 4 infants ( 2.3 % ) , most of whom had a low birth iron endowment .  Mild ID was common in the second year of life . CONCLUSIONS Regular provision of medicinal iron or iron-fortified cereal improves the iron status of breastfed infants and may prevent ID . Both modalities are equally effective , but medicinal iron leads to somewhat reduced growth . This trial was registered at Clinical Trials.gov as NCT00760890 OBJECTIVES For bottle-fed babies or nursing infants who receive milk supplements , the American Academy of Pediatrics recommends the use of iron-fortified infant formula . Because these recommendations have not been universally adopted , the hematologic effects of currently available low-iron formulas need to be determined . STUDY DESIGN Healthy Chilean 6-month-old infants ( without iron-deficiency anemia , born at term weighing > or 3.0 kg ) who were totally or partially weaned from the breast were r and omly allocated in a double-blind fashion to receive high-iron ( n = 430 ) or low-iron formula ( n = 405 ) , containing an average of 12.7 mg/L or 2.3 mg/L , respectively , of elemental iron as ferrous sulfate . Iron status was determined at 12 months . RESULTS The prevalence of iron-deficiency anemia was not different in the high- and low-iron groups ( 2.8 % versus 3.8 % , p = 0.35 ) . Nevertheless , infants receiving high-iron formula had somewhat higher levels of hemoglobin and serum ferritin , greater mean cell volumes , and lower erythrocyte protoporphyrin levels ( p < 0.005 ) . CONCLUSIONS Although high-iron formulas are more efficacious in improving iron status , currently available low-iron formulas may prevent iron-deficiency anemia in selected healthy , term infant population s with otherwise poor sources of dietary iron after 6 months of life . Formulas with relatively small amounts of iron appear to prevent iron-deficiency anemia . We speculate that the optimal level of iron fortification likely lies somewhere between the current levels in high- and low-iron formulas Summary Single interventions for helminthic infections and micronutrient deficiencies are effective , but it is not clear whether combined interventions will provide equal , additive or synergistic effects to improve children 's health . The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children . A double-blind , r and omized , placebo-controlled trial in 11 rural South African primary schools r and omly allocated 579 children aged between 8 and 10 years into six study groups , half of whom received antihelminthic treatment at baseline . The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits , either unfortified or fortified with vitamin A and iron or with vitamin A only , given daily for 16 weeks . The outcome measures were anthropometric , micronutrient and parasite status , and scholastic and cognitive test scores . There was a significant treatment effect of vitamin A on serum retinol ( p < 0.01 ) , and the suggestion of an additive effect between vitamin A fortification and de-worming . Fortified biscuits improved micronutrient status in rural primary school children ; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection . The burden of micronutrient deficiency ( anaemia , iron and vitamin A ) and stunting in this study population was low and , coupled with the restricted duration of the intervention ( 16 weeks ) , might have limited the impact of the interventions OBJECTIVE Low iron status is a well known risk factor for iron deficiency anemia in infants and young children . The aim of the present study was to evaluate the influence of an iron-fortified toddler formula on iron status in 1 - 3 year-olds . PATIENTS AND METHODS Thirty-three healthy infants and young children were assigned to two groups that received 500 mL/day of and iron-fortified toddler formula or 500 mL/day of unmodified cow 's milk for 4 months . Allocation was r and om and double-blind . Daily dietary intake was calculated by dietary evaluation , and iron nutritional status was assessed ( hemoglobin , hematocrit , mean corpuscular volume , mean corpuscular hemoglobin , mean corpuscular hemoglobin concentration , serum iron , ferritin , and transferrin ) . RESULTS At enrollment , no anemia was found in either group , although hemoglobin concentration and hematocrit were significantly lower in the toddler formula group than in the unmodified cow 's milk group . However , these differences disappeared at the end of the intervention period . After 4 months , the toddler formula group showed significantly higher serum ferritin and lower serum transferrin concentrations than the cow 's milk group . CONCLUSION Intake of iron-supplemented toddler formula for 4 months in 1 - 3 year-olds is more effective in maintaining iron nutritional status than cow 's milk The present study was undertaken to determine the actual amounts of mush consumed and energy iron and zinc intakes of , and to investigate the attendance rate among , children aged 6–23 months due to an improved mush intervention .  A cohort of 208 children from 27 villages was followed up for 6 months . Twice a day , 6 days/week , each mother took her child to the nutrition centre we had opened in her village to receive the mush and fed it to her child . Amounts consumed were 15 , 21 and 33 g/kg body weight/meal for children aged 6–8 , 9–11 and 12–23 months respectively . The average ( st and ard deviation ) attendance rate was 68.0 % ( 25.6 % ) . The median ( range ) daily intakes from the mush were 213 ( 25–373 ) kcal , 5.3 ( 0.6–9.3 ) mg , and 2.3 ( 0.3–4.1 ) mg for energy , iron and zinc , respectively . This flour and mush production should enter the routines of individual households , supported by a large-scale programme of nutrition education Background / Objectives : Despite repeated public commitments and availability of various forms of iron supplements , rates of anaemia in developing countries remain high . A major reason for this lack of success has been poor adherence . The objective of this study was to compare the effectiveness of daily and flexible administration of micronutrient Sprinkles on adherence , acceptability and haematological status among young children in rural Bangladesh . Subjects/ Methods : A sample of 362 children ( haemoglobin (Hb)⩾70 g l−1 ) aged 6–24 months were cluster-r and omized to receive 60 sachets of Sprinkles either ( i ) daily over 2 months ; ( ii ) flexibly over 3 months ; or ( iii ) flexibly over 4 months . With a flexible regimen , mothers/caregivers decided how frequently to use Sprinkles without exceeding one sachet per day . Adherence was assessed monthly by counting the number of sachets used and acceptability was evaluated through focus group discussion s. Haemoglobin was measured at baseline , at the end of each intervention period and 6 months post-intervention . Results : Mean percent adherence was significantly higher in the flexible-4-month group ( 98 % ) compared to the flexible-3-month ( 93 % ) and daily-2-month ( 88 % ) groups ( P<0.01 ) . Most mothers found flexible administration to be more acceptable than daily due to perceived benefits of use . Hb at the end of intervention was significantly higher in the flexible-4-month group compared to the daily group ( P=0.03 ) . Anaemia prevalence decreased by 65 % in the flexible-4-month group compared to 54 % in the flexible-3-month and 51 % in the daily-2-month groups . Percent of cured children who maintained a non-anaemic status 6 months post-intervention was significantly higher in the flexible-4-month ( 82 % ) and flexible-3-month ( 80 % ) groups than the daily-2-month ( 53 % ) group ( P<0.05 ) . Conclusions : The adherence , acceptability and haematological response to flexible administration over 4 months were found preferable to daily We tested in the field an extruded rice flour , fortified with a bovine haemoglobin concentrate ( Fe:14 mg/100 g of powder ) . This cereal has a high iron bioavailability , good protein quality and amino acid score . Healthy , term breast-fed infants were prospect ively studied . One group ( n = 92 ) received the fortified cereal ( from 4 to 12 months of age ) . As control , 96 infants received  regular solid foods ( cooked vegetables and meat ) from age 4 months . At the end of the field trial , a sub sample of infants in both groups was supplemented with 45 mg Fe during 90 d. Iron nutrition status was determined at 9 , 12 and 15 months . At 12 months , iron deficiency anaemia was present in 17 per cent of controls , in 10 per cent of fortified infants as a whole , but only in 6 per cent of the babies who consumed over 30 g of cereal/d . In addition , this latter group did not show any significant changes in iron nutrition status after the supplementation trial . Results demonstrate that the consumption of a haemoglobin fortified cereal is effective in markedly reducing the incidence of iron deficiency in breast-fed infants BACKGROUND Iron is essential for the growth and virulence of many pathogenic enterobacteria , whereas beneficial barrier bacteria , such as lactobacilli , do not require iron . Thus , increasing colonic iron could select gut microbiota for humans that are unfavorable to the host . OBJECTIVE The objective was to determine the effect of iron fortification on  gut microbiota and gut inflammation in African children . DESIGN In a 6-mo , r and omized , double-blind , controlled trial , 6 - 14-y-old Ivorian children ( n = 139 ) received iron-fortified biscuits , which contained 20 mg Fe/d , 4 times/wk as electrolytic iron or nonfortifoed biscuits . We measured changes in hemoglobin concentrations , inflammation , iron status , helminths , diarrhea , fecal calprotectin concentrations , and microbiota diversity and composition ( n = 60 ) and the prevalence of selected enteropathogens . RESULTS At baseline , there were greater numbers of fecal enterobacteria than of lactobacilli and bifidobacteria ( P < 0.02 ) . Iron fortification was ineffective ; there were no differences in iron status , anemia , or hookworm prevalence at 6 mo . The fecal microbiota was modified by iron fortification as shown by a significant increase in profile dissimilarity ( P < 0.0001 ) in the iron group as compared with the control group . There was a significant increase in the number of enterobacteria ( P < 0.005 ) and a decrease in lactobacilli ( P < 0.0001 ) in the iron group after 6 mo . In the iron group , there was an increase in the mean fecal calprotectin concentration ( P < 0.01 ) , which is a marker of gut inflammation , that correlated with the increase in fecal enterobacteria ( P < 0.05 ) . CONCLUSIONS Anemic African children carry an unfavorable ratio of fecal enterobacteria to bifidobacteria and lactobacilli , which is increased by iron fortification . Thus , iron fortification in this population produces a potentially more pathogenic gut microbiota profile , and this profile is associated with increased gut inflammation . This trial was registered at controlled-trials.com as IS RCT N21782274 BACKGROUND Anemia during infancy impairs neurodevelopment . Little information has been published about the effectiveness of large-scale programs on anemia and iron-deficiency prevention . OBJECTIVE The objective was to assess the effectiveness of a large-scale program that distributes subsidized iron-fortified milk in Mexico on  anemia and iron deficiency in children aged 12 - 30 mo . DESIGN A double-blinded , group-r and omized effectiveness trial was conducted in 12 milk distribution clusters assigned to consume iron-fortified ( FM ; n = 7 ) or nonfortified ( NFM ; n = 5 ) milk . A daily portion of FM contained 5.28 mg Fe ( ferrous gluconate ) and 48 mg sodium ascorbate . RESULTS Overall treatment effects were documented at 6 and 12 mo for anemia and for iron deficiency assessed by both serum ferritin ( SF ) and serum soluble transferrin receptor ( sTfR ) ( interaction : P < 0.10 ) . Differential effects at 6 mo ( P = 0.004 ) and 12 mo ( P = 0.664 ) were documented only for sTfR. Estimated prevalences ( EPs ) of anemia ( hemoglobin < 110 g/L ) from baseline to 6 and 12 mo decreased from 42.6 % to 19.7 % and 9.4 % , respectively , in the NFM group ( n = 210 ) and from 44.5 % to 12.7 % and 4.0 % , respectively , in the FM group ( n = 357 ) . EPs of SF < 12 mug/L from baseline to 6 and 12 mo changed from 36.0 % to 41.8 % and 17.1 % , respectively , in the NFM group ( n = 43 ) and from 29.8 % to 18.6 % and 5.7 % , respectively , in the FM group ( n = 144 ) . EPs of sTfR > 3.3 mg/L from baseline to 6 and 12 mo decreased from 16.2 % to 8.3 % and 2.0 % , respectively , in the NFM group ( n = 114 ) and from 15.5 % to 0.7 % and 1.1 % , respectively , in the FM group . CONCLUSION A large-scale iron-fortified subsidized-milk program was effective at reducing the rates of anemia and iron deficiency in Mexican children during 12 mo of implementation . This trial was registered at clinical trials.gov as NCT00508131 We conducted a r and omized double-blind trial of a cow 's milk infant formula with increased iron fortification in order to confirm its safety and to measure its effects on iron status and immune function .  