Iron biofortification interventions to improve iron status and functional outcomes

This analysis was conducted to evaluate the evidence of the efficacy of iron biofortification interventions on iron status and functional outcomes. Iron deficiency is a major public health problem worldwide, with a disproportionate impact on women and young children, particularly those living in resource-limited settings. Biofortification, or the enhancing of micronutrient content in staple crops, is a promising and sustainable agriculture-based approach to improve nutritional status. Previous randomised efficacy trials and meta-analyses have demonstrated that iron-biofortification interventions improved iron biomarkers; however, no systematic reviews to date have examined the efficacy of biofortification interventions on health outcomes. We conducted a systematic review of the efficacy of iron-biofortified staple crops on iron status and functional outcomes: cognitive function (e.g. attention, memory) and physical performance. Five studies from three randomised efficacy trials (i.e. rice, pearl millet, beans) conducted in the Philippines, India and Rwanda were identified for inclusion in this review. Iron status (Hb, serum ferritin, soluble transferrin receptor, total body iron, α-1-acid glycoprotein) was measured at baseline and endline in each trial; two studies reported cognitive outcomes, and no studies reported other functional outcomes. Meta-analyses were conducted using DerSimonian and Laird random-effects methods. Iron-biofortified crop interventions significantly improved cognitive performance in attention and memory domains, compared with conventional crops. There were no significant effects on categorical outcomes such as iron deficiency or anaemia. Further studies are needed to determine the efficacy of iron-biofortified staple crops on human health, including additional functional outcomes and other high-risk populations.

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The prevalence of anemia and iron deficiency among pregnant Ghanaian women, a longitudinal study

PLoS ONE ◽

10.1371/journal.pone.0248754 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248754

Author(s):

Ruth A. Pobee ◽

Jacob Setorglo ◽

Moses Klevor ◽

Laura E. Murray-Kolb

Keyword(s):

Iron Deficiency ◽

Repeated Measures ◽

Iron Status ◽

Transferrin Saturation ◽

Significant Proportion ◽

Public Health Problem ◽

Deficiency Anemia ◽

Major Public Health Problem ◽

Ghanaian Women ◽

Prevalence Of Anemia

Background Gestational iron deficiency (ID) can be deleterious to mother and fetus. However, iron status is not routinely measured during pregnancy in Ghana. Therefore, the scope of ID in this population is unknown. Objective To determine the prevalence of anemia and ID across pregnancy in the Central Region of Ghana. Methods Women were recruited during their 1st trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2nd (n = 71) and 3rd (n = 71) trimesters. Data on socio-demographic variables, weekly intake of iron-rich foods and vitamin C-rich fruits were collected. Blood samples were drawn and the concentrations of hemoglobin (Hb), ferritin (Ft), serum iron (sFe), total iron binding capacity (TIBC), were measured; transferrin saturation (TSAT) was calculated. Repeated measures ANOVA was used to determine change in anemia and iron variables over time with groups categorized by 1st trimester iron status. Results Participants were 27.1 ± 5.2 years, on average. Prevalence of anemia (Hb <11.0 g/dL) was 37%, 63%, 58%; ID (Ft <15 μg/L) was 16%, 20%, 38%; and iron deficiency anemia (IDA; based on low Ft and Hb) was 6%, 12%, 25% in 1st, 2nd and 3rd trimesters, respectively. Significant changes in Hb, Ft and TIBC occurred across time. Iron status at 1st trimester had a significant effect on 2nd but not 3rd trimester iron status. Conclusions ID is prevalent in pregnant Ghanaian women, especially during the 3rd trimester. Anemia is a major public health problem during pregnancy in Ghana with a significant proportion due to factors other than ID.

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Efficacy of Multiple Micronutrients Fortified Milk Consumption on Iron Nutritional Status in Moroccan Schoolchildren

Journal of Nutrition and Metabolism ◽

10.1155/2015/690954 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Imane El Menchawy ◽

Asmaa El Hamdouchi ◽

Khalid El Kari ◽

Naima Saeid ◽

Fatima Ezzahra Zahrou ◽

...

