title: Improving iron absorption from a Peruvian school breakfast meal by adding ascorbic acid or Na2EDTA. Iron supplementation improves iron status and reduces morbidity in children with or without upper respiratory tract infections: a randomized controlled study in Colombo, Sri Lanka. Fortification of curry powder with NaFe(111)EDTA in an iron-deficient population: report of a controlled iron-fortification trial. Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women. Fortification of sugar with iron sodium ethylenediaminotetraacetate (FeNaEDTA) improves iron status in semirural Guatemalan populations. Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate. The use of NaFeEDTA-fortified fish sauce is an effective tool for controlling iron deficiency in women of childbearing age in rural Vietnam. Serum ferritin as a measure of iron stores in normal subjects. Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial Therapeutic effects of NaFeEDTA-fortified soy sauce in anaemic children in China. Evaluation of cluster randomized controlled trials in sub-Saharan Africa.
abstract: BACKGROUND Iron-fortified school breakfasts have been introduced in Peru to combat childhood iron deficiency . OBJECTIVE We evaluated whether iron absorption from a school breakfast meal was improved by increasing the ascorbic acid content or by adding an alternative enhancer of iron absorption , Na2EDTA . DESIGN In a crossover design , iron absorption from test meals was evaluated by erythrocyte incorporation of 58Fe and 57Fe . The test meals ( wheat bread and a drink containing cereal , milk , and soy ) contained 14 mg added Fe ( as ferrous sulfate ) including 2.0 - 2.6 mg 58Fe or 4.0 - 7.0 mg 57Fe . RESULTS Geometric mean iron absorption increased significantly from 5.1 % to 8.2 % after the molar ratio of ascorbic acid to fortification iron was increased from 0.6:1 to 1.6:1 ( P < 0.01 ; n = 9 ) . Geometric mean iron absorption increased significantly from 2.9 % to 3.8 % , from 2.2 % to 3.5 % , and from 2.4 % to 3.7 % after addition of Na2EDTA at molar ratios relative to fortification iron of 0.3:1 , 0.7:1 , and 1:1 , respectively , compared with test meals containing no added enhancers ( P < 0.01 ; n = 10 for all ) . Iron absorption after addition of ascorbic acid ( molar ratio 0.6:1 ) was not significantly different from that after addition of Na2EDTA ( molar ratio 0.7:1 ) . CONCLUSIONS Ascorbic acid and Na2EDTA did not differ significantly in their enhancing effects on iron absorption at molar ratios of 0.6:1 to 0.7:1 relative to fortification iron . Additional ascorbic acid ( molar ratio 1.6:1 ) increased iron absorption significantly . Increasing the molar ratio of Na2EDTA to fortification iron from 0.3:1 to 1:1 had no effect on iron absorption BACKGROUND Iron deficiency anemia and recurrent infections are common among children of low socioeconomic status . OBJECTIVE The objective was to evaluate the effects of iron supplementation on iron status and morbidity in children with or without infection . DESIGN Children aged 5 - 10 y were recruited for a r and omized , controlled , double-blind study from out patients attending the Children 's Hospital , Colombo , Sri Lanka . Clinical , inflammatory , nutritional , and iron statuses were determined at baseline and after the intervention . Children with a history of recurrent upper respiratory tract infections ( URTIs ) and with laboratory and clinical evidence of a current URTI constituted the infection group ( n = 179 ) , and children without infection constituted the control group ( n = 184 ) . Subjects in both groups were supplemented with ferrous sulfate ( 60 mg Fe ) or placebo once daily for 8 wk . Morbidity from URTIs , the number of gastrointestinal infections , and compliance were recorded every 2 wk . RESULTS The overall prevalence of anemia was 52.6 % . Iron supplementation significantly improved iron status by increasing hemoglobin ( P < 0.001 ) and serum ferritin ( P < 0.001 ) concentrations from baseline values in the children with or without infection . There was no significant improvement in iron status in the children who received placebo . In both the infection group and the control group , the mean number of URTI episodes and the total number of days sick with an URTI during the period of intervention were significantly lower ( P < 0.005 and P < 0.001 , respectively ) in the children who received iron supplements than in those who received placebo . CONCLUSION Iron supplementation significantly improves iron status and reduces morbidity from URTIs in children with or without infection 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 We studied the effect of iron supplementation on the iron status of mothers and on biochemical iron status and clinical and anthropometric measures in their infants . The subjects were 197 