A group of full-term , well nourished and healthy infants was followed from the age of 3 months to 1 year . A control group of 74 infants was given a commercially available infant formula containing 8.3 mg Fe/100 g . The test group of 75 infants received a similar formula with 40 mg Fe/100 g. The formula with the extra iron proved to be safe and , when compared with the control group , the children in the test group had significantly improved iron status as reflected by the proportion of children classed as normal ( 25 of 61 cf . 44 of 65 ; p less than 0.003 ) , and by the mean values of the haemoglobin concentration ( 11.5 cf . 11.9 g/dl ; p = 0.04 ) , red cell distribution width ( 15.5 % cf . 14.4 % ; p = 0.0005 ) , red cell zinc protoporphyrin ( 3.4 cf . 4.0 micrograms/g Hb ; p = 0.04 ) and ferritin ( 29 cf . 17.3 micrograms/l ; p = 0.004 ) . The extra iron fortification depressed zinc concentration in plasma ( 90.6 cf . 83.5 micrograms/l ; p = 0.05 ) . There was no significant difference between the two groups for laboratory measures of immune function or for incidence of infection . No adverse effects such as infection could be attributed to the increased iron . We conclude that iron fortification of cow 's milk infant formula may be safely increased to 40 mg/100 g ( i.e. by a factor of 4.8 over the common concentration of 8.3 mg/100 g ) , but that this has less than the expected effect on iron status . Further studies are required to define ( a ) the long-term role of facilitators of iron absorption such as ascorbic acid , ( b ) the interaction of iron with absorption of divalent trace elements such as zinc , and ( c ) the effect of iron status on immune function and susceptibility to infection Previous data from Vietnam show that anaemia is highly prevalent among schoolchildren , who are considered not to be iron deficient . Trichuris infection doubled the risk of anaemia . The present study aim ed to evaluate the hypothesis that de-worming is more effective than iron fortification in an anaemic , infection-prone population . In a trial with a 2 x 2 factorial design , 425 anaemic children aged 6 - 8 years were r and omly assigned to receive either iron-fortified noodles or placebo , and mebendazole or placebo . Outcomes considered were change in haematological indicators of iron status ( Hb , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) and haemoglobinopathies analysis ) ; inflammations ( C-reactive protein ( CRP ) ) ; parasite infection status ( hookworm , Trichuris and Ascaris infection ) ; and IgE. ANOVA and logistic regression were used to assess the effects of iron fortification and de-worming on Hb , SF , TfR , body iron and anaemia . Hb improved in all groups after 6 months of intervention . Iron fortification significantly improved Hb , SF and body iron ( 2.6 g/l , 16.3 microg/l and 1 mg/kg , respectively ) . Prevalence of elevated IgE was very high at baseline ( 99 % ) and significantly reduced to about 75 % in all groups after intervention . De-worming unexpectedly showed no effect on Hb , iron status and IgE level . It is concluded that iron fortification slightly improved anaemia and iron status in anaemic schoolchildren in rural Vietnam that were not considered iron deficient . Chronic infection or other unidentified factors may play an important role in the seasonal reduction of anaemia seen in all treatment groups In an attempt to determine whether iron-fortified infant formulas produced gastrointestinal symptoms in infants , we fed two similar formulas , one with and one without iron fortification , to a group of 93 term infants upon discharge from the nursery on the third day of life . Infants were fed the formulas for a period of 42 days while their mothers kept detailed daily records of all gastrointestinal symptoms . A total of 49 infants were fed the non-iron-fortified formula and 44 infants were fed the iron-fortified formula .  Review of the records revealed no differences in the number of stools per day , the description of the stools , the number of days without stools , the incidence or frequency of colic , spitting-up , or vomiting . We conclude that the feeding of iron-fortified formulas to infants does not produce an increased incidence of gastrointestinal symptoms or signs Background Universal fortification of staple foods with iron has been widely promoted as a cost-effective strategy to reduce iron deficiency in developing-country population s. Nonetheless , relatively few efficacy trials have been reported to date to demonstrate impact on iron status . The Ultra Rice technology provides a means of delivering fortificant iron via rice . Objective The objective of this study was to test the efficacy of rice fortified with microencapsulated , micronized iron pyrophosphate to improve the iron status of women in Mexico in a r and omized , controlled intervention trial . Methods Nonpregnant , nonlactating women 18 to 49 years of age were recruited from six factories . The women received a daily portion of cooked rice 5 days per week for a period of 6 months , before and after which iron status indicators were determined in venous blood sample s. Results The average intake of iron from the fortificant was 13 mg/day . Mean plasma ferritin concentration and estimated body iron stores were significantly higher , and transferrin receptors were lower , in the iron-fortified rice group following the intervention . Mean hemoglobin concentration also increased in the treatment group , but the increase was significant only when the analysis was restricted to those with baseline hemoglobin < 12.8 g/dL. The absolute reduction in anemia and iron deficiency was 10.3 and 15.1 percentage points , respectively . Total iron intake from fortificant was a significant covariate of change in body iron stores . The overall prevalence of anemia was reduced by 80 % . Conclusions Fortification of rice with iron using this technology is an efficacious strategy for preventing iron deficiency Objective : This study was undertaken to assess the feasibility and effects of consuming either meat or iron-fortified infant cereal as the first complementary food . Methods : Eighty-eight exclusively breastfed infants were enrolled at 4 months of age and r and omized to receive either pureed beef or iron-fortified infant cereal as the first complementary food , starting after 5 months and continuing until 7 months . Dietary , anthropometric , and developmental data were obtained longitudinally until 12 months , and biomarkers of zinc and iron status were measured at 9 months . Results : Mean ( ±SE ) daily zinc intake from complementary foods at 7 months for infants in the meat group was 1.9 ± 0.2 mg , whereas that of the cereal group was 0.6 ± 0.1 mg , which is approximately 25 % of the estimated average requirement . Tolerance and acceptance were comparable for the two intervention foods . Increase in head circumference from 7 to 12 months was greater for the meat group , and zinc and protein intakes were predictors of head growth . Biochemical status did not differ by feeding group , but approximately 20 % of the infants had low ( < 60 μg/dL ) plasma zinc concentrations , and 30 % to 40 % had low plasma ferritin concentrations ( < 12 μg/L ) . Motor and mental subscales did not differ between groups , but there was a trend for a higher behavior index at 12 months in the meat group . Conclusions : Introduction of meat as an early complementary food for exclusively breastfed infants is feasible and was associated with improved zinc intake and potential benefits . The high percentage of infants with biochemical evidence of marginal zinc and iron status suggests that additional investigations of optimal complementary feeding practice s for breastfed infants in the United States are warranted Infants were fed  cow 's milk‐based formulas  containing 4 mg of iron/I  from 1.5 to 6 months of age and their hematological status was compared to infants receiving the same formula but with 7 mg of iron/l and with breast‐fed infants . One formula with 4 mg of iron/l contained iron as ferrous sulfate , in another , part of the iron was provided as bovine lactoferrin . We also studied the effect of selenium ( 10 μg/l ) and copper ( 0.4 mg/l ) supplementation on selenium and copper status . There were no significant differences in hematological indices among the groups at 6 months of age ; all infants had satisfactory iron status . Serum transferrin receptor levels , a potential novel indicator of iron status , were highest in breast‐fed infants , suggesting a cellular need for iron , and lowest in infants receiving formula with 7 mg of iron/l . Selenium status , as assessed by serum glutathione peroxidase activity , was similar at 6 months of age in breast‐fed infants and infants fed  formula fortified with selenium but lower in infants fed unfortified formula . The lowest levels of glutathione peroxidase activity were found in infants fed the highest concentration of iron ( 7 mg/l ) . Serum copper concentrations were similar in all groups , but the lowest levels were found in infants fed the highest concentration of iron . These results suggest that 4 mg of iron/l is adequate for infants up to 6 months of age and that higher levels may have some negative effects INTRODUCTION In undeveloped countries such as Peru there is a high prevalence of ferropenic anemia . In addition , iron deficiency produces cognitive alterations that could be corrected by iron treatment . OBJECTIVE To evaluate the effect of administration of heme iron-fortified cookies on the intellectual status of preschool children . PATIENTS AND METHODS Using the Goodenough-Harris Test ( GHT ) and Wechsler Preschool and Primary Scale of Intelligence ( WPPSI ) we studied the intellectual status of 53 children who received heme iron-fortified cookies for 6 - 8 weeks and 55 controls without fortification  , in 2 occasions ( before and after intervention ) . RESULTS We observed a significantly higher improvement in children who received iron respect to controls for GHT score ( p < 0.001 ) , WPPSI score ( p < 0.05 ) , WPPSI attention-concentration subscale ( p < 0.01 ) and WPPSI pure attention subscale ( p < 0.05 ) . CONCLUSION Administration of heme iron-fortified cookies may improve the intellectual performance of low-income preschool children Adverse sensory changes prevent the addition of highly bioavailable ferrous sulfate ( FeSO4 ) to most wheat flours . Poorly absorbable reduced Fe powders are commonly used . Encapsulation of FeSO4 can overcome these sensory changes , but the particle size of commercial compounds is too large to be used by flour mills . The first objective of the study was to measure the efficacy in wheat flour of two newly developed Fe compounds , an H-reduced Fe powder ( NutraFine RS ; North America Höganäs High Alloys LLC , Johnstown , PA , USA ) and small particle-sized ( 40 microm ) encapsulated FeSO4 . As a second objective , the microcapsules were evaluated as a vehicle for iodine fortification . A r and omised , double-blind controlled intervention trial was conducted in Kuwaiti women ( n 279 ; aged 18 - 35 years ) with low body Fe stores ( serum ferritin ( SF ) < 25 microg/l ) r and omly assigned to one of three groups ( 20 mg Fe as NutraFine RS , 10 mg Fe as encapsulated FeSO4 and 150 microg iodine , or no fortification Fe ) who consumed wheat-based biscuits 5 d per week . At baseline and 22 weeks , Hb , SF , transferrin receptor , urinary iodine and body Fe stores were measured . Relative to control , mean SF in the encapsulated FeSO4 group increased by 88 % ( P < 0.001 ) and body Fe stores increased from - 0.96 to 2.24 mg/kg body weight ( P < 0.001 ) , while NutraFine RS did not significantly increase SF or body Fe stores . The median urinary iodine concentration increased from 140 to 213 microg/l ( P < 0.01 ) . NutraFine RS added at double the amount of Fe as FeSO4 was not efficacious in improving Fe status . The newly developed microcapsules were highly efficacious in improving both Fe stores and iodine status OBJECTIVE To determine whether low-income infants ' adherence to nutritional supplementation with ferrous fumarate sprinkles was better than that with ferrous sulfate drops . STUDY DESIGN The study was a r and omized clinical trial of healthy 6-month-old infants . Each infant received either a daily packet of sprinkles or a dropperful of liquid . Follow-up included alternating telephone and home visits biweekly for 3 months . Adherence was defined as high if the infant 's caregiver reported supplement use on 5 to 7 days during the week before assessment . Side effects and caregiver attitude about supplements were secondary outcomes . Analyses were conducted using generalized estimating equations and chi(2 ) and Wilcoxon rank-sum tests . RESULTS A total of 150 of 225 eligible infants were enrolled .  Adherence to supplementation was generally poor . High adherence ranged from 32 % to 63 % at any assessment in the subjects receiving drops , compared with 30 % to 46 % in those receiving sprinkles . The drops group was more likely to have at least four assessment s with high adherence ( 22 % vs 9.5 % ; P = .03 ) . Caregivers of the drops infants were more likely to report greater than usual fussiness ( P < .01 ) ; however , fussiness had no consistent impact on adherence . CONCLUSIONS The use of ferrous fumarate sprinkles rather than traditional ferrous sulfate drops did not improve adherence with daily iron supplementation in low-income infants The effect of chronic iron intake on diarrhoeal disease was evaluated in children in a community of low socio-economic stratum in Santiago , Chile . Children were incorporated into each of two consecutive cohorts ; each cohort was divided into two groups , one receiving iron-enriched milk ( 12 mg/l ) ( monthly average = 70 children ) and the other a control milk ( 1 mg/l ) ( monthly average = 83 children ) , and each cohort was followed up for 6 months . The incidence of diarrhoea was higher among the iron-supplemented children ( 30.4 vs 25.5 episodes/100 children/month , P < 0.025 ) . This was mainly due to results obtained in infants 3 - 8 months of age during the summer months . Supplemented infants had more bowel movements on day 1 ( P < 0.03 ) and liquid or semi-liquid stools were passed for more than 15 days more frequently ( P < 0.05 ) . While no differences were detected in aetiology , Shigella-associated episodes were less common among iron-supplemented infants ( P < 0.008 ) . Asymptomatic shedding of enteropathogens significantly increased in infants 12 - 18 months of age receiving iron-supplemented milk . In areas with inadequate environmental sanitation , chronic iron supplementation may have negative effects on diarrhoeal morbidity , despite improving iron nutritional status BACKGROUND In many developing countries , children are at high risk for both goiter and anemia . In areas of subsistence farming in rural Africa , salt is one of the few regularly purchased food items and could be a good fortification vehicle for iodine and iron , provided that a stable yet bioavailable iron fortificant is used . OBJECTIVE We tested the efficacy of salt dual-fortified with iodine and micronized ferric pyrophosphate for reducing the prevalence of iodine and iron deficiencies in children . DESIGN In rural northern Morocco , we fortified local salt with 25 microg I ( as potassium io date ) /g salt and 2 mg Fe ( as micronized ferric pyrophosphate ; mean particle size = 2.5 microm)/g salt . After storage and acceptability trials , we compared the efficacy of the dual-fortified salt ( DFS ) with that of iodized salt in a 10-mo , r and omized , double-blind trial in iodine-deficient 6 - 15-y-old children ( n = 158 ) with a high prevalence of anemia . RESULTS After storage for 6 mo , there were no significant differences in iodine content or color lightness between the DFS and iodized salt . During the efficacy trial , the DFS provided approximately 18 mg Fe/d ; iron absorption was estimated to be approximately 2 % . After 10 mo of treatment in the DFS group , mean hemoglobin increased by 16 g/L ( P < 0.01 ) , iron status and body iron stores increased significantly ( P < 0.01 ) , and the prevalence of iron deficiency anemia decreased from 30 % at baseline to 5 % ( P < 0.001 ) . In both groups , urinary iodine ( P < 0.001 ) and thyroid volume ( P < 0.01 ) improved significantly from baseline . CONCLUSION A DFS containing iodine and micronized ferric pyrophosphate can be an effective fortification strategy in rural Africa AIMS Iron deficiency anaemia is associated , in observational studies , with developmental disadvantage . This study tested the hypothesis that feeding iron supplemented formula from 9 to 18 months of age would improve developmental performance . SUBJECTS AND METHODS 493 healthy children aged 9 months being fed pasteurised cows ’ milk were recruited from three UK centres . They were r and omised to : cows ’ milk as before , formula containing 0.9 mg/litre iron , or formula containing 1.2 mg/litre iron , until 18 months of age . Bayley mental and psychomotor developmental indices were measured at 18 months , as were growth and haematological indices . RESULTS Children fed iron fortified formula had higher plasma ferritin concentrations , but there were no significant intergroup differences in development or growth . CONCLUSIONS There are no developmental or growth advantages in children given iron supplemented formula , but a benefit for a minority who were anaemic , or the possibility that a benefit may emerge at a later age , can not be excluded To address the hypothesis that increased infectious morbidity is associated with iron supplementation , 783 r and omly selected infants were provided with a powdered full fat cow 's milk ( non-fortified group ) and 872 with a  powdered acidified full fat cow 's milk fortified with 15 mg of iron as ferrous sulfate ( fortified group ) . All infants were followed from birth to 15 months of age with a monthly home visit by a nurse who recorded morbidity occurring during the previous 30 days . At 9 months of age , 15 % of infants in each cohort were receiving breast milk only ; data for these infants were segregated to make the third group . Episodes ( mean + /- SD ) of diarrhea/infant/year were 1.06 + /- 1.29 , 1.14 + /- 1.37 , and 0.82 + /- 1.04 for the fortified , non-fortified and breast-fed groups , respectively ; the fortified and non-fortified bottle-fed groups had a very similar incidence of respiratory illness ; 2.66 + /- 2.07 and 2.74 + /- 2.24 episodes/infant/year , respectively . The incidence of respiratory illness for both bottle-fed groups was significantly higher than that for the breast-fed group ( 2.22 + /- 1.84 respiratory episodes/infant/year ) . We conclude that for the infants the tested form of iron fortified milk , which is sufficient to lower iron deficiency anemia , does not result in an increased incidence of diarrhea or respiratory illness BACKGROUND Inhabitants of agrarian villages of rural Cambodia suffer from high prevalences of iron deficiency and anemia in the context of a monotonous diet . OBJECTIVE To compare the efficacy and safety of placebo Khmer fish sauce to that of 10 mL of fish sauce containing 10 mg of iron , added to daily school meals either as NaFe-EDTA or as FeSO4 + citrate . METHODS 140 students aged 6 - 21 years were enrolled in a double-blinded , placebo-controlled intervention trial . They were r and omly allocated to one of three treatment groups , and followed for 21 weeks during which 114 school meals seasoned with 10 mL of fish sauce were consumed by each participant . Changes in the concentrations of hemoglobin ( hb ) , serum ferritin ( SF ) , and C-reactive protein ( CRP ) and in body weight and st and ing height were determined . Prevalences of vomiting , diarrhea , and acute respiratory infections were monitored weekly . RESULTS Both iron-fortified fish sauces increased hb and SF concentrations significantly as compared to placebo . No significant differences were observed between FeSO4+citrate and NaFe-EDTA fortification , regarding mitigation of iron-deficiency anemia ( IDA ) or regarding CRP , growth , infections , or side-effects . CONCLUSIONS Iron-fortified Khmer fish sauce added to Khmer food is a suitable vehicle for iron fortification in children and adolescents . FeSO4+citrate and NaFe-EDTA show equivalent efficacy and safety Objectives : To evaluate the effects of fortified drinking water , with different concentrations of iron added , on hemoglobin and hematocrit values in preschoolers . Methods : Double-blind , r and omized cluster clinical trial , with children aged 2 to 5 years of age , from 4 state-run schools , forming 1 group for each school . For fortification , ferrous sulphate in concentrations of 5 mg of elemental iron per liter of water ( group A ) , 7.5 mg ( group B ) , and 10 mg ( group C ) , was used during a period of 4 months . In group D , the control , a placebo ( Bixa orellana ) was added . Hemoglobin and hematocrit values were checked before and after intervention . Results : Before fortification , hemoglobin and hematocrit averages were below the reference values adopted in all groups . After fortification , the prevalence of anemia showed a reduction in the 4 groups , which was more pronounced in group B , at 48.3 % . The hemoglobin values in groups B ( 11.5 ) and C ( 11.4 ) were statistically similar . However , the average consumption of water/day/student was lower in group C. Comparison of hemoglobin values between groups A ( 11.2 ) and D ( 11.0 ) did not show a significant difference , suggesting insignificant efficacy with 5 mg Fe/L fortification . Conclusions : The consumption of drinking water fortified with 7.5 mg of elemental iron/L water result ed in greater adhesion and an increase in hemoglobin values , with a reduction in the prevalence of anemia Results of research into preventing iron-deficiency anaemia in inner-city toddlers , published in full in Archives of Disease in Childhood ( 1996 ; 75 : 9 - 16 ) , are discussed by the authors . In a prospect i ve study , 100 infants already receiving pasteurised cow 's milk by six months old were r and omly divided into two groups , one to receive a follow-on formula and the other to continue on cow 's milk until aged 18 months . At 18 months one-third of the cow 's milk group were anaemic compared with 2 % of the formula group . The authors consider that if the same volume of st and ard infant formula had been given instead of a follow-on formula , substantially fewer of the children would have reached the correct reference nutrient intake for iron BACKGROUND Iron deficiency continues to be a common problem among infants throughout the world .  Iron-fortified formula is effective in preventing iron deficiency but the benefit of iron-fortified cereal is controversial . METHODS We compared iron-fortified rice cereal to unfortified rice cereal in infants who were exclusively breast-fed for more than 4 months and to iron-fortified formula  in infants who were weaned to formula before 4 months of age . The design was double blind in respect to the presence or absence of fortification iron in the cereal or formula and included 515 infants who were followed on the protocol from 4 to 15 months of age .  