pregnant women selected at 28 wk + /- 21 d of gestation at a mother- and -child health center in Niamey , Niger . Ninety-nine women received 100 mg elemental Fe/d  throughout the remainder of their pregnancies and 98 received placebo . The prevalence of anemia and iron deficiency decreased markedly during the last trimester of pregnancy in the iron-supplemented group but remained constant in the placebo group . Three months after delivery , the prevalence of anemia was significantly higher in the placebo group . At delivery , there were no differences between the two groups in cord blood iron variables . Three months after delivery , serum ferritin concentrations were significantly higher in infants of women in the iron-supplemented group . Mean length and Apgar scores were significantly higher in infants with mothers in the iron group than in those with mothers in the placebo group 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 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 dose-dependent inhibitory effect of sodium phytate on  iron absorption  was studied in man by serving wheat rolls containing no phytates and rolls  to which various amounts  ( seven dose levels between 2 and 250 mg expressed as phytate phosphorus ) were added just before serving . Fe in the two kinds of rolls was labeled with two radioisotopes of Fe ( 55Fe , 59Fe ) and the rolls were served on alternate days . The inhibition of Fe absorption was strongly related to the amount of phytate added ; 2 mg inhibited absorption by 18 % , ( p less than 0.001 ) , 25 mg by 64 % ( p less than 0.001 ) , and 250 mg by 82 % ( p less than 0.001 ) . The addition of ascorbic acid significantly counteracted the inhibition whereas the corresponding effect of meat was less well defined and only seen at the highest phytate level . The marked inhibition of Fe absorption by phytates and the significant counteracting effect of ascorbic acid have wide nutritional implication 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 Serum ferritin has been measured by a two-site immunoradiometnic assay employing antibody-coated polystyrene tubes . Normal values were established by performing measurements in male and female subjects between 20 and 50 years of age in whom iron-deficient erythropoiesis was excluded on the basis of transferrin saturation and red cell protoporphyrin . The serum fernitin was log-normally distributed with a geometric mean of 94 ng/ml in 174 males and 34 ng/ml in 152 females . Additional studies were performed in 83 healthy women to determine the relationshipbetween serum ferritin and iron stores measured by radioiron absorption . A high correlation between these measurements indicates that the serum ferritin is a useful survey tool for the initial assessment and prospect i ve monitoring of iron stores in a normal population . Am . J. Clin . Nutr . 27 : 681 -687 , 1974 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 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 Cluster r and omized controlled trials ( C RCTs ) are attractive in setting s in which individual r and omization is difficult or impossible . This issue is common when study ing several health problems in developing countries . The authors aim ed to assess empirically the extent to which the prerequisite design and analysis aspects of cluster r and omization were taken into account and reported properly in C RCTs conducted in sub-Saharan Africa . C RCTs published in the last three decades were evaluated by using a checklist based on the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement . The authors identified 51 eligible C RCTs ; 40 of them ( 78 % ) had been published after 1990 . Only 10 ( 20 % ) studies took clustering into account in sample size or power calculations , and only 19 ( 37 % ) took clustering into account in the analysis . Intracluster correlation coefficients and design effects were reported in only one ( 2 % ) and three ( 6 % ) trials , respectively . An increasing number of C RCTs are conducted in sub-Saharan Africa , but many are not analyzed and reported properly . The special features stemming from cluster r and omization need to be addressed in the design , analysis , and reporting of these studies
target: After the intervention , Hb concentration and serum ferritin concentration were both higher in the NaFeEDTA group compared with the control group .
  Subgroup analysis indicated that a lower baseline Hb level was associated with a greater increase in Hb concentration .
  No significant difference in serum Zn concentration was found .
  We concluded that NaFeEDTA increased both Hb concentration and serum ferritin concentration substantially in Fe-deficient population s , and could be an effective Fe preparation to combat Fe deficiency
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