Rice cereal was fortified with 55 mg of electrolytic iron per 100 g of dry cereal and infant formula with 12 mg of ferrous sulfate per 100 g of dry powder , levels approximating those in use in the United States . Measures of iron status were obtained at 8 , 12 , and 15 months . Infants with hemoglobin levels of < 105 g/L were excluded from the study and treated . RESULTS Consumption of cereal reached plateaus at means of about 30 g/d after 6 months of age in the formula-fed groups and 26 g/d after 8 months in the breast-fed groups ; these amounts are higher than the 19-g/d mean intake by the 73 % of infants who consume such cereal in the United States . Among infants weaned to formula before 4 months , the cumulative percentages of infants excluded for anemia by 15 months were 8 % , 24 % , and 4 % , respectively , in the fortified cereal , unfortified cereal and formula , and fortified formula groups ( P < .01 unfortified vs either fortified group ; the difference between the two fortified groups was not significant ) . In infants breast-fed for more than 4 months , the corresponding values were 13 % and 27 % , respectively , in the fortified and unfortified cereal groups ( P < .05 ) . Mean hemoglobin level and other iron status measures were in accord with these findings . CONCLUSION Iron-fortified infant rice cereal can contribute substantially to preventing iron deficiency anemia Abstract Six‐month‐old infants were recruited at 21 centres in the UK and Irel and and r and omly assigned to receive matching iron‐fortified ( 12.3 mg/l iron ) or non‐fortified ( 1.4 mg/l iron ) formula for 9 months . Infants already receiving cow 's milk continued this feed . Haematological indices and iron status were evaluated at age 6 months , 9–10 months and 15 months . Four hundred and six infants entered and 302 completed the study . There were no differences between the groups for increases in weight , head circumference or length . Significant differences between the groups were observed at 15 months for haemoglobin , serum ferritin , serum iron and total iron binding capacity . Haemoglobin levels were < 110 g/l in 33 % of infants fed cow 's milk compared with 13 % and 11 % in those receiving non‐iron‐fortified and iron‐fortified formula respectively . The corresponding figures for serum ferritin < 10 µg/l were 43 % , 22 % and 6 % . Follow‐on formula provides an acceptable vehicle for preventing iron deficiency in this vulnerable group Iron deficiency anemia ( IDA ) is a significant public health problem among Canadian Aboriginal children . The objectives of this study were to determine the acceptability and safety of microencapsulated-iron sprinkles , a new powdered form of iron packaged in a single-serving sachet for prevention of IDA . A total of 102 non-anemic children aged 4 to 18 months from three communities were r and omized to receive sprinkles containing 30 mg Fe/day ( NR = 49 ) or placebo ( NR = 53 ) for six months . To assess acceptability , adherence and side effects were monitored bi-weekly . To assess safety , serum ferritin ( SF ) concentration and anthropometry were measured at baseline and end . Mean adherence was 59.6 + /- 27.7 percent . There were no differences in adherence , SF , anthropometric status or side effects between groups . Although there were no differences in hemoglobin ( Hb ) concentration and anemia prevalence from baseline to end and between groups , the Hb curve shifted to the right ( increased ) for the sprinkles group and to the left ( decreased ) for the placebo group . Sprinkles may provide a safe and acceptable option to the current st and ard of care ( i.e. ferrous sulphate drops ) for the provision of iron in Canadian Aboriginal population This was a double-blind , placebo-controlled , community-based trial . For 16 weeks , children in the intervention group ( n = 180 ) received iron-fortified rice , while children in the control group ( n = 174 ) received rice with placebo .  Anemia was defined as hemoglobin < 11.0g/dL. Student 's t-test was used to compare mean variation in hemoglobin between the groups . Hemoglobin concentration improved in both groups , with a mean increase of 0.42g/ dL in the intervention group ( 11.28+/-1.23g/dL to 11.75+/-1.16g/dL , p < 0.001 ) , and 0.49g/dL in controls ( 11.06+/-1.13g/dL to 11.51+/-1.16g/dL , p < 0.001 ) . Anemia decreased ( p < 0.01 ) in both groups ( 37.8 % to 23.3 % in the intervention group and 45.4 % to 33.3 % in controls ) , with no significant difference between the two . Hemoglobin increase was significantly higher in children that received total iron = 53.76 mg from fortified rice , compared to those who received less than this cut-off value ( 0.94g/dl vs. 0.39g/dl , p = 0.03 ) . The findings suggest that this type of intervention can be useful in anemia control as long as fortified food intake is adequate The effects on  iron absorption  of a traditionally fermented Japanese soy sauce  added to soy and rice meals were assessed . The addition of soy sauce to a soy flour meal could not overcome the strong inhibition of iron absorption ( geometric mean absorption 7.2 per cent with soy sauce vs. 8.7 per cent without , P = 0.5 ) . However , soy sauce added to a rice meal instead of soy flour significantly improved the geometric mean iron absorption ( 13.9 per cent with soy sauce vs. 5.2 per cent with soy flour , P = 0.002 ) and had a promotory effect on absorption from a rice meal alone ( 11.4 per cent with soy sauce vs. 3.5 per cent without , P = 0.0002 ) . Although soy sauce contains appreciable amounts of organic acids , the addition of 340 mg lactic acid to rice did not enhance iron absorption ( 3.1 per cent with lactic acid vs. 2.2 per cent without , P = 0.11 ) . The promotory effect of soy sauce on iron absorption appears to be due not only to its lack of soy protein content but may also be due to the presence of fermentation products other than organic acids OBJECTIVES To investigate the effect of increased iron intakes on hematologic status and cognition in low birth weight infants . STUDY DESIGN We r and omly assigned 58 infants to receive formula with 13.4 mg iron/L ( normal iron ) or 20.7 mg iron/L ( high iron ) . At baseline , discharge , and at 3 , 6 , 9 , and 12 months ' corrected age , we assessed anthropometry ; infections ; red blood cell hemoglobin , catalase , glutathione peroxidase , red blood cell fragility ( hydrogen peroxide test ) , and superoxide dismutase values ; plasma malondialdehyde , ferritin , iron , transferrin , zinc and copper levels ; and  diet intake . Griffiths ' Development Assessment was done at 3 , 6 , 9 , and 12 months only . RESULTS No statistical differences ( P < .05 ) were noted for weight , catalase or malondialdehyde levels , red blood cell fragility , or Griffith 's Development Assessment . Iron intakes were greater in the high iron group except at 12 months . Hemoglobin ( high iron , 123 + /- 9 ; normal iron , 118 + /- 8) was not different at 3 months ( P = .07 ) . Plasma zinc levels ( high iron , 70 + /- 14 ; normal iron , 89 + /- 27 ) and copper levels ( high iron , 115 + /- 26 ; normal iron , 132 + /- 27 ; P = .06 ) at 12 months suggested inhibition of absorption by high iron formula . Glutathione peroxidase levels were higher in the high iron group . The total number of respiratory tract infections was greater in the high iron group ( 3.3 + /- 0.9 ) than in the normal iron group ( 2.5 + /- 0.9 ) . CONCLUSION In terms of cognitive outcome , there is no advantage associated with elevated iron intake for low birth weight infants The effect of Fe fortification on the absorption of Zn was studied by radioisotopic labelling of single meals , followed by measurements of whole-body retention of 65Zn at 14 d after intake . Healthy adult volunteers participated in the study . Weaning cereal , wheat bread and infant formula , foods that are all frequently Fe-fortified , were evaluated in the study . The amounts of Fe added as FeSO4 were similar to the levels in commercial products in Europe and the USA , and were 200 or 500 mg Fe/kg ( weaning cereal ) , 65 mg Fe/kg ( white wheat flour ) and 12 mg Fe/l ( infant formula ) . For comparison , Zn absorption was measured in the same subjects , from identical test meals containing no added Fe . No statistically significant differences were found when Zn absorption from the Fe-fortified test meals was compared with that from non-Fe-fortified test meals . Fractional Zn-absorption values from Fe-fortified v. non-fortified meals were 31.1 ( SD 11.9 ) v. 30.7 ( SD 7.0)% ( weaning cereal ; 200 mg Fe/kg ) , 37.7 ( SD 16.6 ) v. 30.2 ( SD 9.9)% ( weaning cereal ; 500 mg Fe/kg ) , 36.5 ( SD 14.4 ) v. 38.2 ( SD 18.1)% ( bread ; 65 mg Fe/kg flour ) and 41.6 ( SD 8.1 ) v. 38.9 ( SD 14.5)% ( infant formula ; 12 mg Fe/l ) . The addition of Fe to foods at the currently used fortification levels was thus not associated with impaired absorption of Zn and the consumption of these Fe-fortified foods would not be expected to have a negative effect on Zn nutrition Iron intakes and iron status were evaluated in 36 young Swedish children given either iron‐fortified or unfortified cow 's milk . All children had good iron status and had received breast milk or ironfortified formulae during infancy . Twenty 1‐y‐old children were r and omized to a diet with iron‐fortified milk ( 7.0 or 14.9 mg Fe T−1 ) and 16 to a diet with unfortified milk . The  iron  intakes in the unfortified group at 15 and 18 mo ( mean ± SD 5.19 ± 2.29 and 5.84 ± 1.62 mg d−1 ) were low in relation to Nordic Nutrition Recommendations , while the intakes in the iron‐fortified group ( 10.20 ±2.60 and 10.87 ± 2.79 mg d−1 ) were normal in relation to recommendations . The gain ( increase ) from receiving fortified diet during the study period was at most [ upper limit for 95 % confidence interval ( CI ) ] 2.6 g T−1 in blood haemoglobin , 1.9 fl in mean corpuscular volume , 2.7 Limol in serum iron and 4.5 % in transferrin iron saturation , and the gain ( decrease ) was at most ( lower limit for 95 % CI ) 0.29 g T−1 in serum transferrin and 0.9 mgr−1 in serum transferrin receptor ( TfR ) . None of these differences was statistically significant . There was an almost significantly higher increase in serum ferritin ( 1.4 times higher relation of values at the end compared with the beginning , p= 0.06 ) and a significantly higher ( 1.2 ; p= 0.047 ) decrease in TfR/ log10 ferritin ratio in the fortified group The therapeutic effects of NaFeEDTA-fortified soy sauce on anaemic students were investigated . Three hundred and four iron-deficient anaemic school children ( 11 - 17 years ) were r and omly assigned to three treatment groups : control group ( consuming non-fortified soy sauce ) , low-NaFeEDTA group ( consuming fortified soy sauce , providing 5 mg Fe/day ) and high-NaFeEDTA group ( consuming fortified soy sauce , providing 20 mg Fe/day ) . Blood haemoglobin ( Hb ) levels were determined before and after 1 month , 2 months and 3 months of intervention . In addition , serum iron ( SI ) , serum ferritin ( SF ) , free erythrocytic porphyrin ( FEP ) , total iron binding capability ( TIBC ) and transferritin ( TF ) were measured before and after consumption of soy sauce for 3 months . The results obtained herein show that the parameters measured were not changed remarkably within the 3-month intervention in the control group ( P < 0.05 ) . However , increased Hb , SI , SF and TF levels and decreased TIBC and FEP levels were observed in both the high-NaFeEDTA group ( P < 0.01 ) and the low-NaFeEDTA group ( P < 0.05 ) . The effectiveness of iron intervention in the low-NaFeEDTA group and high-NaFeEDTA group had no statistical significance after 3 months . It was concluded that nutritional intervention for anaemic students using NaFeEDTA-fortified soy sauce could play a positive role in the improvement of iron status and control of anaemia OBJECTIVE A r and omized , double-blind study was conducted comparing high-iron content ( 15 mg/L ) with low-iron content ( 3 mg/L ) premature formula given during initial hospitalization to infants with birth weights less than 1800 g to determine the influence of these differing intakes on the iron nutritional status during the first 4 months of life . A third group of similar infants received human milk mixed with an equal volume of liquid fortifier result ing in an iron content of approximately 1.7 mg/L. PATIENTS AND METHODS Mean birth weight , gestational age , age at study entry , volume of blood removed for studies , and volume of red cells transfused were not different among the three groups . After hospitalization both formula-fed groups were given a cow milk formula with an iron content of 12 mg/L , and breast-fed infants were given an iron-containing multivitamin with a result ing iron intake of 10 mg/d . Infants were observed to 8 weeks after discharge . RESULTS There were no differences in serum iron , ferritin , transferrin , transferrin saturation , hemoglobin , hematocrit , or reticulocyte count among the three groups at study entry , although mean corpuscular hemoglobin and mean corpuscular volume were lower in infants in the low-iron formula group . Mean plasma ferritin was significantly lower in infants receiving low-iron content premature formula at the time of hospital discharge compared with the other two groups . The incidence of anemia ( hemoglobin < 9.0 g/dL ) and low transferrin saturation ( < 24 % ) was also greater in the low-iron content formula group . Eight weeks after discharge , the incidence of low plasma ferritin ( < 19 ng/mL ) remained greater in infants receiving low-iron content formula than in the other two groups . No adverse effects of iron intake were observed . Growth was not different among the three groups . CONCLUSIONS These data indicate that preterm infants with < 1800 g birth weight receiving premature infant formula benefit from formula given during initial hospitalization containing 15 mg/L iron compared with that containing 3 There are few data to support the use of follow-on formulas in infants from the age of 6 months . In a prospect i ve trial in a deprived inner city area of Birmingham 100 infants who were already receiving pasteurised cows ' milk by 6 months of age were enrolled and r and omised either to receive a follow-on formula or to continue on cows ' milk from 6 months until 18 months . At 18 months of age the follow-on formula group returned to cows ' milk and both groups were followed up until 24 months . Iron status , growth , and nutritional status were analysed at intervals of six months . At enrollment , no differences in haematological status were evident . However , by 12 months of age , 31 % of the cows ' milk group were anaemic ( haemoglobin concentration < 110 g/l ) compared with only 3 % of those receiving follow-on formulas . At 18 months , 33 % of the cows ' milk group were anaemic compared with only 2 % of the follow-on formula group and by 24 months of age none of the follow-on formula group was anaemic , whereas 26 % in the cows ' milk group still had a haemoglobin of < 110 g/l . Mean corpuscular volume was significantly smaller and ferritin significantly lower in the cows ' milk group at 12 , 18 , and 24 months . Dietary iron intake was higher in the follow-on formula group at 12 and 18 months but not at 24 months , when both groups were back on cows ' milk . Infants and toddlers at high risk of iron deficiency are therefore unlikely to become anaemic if receiving a follow-on formula , although the relative merits of follow-on formula compared with an ordinary infant formula remain uncertain 1 . Two large-scale community based studies of the  haematinic effect of iron added to flour used to bake bread are reported . These were design ed to simulate conditions in the community as closely as possible . 2 . Neither trial gave conclusive evidence of benefit in terms of an effect on circulating haemoglobin level , but in one trial the results suggested a small haematinic effect . 3 . The availability of an iron salt from bread eaten in a normal varied diet is clearly much lower than has been suggested from highly controlled radioactive isotope studies OBJECTIVE To determine the efficacy of iron-fortified infant formula in preventing  developmental delays and abnormal behavior . DESIGN Double-blind , r and omized , controlled trial . SETTING Urban hospital clinic . PARTICIPANTS A total of 283 healthy , bottle-fed infants from very low income families . Children with prematurity , low birth weight , and major anomalies and those who had received more than 2 weeks of evaporated-milk feedings were excluded . The groups were similar for sociodemographic background variables . Fifty-eight infants ( 20.5 % ) dropped out before any outcome data were gathered ; 225 , 204 , 186 , and 154 remained at 6- , 9- , 12- , and 15-month assessment s , respectively . INTERVENTION Iron-fortified formula ( 12.8 mg iron per liter ) versus regular formula ( 1.1 mg iron per liter ) . MAIN OUTCOME MEASURES Iron status was measured on venous blood by determination of hemoglobin , serum iron and iron-binding capacity , serum ferritin , and free erythrocyte protoporphyrin values . The Bayley Scales of Infant Development ( mental and psychomotor indexes ) and two factors of the Infant Behavior Record ( test affect and task orientation ) were the outcomes of interest . RESULTS All measures of iron status were significantly different between groups ( p < 0.001 ) . Psychomotor development patterns differed between groups ( F3,520 , 3.4 ; p = 0.02 ) with time . Mean values were similar at 6 months but differed at 9 and 12 months of age ( p < 0.001 ) , with a decline of 6.4 points in the regular-formula group . By 15 months of age the differences were no longer significant ( p = 0.23 ) . Mental development and behavior were not affected . CONCLUSIONS Iron-fortified formula significantly reduced iron deficiency in a high-risk group of infants and prevented a decline in psychomotor development quotients . This effect may be transient , and its long-term significance needs further study The interactions between infections , malnutrition and poor iron nutritional status in infants at weaning ages are poorly defined . Therefore , four groups of infants from an area with a high incidence of malnutrition ( Lahore , Pakistan ) were enrolled in a prospect i ve , r and omized nutritional intervention study . Between 122 and 365 days of age , the infants from one community received either a milk cereal without iron fortification ( n= 29 ) , a milk cereal fortified with ferrous fumarate ( 7.5 mg/100 g ; n= 30 ) , or a milk cereal fortified with ferric‐pyrophosphate ( 7.5 mg/100 g ; n= 27 ) . Forty‐four infants from a neighbouring community did not receive a nutritional supplement and served as the control group . Calculated mean daily energy‐ and protein intake with the cereals was between 259–287 kcal , and 9.6–10.6 g at 12 months of age , respectively . Mean daily iron intake with the fortified cereals was between 4.1–5.1 mg at corresponding age . Nutritional supplementation result ed in significantly lower incidence of malnutrition and heigher weight gain . Incidence of acute diarrhoea was significantly ( p<0.05 ) lower in the supplemented groups . The infants fed the iron‐fortified milk cereals had significantly higher hemoglobin ( mean 10.4 vs. 9.8 gdl‐1 ) and serum ferritin ( mean 13.3 vs. 8.5 ngml‐1 ) values than the infants fed the non‐fortified milk cereals . However , no differences in the incidence of infections were found between the supplemented groups . It is concluded that poor nutritional intake between 122 and 365 days of age substantially contributed to the high incidence of diarrhoea and malnutrition in Pakistani infants Iron deficiency and iron-deficiency anemia are common in the developing world . We evaluated the feasibility of iron fortification of domestic drinking water to prevent and control iron deficiency and iron-deficiency anemia .  Twenty-one families representing 88 persons , including children , were selected to participate in this study . Twelve families added an iron solution plus ascorbic acid to their domestic drinking water over a four months period and nine families added a placebo . Blood sample s were collected , before and after the four months , for hemoglobin and serum ferritin measurements . Iron-fortified drinking water increased hemoglobin ( children 10.9 ±1.1 g/dl to 11.7 ± 1.1 g/dl p < .01 , adults 12.9 ± 1.7 g/dl to 13.7 ± 1.7 g/dl p < .01 ) and ferritin ( children 27.6 ± 21.6 ng/dl to 33.8 ± 22.1 ng/dl , adults 74.8 ± 41.3 ng/dl to 106.2 ± 93.9 ng/dl p < .05 ) . No significant changes in hemoglobin and ferritin were found in the placebo group after 4 months . Preparation , distribution , and consumption of the solutions were successful . Iron fortification of household drinking water can be a simple and effective alternative to deal with iron deficiency and iron-deficiency anemia in less developed areas UNLABELLED Recent research has not only question ed the necessity of iron supplementation in human milk substitutes prior to weaning , but also suggested some potential adverse effects . This study investigated the hypothesis that infant formula need not contain added iron in the first 3 mo . Healthy term infants were recruited into a double-blind controlled trial and r and omized to receive either a new no added iron formula ( New ; < 0.1 mg Fe 100 ml(-1 ) ) or a st and ard formula ( St and ard ; 0.5 mg Fe 100 ml(-1 ) ) for the first 3 mo of life . A breastfed reference group was also studied . Iron status was assessed at 3 and 12 mo from heel-prick capillary blood sample s evaluated by full blood-count analysis , including reticulocytes and serum ferritin . In total , 149 infants were entered ( 51 New , 49 St and ard , 49 breastfed ) with no differences between the groups in gender distribution , birthweight , gestation or numbers completing the study . There were no significant differences between the principal outcome measures : mean values for haemoglobin , mean cell volume and ferritin , between the two formula-fed groups , and the proportion with a haemoglobin level < 11 g dl(-1 ) or ferritin < 10 microg l(-1 ) did not differ . CONCLUSION The use of a " no added iron " infant formula in place of an iron-fortified formula during the first 3 mo of life did not clinical ly affect iron status at 3 and 12 mo of age . The universal supplementation of formulae with iron during this initial period needs further consideration OBJECTIVE Preventing iron deficiency has been a main target of the World Health Organization since 1992 . Difficulties to reach dietary recommended iron intakes and to enhance iron absorption should be overcome . We compared in iron-deficient women the bioavailability of iron of three meat pate products enriched with ferrous sulfate , ferric pyrophosphate encapsulated in liposomes , or ferric pyrophosphate encapsulated in liposomes plus a hemoglobin-based meat pigment . METHODS Seventeen women with low iron stores ( ferritin < 30 microg/L ) took part in a three-way , r and omized , crossover , double-blind postpr and ial intervention . Test meals consisted of 80 g of the three different enriched meat pate products , which were spread on two slices of white bread . The pate composition was 13.5 g of protein/100 g , 30 g of fat/100 g ( 49 % monounsaturated fatty acids , 35 % saturated fatty acids , 16 % polyunsaturated fatty acids ) , 1 g of carbohydrates/100 g , and 19 mg of total iron ( including 15 mg of iron from the test fortificants ) . Blood sample s were taken at baseline and each hour for 6 h after eating the meal and serum iron was determined . RESULTS Serum iron concentration evolution during the postpr and ial study was similar with the three meals , and maximum concentrations were obtained between hours 2 and 4 . The effect of type of fortificant was not significant . CONCLUSION Consumption of meat pate fortified with ferric pyrophosphate encapsulated in liposomes can be part of a dietary strategy for preventing iron deficiency in humans . The addition of larger amounts of a meat pigment rich in heme iron should be further studied The Thriposha programme is a community-level nutrition intervention in Sri Lanka that provides a combination of energy , protein and micronutrients as a ' ready-to-eat ' cereal-based food . We measured the bioavailability of Fe and Zn from Thriposha formula at two different molar ratios of Zn : Fe in order to determine the effect on Fe and Zn absorption . Children 4 - 7 years ( n 53 ) were given a meal prepared with 50 g Thriposha containing 1.5 mg Zn as zinc sulphate and either 9 mg ( high Fe concentration ( HiFe ) ) or 4.5 mg ( low Fe concentration ( LoFe ) ) Fe as ferrous fumarate .  Zn and Fe percent absorption were measured using stable isotopes by tracer : tracee ratio and by incorporation of erythrocytes , respectively . Percent Fe absorption from the two meals was similar ( 6.6 % ( 4.8 ) v. 4.8 % ( 2.6 ) ; P = 0.15 ) , but total Fe absorption was significantly higher from the HiFe meal ( 0.59 ( 0.43 ) mg ) than the LoFe meal ( 0.20 ( 0.12 ) mg ; P = 0.01 ) . There was no significant difference between the two groups in Zn absorption ( 10.7 % ( 0.9 ) v. 8.8 % ( 1.4 ) , P = 0.13 , respectively ) . Decreasing the amount of Fe in Thriposha did not cause a significant change in the percent absorption of Fe and Zn , but significantly lowered the total amount of absorbed Fe . These results demonstrate the utility of maintaining a higher Fe content in this supplement . Further studies to increase Zn content are warranted while maintaining a HiFe Anemia is still the major nutritional problem among pregnant women in Southeast Asia . The objective of this study was to measure hemoglobin status and reduction of underweight in a group of pregnant women who received iron-fortified or nonfortified milk  , and another group who received iron supplements ( tablets ) or placebo . The 44 women in the iron-fortified milk group received 15 mg of iron per day per 400 ml of milk , and 41 women received placebo . The 40 women in the iron supplement group received 60 mg of iron per day , and 43 women received nonfortified milk . During this intervention trial , all women were supervised from the 14th to the 18th week of gestation until delivery . Blood was sample d at 0 , 5 , 10 , and 16 weeks of intervention . After the 16th week of intervention , the changes in hemoglobin ( ΔHb ) concentrations in both treatment groups ( the iron-fortified milk and the iron tablet groups ) were not significantly different ( ΔHb : −0.5 ± 0.9 and −0.3 ± 0.9 g/L , respectively ) , but the changes were significantly greater in the nonfortified milk and placebo groups ( ΔHb : −1.2 ± 0.9 and −1.1 ± 0.8 g/L , respectively ; p < .01 ) . The change in transferrin saturation ( ΔTS ) in the iron-fortified milk group ( ΔTS : 3.4 ± 12.9 % ) was greater than that in the placebo and nonfortified milk groups ( ΔTS : −10.1 ± 9.8 % and −11.6 ± 10.7 % , respectively ) ( p < .01 ) . The weight gain of the subjects during intervention did not differ significantly in the fortified and nonfortified milk groups ( Δweight : 5.0 ± 2.0 and 5.8 ± 2.1 kg , respectively ) , but was higher than in the iron tablet group ( Δweight : 4.6 ± 3.1 kg p < .05 ) and the placebo group ( Δweight : 3.8 ± 2.5 kg ; p < .001 ) . Iron supplementation and fortification were seen to be effective in promoting weight gain in pregnant Vietnamese women . For women who are underweight , the administration of iron-fortified milk has additional benefits to those of supplementation , most likely due to additional energy and nutrient inputs Summary Background Bioavailability data in humans of elemental iron powders is limited although elemental iron is a common form of iron when used as a fortificant . Aim of the study The relative bioavailability ( RBV ) of seven elemental iron powders , five commercially available and two developmental are evaluated . In addition , one commercial electrolytic iron powder given with ascorbic acid ( AA ) was examined . Methods Based on a vali date d method this double – blinded r and omized crossover study included three groups of male blood donors ( n = 3 * 16 ) who were served rolls fortified with different elemental iron powders or ferrous sulfate ( FeSO4 ) nine weeks apart . Blood sample s were drawn every hour for six hours . RBV was obtained by comparing the increase in serum iron concentration induced by the elemental iron with the increase induced by FeSO4 . Results All elemental iron powders studied were significantly less well absorbed compared to FeSO4  . The electrolytic iron given with 50–mg AA was as well absorbed as FeSO4 ( molar ratio = 1:6 , AA : Fe ) . The mean RBVs of the iron powders were : electrolytic ( A–131 , RBV = 0.65 ) ; electrolytic ( Electrolytic , RBV = 0.59 ) ; carbonyl ( Ferronyl , RBV = 0.58 ) ; H – reduced ( AC– 325 , RBV = 0.56 ) ; H – reduced ( Hi – Sol , RBV = 0.50 ) ; carbonyl ( CF , RBV = 0.37 ) ; reduced ( Atomet 95SP , RBV = 0.36 ) . The reduced iron was distinguished by having significantly lower RBV ( 0.36 ) although no significant overall ranking was possible . Conclusion Based on a vali date d method this doubleblinded cross – over study in humans showed that the evaluated elemental iron powders currently available for commercial use are significantly less well absorbed compared to FeSO4 . The results indicate that the reduced iron powder was absorbed to a lower extent compared to the other iron powders and only 36 % compared to FeSO4 . Ascorbic acid seems to improve the bioavailability of elemental iron even though a rather low molar ratio is used . Thus , if confirmed , this enhancing effect of ascorbic acid on elemental iron when used as a fortificant could be used by co – fortifying them Iron nutrition in infants was studied in a double-blind trial with artificial milk formula . Statistically significant differences were observed with the iron-fortified formula . Not all haematological indices showed significant differences . The fragiligraph technique result was the only parameter showing differences not influenced by other variables examined The hematinic effect of ferrous sulphateenriched flour has been examined in a long-term , community-based experiment . During a period of 20 consecutive months 17000 metric tons of iron-fortified flour were produced at Tau M@lle in Stavanger , Norway ( total iron content 6.2 mg/100 g flour ) . There were neither complaints of rancidity of the flour nor of any harmful effect on its baking qualities . The monitoring of the effect of the iron-fortification programme was performed on an experimental group of 202 women of child-bearing age living in Stavanger . A control group of 215 women was established in Bergen .  Blood examinations ( Hb , Hct and MCHC ) were performed at the start of the experiment and repeated on three occasions during the study . The results failed to give conclusive evidence of the hematinic effect of the iron supplement . However , the results obtained in the few women with the lowest circulating Hlb levels ( Hb < 12 g/lOO ml ) suggested that the added iron was absorbed and utilized for Hb synthesis . The authors have recommended to the Norwegian health authorities that all white flour should be fortified with ferrous sulphate . I mt seems reasonable to apply the same level of enrichment as was recently proposed by the US Commissioner of Food and Drug Administration ( total level of iron 9 mg/ 100 g flour ) . Food fortification is a public health measure aim ed at improving and maintaining the health of individuals in the population through the provision of adequate levels of nutrient intake ( 13 ) . Iron is one of the nutrients which requires special consideration . Based on normal values for Hb concentration and other hematological parameters , we have in previous studies estimated the prevalence of anemia in various population groups ( 18 ) . Iron-deficiency anemia is rather prevalent in Norway : it is not uncommon in schoolchildren and is frequently found in women of reproductive age and in the elderly . At present the level of iron in the average Norwegian diet is only about 4 - 5 mg/l 000 kcal ( 28 , 29 ) . Infants and small children , elderly people , patients and physically inactive individuals with a low caloric intake , as well as those with an increased iron requirement due to growth , convalescence , menstrual bleeding , pregnancy and other special needs , are likely to receive an insufficient supply of iron . The recommended daily intake for women of reproductive age is , for example , 18 mg iron , which should be provided in no more than 1850 - 2 400 kcal ( 4 ) . Thus the lowcalorie consumer ( < 2 000 kcal/day ) requires a diet with no less than 10 mg iron/l 000 kcal in order to satisfy the iron needs . This is theoretically possible to accomplish by choosing foods with a high iron content ( blood , liver , kidneys , wholemeal bread , green vegetables ) . Apart from the fact that blood and entrails are in short supply , it is unrealistic to assume that the majority of people will change their food habits according to these suggestions . An increase in the dietary iron intake might be most easily accomplished through a fortification programme . Iron fortification of the Norwegian brown-cheese with ferrous sulphate was first performed on an experimental scale in the late 1960 's ( 26 ) . In 1972 the enriched cheese became available to the ordinary consumer . The most suitable vehicle , however , for iron fortification would probably be flour and bread . In Great Britain the Bread and Flour Regulations ( 1 ) require that either reduced iron or ferric ammonium citrate shall be added , if necessary , to restore the iron content of flour , other than wholemeal , to at least 1.65 mg/100 g flour . In Acta med . sc and . 194 464 H . Natvig and 0 . D. Vellar Denmark 3 mg iron/l00 g flour is added in the form of reduced iron to wheat and rye flour ( 12 ) . In Sweden iron enrichment of flour ( up to 7 mg iron/100 g flour as reduced iron , ferrous sulphate or ferrous fumarate ) is undertaken on a voluntary basis ( 14 ) . In the USA the level of iron in " enriched " flour is raised to that of wholemeal flour ( 3.5 mg Fe/100 g flour ) . However , the US Commissioner of the Food and Drug Administration has proposed an increase of the level of enrichment to ensure a level of 9 mg Fe/100 g flour ( 3 , 7 ) . Finch and Monsen ( 7 ) emphasize that such manipulation of the public diet carries with it the responsibility for monitoring its effect on the iron balance of the population and on the prevalence of iron deficiency and iron overload . Based on our previous Hb studies ( 18 ) we proposed that the possibility of iron enrichment of flour and bread should be considered also in Norway . I t would be necessary , however , to examine the biological effect of various iron preparations when baked into bread as well as the technological problems relating to the baking process . While iron fortification programmes have been in force for many years in many countries , there appear to have been few thorough attempts to evaluate their effectiveness until recently . Furthermore , the results of these studies have been controversial . Three long-term feeding trials with ferrous carbonate or ferrum-reductum-enriched bread ( 5 , 15 , 25 ) showed no effect on the Hb values . Studies reported by Stott ( 23 ) , however , are at variance with these negative results . Using prisoners , Stott fed ferrous-sulphate-enriched bread for four months and obtained a considerable increase in the Hb concentration . This work , however , has been justifiably criticized because there was no control group , and because the absorption of iron from the added ferrous sulphate would have to have been in excess of 30 % in order to account for the recorded Hb rise during the first two months of supplementation . During a long-term trial we fed ferrous-sulphate-enriched bread to 77 women inmates in a mental hospital ( 24 ) . A control group was given the same bread without fortification . After a 12week period the mean Hb level increased from 13.96 to 14.32 g/100 ml in the experimental group . This increase of 0.36 g/100 ml was statistically significant at the 5 % level . However , the Acta med . sc and . 194 mean Hb increase in the control group was almost as great , but these results were difficult to assess as so many of the controls dropped out . Thus the experiment did not provide convincing proof of the effectiveness of the supplement , In a recent long-term feeding trial by Elwood et al. ( 6 ) the effect of ferric-ammonium-citrateenriched bread was examined . Although the results were not entirely consistent , they indicated a small hematinic effect of the iron supplement . Balance studies ( 9 ) with bread enriched with ferrum reductum , ferrous sulphate of ferric orthophosphate revealed some absorption ( OR an average 3 % ) of the added iron . There was no particular difference in the amount of iron absorbed from the three preparations . In absorption studies ( 24 ) we have found that ferrous-sulphate-enriched bread gave favourable results , with an increase in serum iron values two hours after the test meal . When reduced iron was used for enrichment , the response was not so pronounced . It was also observed that the added ferrous sulphate was better absorbed from white wheaten bread than from wholemeal bread . In radioactive absorption studies Steinkamp et al. ( 22 ) examined the effect of bread enriched with radioactive ferrous sulphate , reduced iron , ferric orthophosphate , and sodium ferric pyrophosphate , and found an equal effectiveness of all four forms of iron used for enrichment . In recent studies Hoglund and Reizenstein ( 10 , ll ) , using more modern technique with a whole body counter , found that the absorption of iron from ferrous-sulphate-enriched bread was much higher than when reduced iron was used for enrichment . When fine grain-reduced iron was used to enrich flour , the absorption was 50 % lower , and when a coarser grain-reduced iron was used , it was 85 % lower , than when ferrous sulphate was used for enrichment . Animal studies performed by Fritz et al. ( 8 , 20 , 21 ) of the biological availability of iron in iron-depleted chicks and rats also indicated that ferrous sulphate has a high relative biological value compared with other iron compounds . I t was also found that ferrous sulphate added to a biscuit mix prior to baking was utilized nearly as well as the same quantity of ferrous sulphate added directly to the test diet ( 8) . When these animal repletion studies were compared with human plasma iron responses following test doses of Iron-fortified bread 465 five sources of iron ( ferrous sulphate , reduced iron , sodium iron pyrophosphate , ferric orthophosphate and ferrous carbonate ) a similar ranking with ferrous sulphate as the best compound was obtained in both experiments ( 21 ) . According to three comprehensive reports on the subject of iron fortification ( 2 , 13 , 16 ) most of the evidence suggests that ferrous sulphate is among the most effective forms . As a supplement to our previous absorption and utilization studies ( 24 ) we felt that a longterm controlled , large-scale community-based feeding trial with ferrous-sulphate-enriched flour and bread should be conducted . Ideally such a trial should evaluate the beneficial effect , if any , on representative sample s of the community in terms of a change in morbidity . However , indices of morbidity are relatively insensitive . Changes in Hb levels and other hematological data might be used , as an indirect measure of health , to assess the immediate effect of the fortification programme , The plan was to supply iron-fortified flour and bread to the entire population in one particular community and to compare the changes in certain hematological data of one group of this experimental area with those obtained in a control group from an area without fortification . MATERIAL AND METHODS Iron enrichment of flour Western Norway was chosen for the trial , as in a previous study we had observed somewhat lower Hb values in the western than in other regions of the country ( 17 ) . Furthermore , in the western region it was also possible , from a practical point BACKGROUND Non-water-soluble iron compounds have been reported to be less well absorbed than ferrous sulfate in young children , and concern has been raised about their usefulness as food fortificants . OBJECTIVE The objective was to evaluate the usefulness of ferrous fumarate and ferric pyrophosphate , compared with ferrous sulfate , in maintaining hemoglobin concentrations > 105 g/L in Bangladeshi children . DESIGN Two hundred thirty-five children aged 7 - 24 mo ( hemoglobin > 105 g/L ) were r and omly assigned in a double-blind study to receive an infant cereal fortified with ferrous fumarate , ferric pyrophosphate , or ferrous sulfate . One serving of cereal ( 9.3 mg Fe ; molar ratio of ascorbic acid to iron of 3:1 ) was consumed per day , 6 d/wk , for 9 mo . Blood sample s were drawn at 4.5 and 9 mo . RESULTS Raw data were reformatted , and a " time to event " was calculated that corresponded to reaching the following thresholds : hemoglobin < 105 g/L , plasma ferritin < 12 microg/L , or plasma C-reactive protein > 10 mg/L at baseline , 4.5 mo , or 9 mo . Data were censored when children did not reach the threshold or were lost to follow-up . A Kaplan-Meier approach was used to compare the 3 groups . No statistically significant differences were observed for hemoglobin < 105 g/L ( P = 0.943 ) , plasma ferritin < 12 microg/L ( P = 0.601 ) , or plasma C-reactive protein > 10 mg/L ( P = 0.508 ) . CONCLUSIONS Contrary to earlier concerns , these results do not indicate differences in usefulness between water-soluble and non-water-soluble iron compounds in maintaining hemoglobin concentrations and preventing iron deficiency . These data will be important in the development of food-fortification strategies to combat anemia and iron deficiency in highly vulnerable population groups The availability of iron added to dried skim milk and to maize-soya-bean-milk mixture ( CMS ) was measured by whole-body counting in thirty clinical ly healthy children and compared with the availability of Fe from ferrous ascorbate alone . The mean absorption of Fe added as ferrous sulphate to a test meal of dried skim milk was 9.5 percent when the test meal was given as a sweetened drink . When maize meal was added to the dried skim milk to produce a porridge the mean absorption of the supplementary Fe was reduced to 6.3 percent . The mean absorption of Fe given as ferrous ascorbate alone was 59.6 percent . These results differed from those reported for indirect tests done with animals in which the absorption of inorganic Fe added to milk-based feed preparations for infants was substantially greater than that of dietary Fe . The mean absorption of Fe added as  ferrous fumarate  to a test meal of maize-soya-bean-milk mixture was 6.0 percent , whereas that of Fe given as ferrous ascorbate alone was 63.5 percent . The amount of supplementary Fe added to maize-soya-bean-milk mixture ( USA Department of Agriculture specification ) was considered to be adequate . ( AU Abstract The increase in serum iron two hours after test-meals in fasting subjects was taken as an expression of iron absorption in three series of experiments . All the individuals , most of them young , healthy , female nurses acted as their own controls . Tests were performed with white wheaten and wholemeal bread fortified with ferrous sulphate or ferrum reductum to 40 mg iron per 100 g. Some experiments with unenriched white bread were also included . It was found that ferrous sulphate gave a more pronounced increase in serum iron than ferrum reductum . The increase was higher after fortified white bread than after fortified wholemeal bread . This was probably due to the inhibitory effect , although only partial , of dietary phytate on iron absorption . Because of the relative uncertainty of the performed absorption experiments , a controlled clinical trial with ferrous-sulphate-enriched white and wholemeal bread to 8 mg iron per 100 g was conducted in 146 adult female patients of a mental hospital . The 12 weeks ' trial was completed in 77 subjects in the experimental group and in only 20 in the control group . In the experimental group the mean Hb value showed a significant increase to 14.32 g% , which is equivalent to the mean optimal value for adult Norwegian women . A concomitant rise in the mean Hct and MCHC values was recorded . The results in the control group are difficult to interpret . The mean increase in Hb concentration after 12 weeks , however , was not statistically significant . The present study indicates that ferrous sulphate baked into bread is better absorbed than ferrum reductum , and is easily available for hemoglobin synthesis . A long-term community-based feeding trial , however , may be necessary before a final conclusion regarding the future Norwegian iron-fortification policy is reached Objective : To assess the efficacy of ferrous sulfate ( FS ) and ferrous gluconate ( FG ) as fortificants for a complementary baby food ( Nutrisano ) to improve the iron status and to reduce the prevalence of anemia in toddlers . Patients and Methods : Toddlers 12 to 30 months old were r and omly assigned to receive either of 3 versions of Nutrisano fortified with FS or FG or not fortified ( CG ) for 6 months . In final blood sample s , the concentrations of hemoglobin , serum ferritin , and soluble transferrin receptors ( sTfR ) were determined . The effects of treatment on final hemoglobin , ferritin , and sTfR were assessed by multivariate analysis . Results : No significant changes in hemoglobin were observed within or among treatment groups . The prevalence of high sTfR decreased 7.1 percentage points in FG , increased 13.1 percentage points in FS , and increased 0.7 percentage points in CG ( P > 0.05 ) . In an interaction between treatment and total intake of Nutrisano on the concentration of ferritin , sTfR , and total iron body stores , adjusted means of serum ferritin in the medium tertiles of intake of Nutrisano for FS ( P = 0.05 ) and in the higher and medium tertiles for FG were higher ( P = 0.001 ) , and adjusted means of sTfR were significantly lower ( P < 0.001 ) , than the respective lower tertile of intake . Conclusions : Fortification of Nutrisano with FG has an acceptable level of beneficial effect on markers of iron status . The satisfactory efficacy and other sensory data has led to the political decision to substitute hydrogen-reduced iron , used formerly as a fortificant , with FG . Studies to assess the effectiveness of the reformulated Nutrisano are in order Objective : To determine the efficacy of p and esal baked from wheat flour fortified with iron , with or without vitamin A ( VA ) , in improving anemic schoolchildren 's iron and anthropometric status . Methods : Anemic 6- to 12-year-old Filipino children ( n = 250 ) received two 60 g  p and esal daily for 8 months . They were r and omized into 1 of 4 groups : ( 1 ) iron-fortified ( with hydrogen-reduced iron at 80 mg/kg , electrolytic iron at 80 mg/kg , or ferrous fumarate at 40 mg/kg ) , ( 2 ) iron and VA-fortified , ( 3 ) VA-fortified ( at 490 RE/100 g ) , and ( 4 ) nonfortified flour .  Hemoglobin ( Hb ) and zinc protoporphyrin ( ZnPP ) concentrations and weight and height were determined before and after intervention . Analyses of variance and chi-square and multiple regression analyses were performed . Results : Mean Hb increased by 1.3 g/dL ( p < 0.001 ) and mean ZnPP decreased by 24.4 µmol/mol ( p < 0.001 ) after 8 months . Anemia decreased to 26 % and iron deficiency decreased from 58 % to 12 % . After controls were applied for baseline concentration , age , and gender , Hb concentration at post intervention was significantly higher in the Iron + VA group than in the nonfortified group ( coefficient = 0.37 ; p = 0.034 ) . The odds of being iron deficient at post intervention were significantly lower in the Iron group than in the nonfortified group after controls were applied for age , gender , and baseline prevalence ( coefficient = 0.12 ; p = 0.006 ) . None of the 3 fortified groups had significantly different weight-for-age z-score , body mass index-for-age z-score , or height-for-age z-score compared with the nonfortified group after controls were applied for baseline z-scores , age , and gender . Conclusions : Our study shows that in a non – malaria-endemic area , iron fortification of flour significantly reduced the prevalence of iron deficiency among anemic schoolchildren , and double fortification with iron and VA significantly improved Hb status BACKGROUND A number of algorithms have been developed that seek to predict the bioavailability of iron from mixed meals and diets , but their direct validity in predicting change in iron status remains question able . Throughout the course of conducting a large feeding trial in convents in Manila , we collected weighed food-intake data and have the opportunity to directly compare the performance of these prediction equations . AIMS The specific aims of this particular analysis are as follows : ( a ) to determine habitual intakes of macro- and micronutrients  in religious sisters in Manila , ( b ) to determine the predicted efficiency of iron absorption from each of the published bioavailability algorithms ( Monsen , Hallberg , Reddy , Tseng , Barghava , and Du ) , and ( c ) to determine which of these equations best predicts the actual " gain " in iron in religious sisters over the duration of the trial . DESIGN The efficacy of consuming high-iron rice was tested during a nine-month feeding trial with a double-blinded dietary intervention ; these results have been published [ 7 ] . Religious sisters living in 10 convents around metropolitan Manila , the Philippines were r and omly assigned to consume either high-iron rice ( 3.21 mg/kg Fe ) or a local variety of control rice ( 0.57 mg/kg Fe ) within each convent . RESULTS Religious sisters in convents consumed a diet that appeared to be typical of habitual intakes of macro- and micronutrients in this part of the Philippines . The analysis of the six equations revealed highly significant differences in predicted efficiency of iron absorption . The Hallberg , Monsen , and Reddy equations all predicted similar median efficiency ( 6.88 , 7.92 , and 6.42 % ) . In contrast , Bhargava ( 4.68 % ) , Tseng ( 3.23 % ) , and Du ( 2.92 % ) were significantly lower . The correlation ( r = 0.98 ) of Monsen to Hallberg was highly significant and the slope was not different than unity . The median efficiency of absorption based on the gain in body iron in 114 subjects over nine months , combined with an estimate of daily iron requirements , was 17.2 % . Thus , none of these equations approximated the computed iron absorption based on improvement in serum ferritin and suggests alternative approaches to predicting iron accumulation from diet need to be formulated . CONCLUSIONS Inhibitory factors in the prediction equations either had little effect or had too large of an effect on apparent bioavailability as compared to median absorption over a nine-month period . The causes of the lack of agreement between computed iron gain and predicted absorption are open to discussion and will need to be resolved OBJECTIVE To evaluate the effectiveness of stainless steel ( Fe alloy ) cooking pots in reducing Fe-deficiency anaemia  in food aid-dependent population s. DESIGN Repeated cross-sectional surveys . Between December 2001 and January 2003 , three surveys among children aged 6 - 59 months and their mothers were conducted in 110 households r and omly selected from each camp . The primary outcomes were changes in Hb concentration and Fe status . SETTING Two long-term refugee camps in western Tanzania . SUBJECTS Children ( 6 - 59 months ) and their mothers were surveyed at 0 , 6 and 12 months post-intervention . Stainless steel pots were distributed to all households in Nduta camp ( intervention ) ; households in Mtendeli camp ( control ) continued to cook with aluminium or clay pots . RESULTS Among children , there was no change in Hb concentration at 1 year ; however , Fe status was lower in the intervention camp than the control camp ( serum transferrin receptor ( sTfR ) concentration : 6.8 v. 5.9 microg/ml ; P < 0.001 ) . There was no change in Hb concentration among non-pregnant mothers at 1 year . Subjects in the intervention camp had lower Fe status than those in the control camp ( sTfR concentration : 5.8 v. 4.7 microg/ml ; P = 0.003 ) . CONCLUSIONS Distribution of stainless steel pots did not increase Hb concentration or improve Fe status in children or their mothers . The use of stainless steel prevents rusting but may not provide sufficient amounts of Fe and strong educational campaigns may be required to maximize use . The distribution of stainless steel pots in refugee context s is not recommended as a strategy to control Fe deficiency Pregnancy anemia and pregnancy-induced hypertension ( PIH ) are common and potentially dangerous disorder in human pregnancy , and nutritional status of pregnant women is one of the leading causes . Chlorella contains large quantities of folate , vitamin B-12 and iron , and can help improve anemia and hypertensive disorder . Our objective was to investigate the preventive effects of Chlorella supplement on pregnancy anemia and PIH in Japanese pregnant women . A total of 70 pregnant women were placed into the  control group  ( n = 38 ) or the Chlorella group ( n = 32 ) . The subjects in the Chlorella group were supplemented daily from 12th–18th wk of gestation until delivery with 6 g of Chlorella supplement . The proportion of anemic ( hemoglobin level < 11 g/dL ) subjects in the Chlorella group were significantly lower compared with the control group at the second and third trimesters . Additionally , in the Chlorella group , the incidences of proteinuria and edema , signs of PIH , were significantly lower during the third trimester . These results suggest that Chlorella supplementation significantly reduces the risk of pregnancy associated anemia , proteinuria and edema .  Chlorella supplement may be useful as a re source of natural folate , vitamin B-12 and iron for pregnant women BACKGROUND Nonanemic iron deficiency is common in toddlers in developed countries . Food-based strategies are safe methods to control and prevent mild micronutrient deficiencies . OBJECTIVE Our objective was to determine the efficacy of an increased intake of red meat , or the consumption of iron-fortified milk , in improvement of iron status in toddlers at a population level . DESIGN In this 20-wk r and omized placebo-controlled trial , 225 healthy nonanemic 12 - 20-mo-old children were assigned to 1 of 3 groups : red meat ( toddlers encouraged to consume approximately 2.6 mg iron from red meat dishes daily ) , fortified milk [ toddlers ' regular milk replaced with iron-fortified ( 1.5 mg iron/100 g prepared milk ) cow milk ] , or control [ toddlers ' regular milk replaced with nonfortified ( 0.01 mg iron/100 g prepared milk ) cow milk ] . Blood sample s were collected at baseline and at 20 wk for hemoglobin , serum ferritin , serum transferrin receptor , and C-reactive protein . The prevalence of suboptimal iron status ( ie , depleted iron stores , iron-deficient erythropoiesis , and iron deficiency anemia ) was determined , and body iron was calculated . RESULTS No intervention effects were shown on the prevalence of suboptimal iron status . Serum ferritin increased by 44 % ( 95 % CI : 14 % , 82 % ; P = 0.002 ) in the fortified milk group , did not change ( + 10 % ) in the red meat group ( 95 % CI : -7 % , 30 % ; P = 0.241 ) , and tended to decrease ( -14 % ) in the control group ( 95 % CI : -27 % , 1 % ; P = 0.063 ) . By 20 wk , in comparison with the control group , serum ferritin and body iron were significantly higher in the fortified milk group ( both P < 0.001 ) , and serum ferritin was significantly higher in the red meat group ( P = 0.033 ) . CONCLUSIONS Consumption of iron-fortified milk can increase iron stores in healthy nonanemic toddlers , whereas increased intakes of red meat can prevent their decline . This trial was registered at actr.org.au as ACTRN12605000487617 BACKGROUND R and om serial sampling is widely used in population pharmacokinetic studies and may have advantages compared with conventional fixed time-point evaluation of iron fortification . OBJECTIVE Our objective was to vali date r and om serial sampling to judge the efficacy of iron fortification of a low-fat margarine . DESIGN We conducted a 32-wk placebo-controlled , double-blind , iron-intervention trial in 18 - 40-y-old Swiss women ( n = 142 ) with serum ferritin ( SF ) concentrations < 25 μg/L. Women were r and omly assigned to 3 groups to receive 20 g margarine , with 14 mg added iron as either micronized ground ferric pyrophosphate ( MGFePP ) or sodium iron edetate ( NaFeEDTA ) , or placebo daily . We measured hemoglobin and iron status of subjects at 2 fixed time points ( at baseline and the endpoint ) plus 3 r and omly assigned time points between 4 and 28 wk . With the use of bootstrapping , the number of observations per individual was reduced to 3 and then compared with the 5-time-point data . Mixed-effects models were used to estimate iron repletion over time for r and om sampling , and analysis of covariance was used for fixed time-point sampling . RESULTS Body iron stores increased in women who received MGFePP or NaFeEDTA compared with women who received placebo ( P < 0.05 ) . The increase in body iron stores  with NaFeEDTA fortification was 2 - 3 times the increase with MGFePP fortification ( P < 0.05 ) ; the difference was more marked in women with baseline SF concentrations < 15 μg/L ( P < 0.05 ) . R and om serial sampling reduced the required sample size per group to one-tenth of that for 2 fixed time points . Compared with the 5-time-point analysis , the 3-time-point sparse sampling generated comparable estimates of efficacy . CONCLUSIONS When used to evaluate the efficacy of iron fortificants , r and om serial sampling can reduce the sample size , invasiveness , and costs while increasing sensitivity . R and om serial sampling more clearly describes the pattern of iron repletion and may prove useful in evaluating other micronutrient interventions Anemia is common among children in sub-Saharan Africa and its etiology is multifactorial . Likely causes of anemia are low bioavailability of dietary iron , malaria , and helminth infection . In this study , we aim ed to assess the effect of iron fortification , intermittent preventive treatment ( IPT ) of malaria , and anthelmintic treatment on hemoglobin concentration and anemia prevalence among school children . The study was a 6-mo , r and omized , double-blind , controlled trial enrolling 591 6- to 14-y-old school children in Côte d'Ivoire using the following : 1 ) iron-fortified biscuits providing an additional 20 mg iron/d as electrolytic iron 4 times/wk ; 2 ) IPT of malaria with sulfadoxine-pyrimethamine at 0 and 3 mo ; and 3 ) anthelmintic treatment at 0 and 3 mo as the interventions . Prevalence of anemia , iron deficiency , malaria parasitemia , and helminth infection was 70.4 , 9.3 , 57.7 , and 54.8 % , respectively . Iron fortification did not improve iron status , IPT of malaria did not affect malaria burden , and neither had an impact on anemia prevalence . Anthelmintics significantly reduced the burden of helminth infections and decreased anemia prevalence ( odds ratio : 0.4 , 95 % CI : 0.3 , 0.7 ) . The low prevalence of iron deficiency and an extended dry season that decreased malaria transmission likely reduced the potential impact of iron fortification and IPT . In this setting , anthelmintic treatment was the only intervention that modestly decreased rates of anemia Precooked , instant ( dry ) infant cereals in the US are fortified with electrolytic iron , a source of low reactivity and suspected low bioavailability . Iron from ferrous fumarate is presumed to be more available . In this study , we compared a dry infant rice cereal ( Cereal L ) fortified with electrolytic iron ( 54.5 mg iron/100 g cereal ) to a similar cereal ( Cereal M ) fortified with ferrous fumarate ( 52.2 mg Fe/100 g ) for efficacy in maintaining iron status and preventing iron deficiency ( ID ) in breast-fed infants .  Ascorbic acid was included in both cereals . In this prospect i ve , r and omized double-blind trial , exclusively breast-fed infants were enrolled at 1 mo and iron status was determined periodically . At 4 mo , 3 infants had ID anemia  and were excluded . Ninety-five infants were r and omized at 4 mo , and 69 ( 36 Cereal L , 33 Cereal M ) completed the intervention at 9 mo . From 4 to 9 mo , they consumed daily one of the study cereals . With each cereal , 2 infants had mild ID , a prevalence of 4.2 % , but no infant developed ID anemia . There were no differences in iron status between study groups . Iron intake from the study cereals was ( mean ± SD ) 1.21 ± 0.31 mg⋅kg(-1)⋅d(-1 ) from Cereal L and 1.07 ± 0.40 mg⋅kg(-1)⋅d(-1 ) from Cereal M. Eleven infants  had low birth iron endowment ( plasma ferritin < 55 μg/L at 2 mo ) and 54 % of these infants had ID with or without anemia by 4 mo . We conclude that electrolytic iron and ferrous fumarate were equally efficacious as fortificants of this infant cereal
target: Sensitivity analyses and meta-regression for hemoglobin suggested a higher response with lower trial quality ( suboptimal allocation concealment and blinding ) , use of condiments , and sodium iron edetate and a lower response when adults were included .
  Consumption of iron-fortified foods results in an improvement in hemoglobin , serum ferritin , and iron nutriture and a reduced risk of remaining anemic and iron deficient
background: BACKGROUND The utility of iron fortification of food to improve iron deficiency , anemia , and biological outcomes is not proven unequivocally .