Keyword(s):

Clinical Trial ◽

Iron Deficiency ◽

Iron Status ◽

Public Health Problem ◽

Iron Sulfate ◽

Deficiency Anemia ◽

Major Public Health Problem ◽

Rural Region ◽

Uht Milk ◽

Fortified Milk

Iron deficiency constitutes a major public health problem in Morocco, mainly among women and children. The aim of our paper is to assess the efficacy of consumption of multiple micronutrients (MMN) fortified milk on iron status of Moroccan schoolchildren living in rural region. Children (N=195), aged 7 to 9 y, were recruited from schools and divided into two groups: the nonfortified group (NFG) received daily a nonfortified Ultra-High-Temperature (UHT) milk and the fortified group received (FG) daily UHT milk fortified with multiple micronutrients including iron sulfate. Blood samples were collected at baseline (T0) and after 9 months (T9). Hemoglobin (Hb) was measuredin situby Hemocue device; ferritin and C Reactive Protein were assessed in serum using ELISA and nephelometry techniques, respectively. Results were considered significant when thepvalue was <0.05. At T9 FG showed a reduction of iron deficiency from 50.9% to 37.2% (p=0.037). Despite the low prevalence of iron deficiency anemia (1.9%); more than 50% of children in our sample suffered from iron deficiency at baseline. The consumption of fortified milk reduced the prevalence of iron deficiency by 27% in schoolchildren living in high altitude rural region of Morocco.Clinical Trial Registration.Our study is registered in the Pan African Clinical Trial Registry with the identification numberPACTR201410000896410.

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Consumption of a Double-Fortified Salt Affects Perceptual, Attentional, and Mnemonic Functioning in Women in a Randomized Controlled Trial in India

Journal of Nutrition ◽

10.3945/jn.117.251587 ◽

2017 ◽

Vol 147 (12) ◽

pp. 2297-2308 ◽

Cited By ~ 6

Author(s):

Michael J Wenger ◽

Laura E Murray-Kolb ◽

Julie EH Nevins ◽

Sudha Venkatramanan ◽

Gregory A Reinhart ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Status ◽

Controlled Trial ◽

Reproductive Age ◽

Deficiency Anemia ◽

Control Group ◽

Attention And Memory ◽

Double Blind ◽

Iron Deficient ◽

Mnemonic Function

Abstract Background: Iron deficiency and iron deficiency anemia have been shown to have negative effects on aspects of perception, attention, and memory. Objective: The purpose of this investigation was to assess the extent to which increases in dietary iron consumption are related to improvements in behavioral measures of perceptual, attentional, and mnemonic function. Methods: Women were selected from a randomized, double-blind, controlled food-fortification trial involving ad libitum consumption of either a double-fortified salt (DFS) containing 47 mg potassium iodate/kg and 3.3 mg microencapsulated ferrous fumarate/g (1.1 mg elemental Fe/g) or a control iodized salt. Participants' blood iron status (primary outcomes) and cognitive functioning (secondary outcomes) were assessed at baseline and after 10 mo at endline. The study was performed on a tea plantation in the Darjeeling district of India. Participants (n = 126; 66% iron deficient and 49% anemic at baseline) were otherwise healthy women of reproductive age, 18–55 y. Results: Significant improvements were documented for iron status and for perceptual, attentional, and mnemonic function in the DFS group (percentage of variance accounted for: 16.5%) compared with the control group. In addition, the amount of change in perceptual and cognitive performance was significantly (P < 0.05) related to the amount of change in blood iron markers (mean percentage of variance accounted for: 16.0%) and baseline concentrations of blood iron markers (mean percentage of variance accounted for: 25.0%). Overall, there was evidence that the strongest effects of change in iron status were obtained for perceptual and low-level attentional function. Conclusion: DFS produced measurable and significant improvements in the perceptual, attentional, and mnemonic performance of Indian female tea pickers of reproductive age. This trial was registered at clinicaltrials.gov as NCT01032005.

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Development of a Healthy Eating and Lifestyle Program (HELP) Online Website for Filipinos: A Case Report

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2019.1694 ◽

2019 ◽

Author(s):

Noelle Lyn Santos

Keyword(s):

Case Report ◽

Nutrition Education ◽

User Satisfaction ◽

Scientific Information ◽

Public Health Problem ◽

The Philippines ◽

Nutrition Information ◽

Major Public Health Problem ◽

The Public ◽

Nutrition Research

Background and Purpose: Non-communicable diseases (NCDs) are a major public health problem in the Philippines and around the world. Preventive measures to reduce its continuous rise require improvement in the health system. Utilization of information and communication technology-(ICT)-based tools will allow dissemination of evidenced-based information in the population. This case report contains the description of the development process of a Web-based nutrition Website. Case Description: ICT-based tools were explored as means of communicating nutrition information to the public because of the increasing access and usage of the Internet among Filipinos. An iterative process with five major phases were followed in the development. Outcome: The Website HELP Online can be accessed through (http://i.fnri.dost.gov.ph/helponline). There is integration of two modules: one for the general public and the other for registered nutritionist dietitians (RND) of the Food and Nutrition Research Institute (FNRI). The first module contained the nutrition counseling platform that connects and records all interactions of online and walk-in clients with their RNDs. The second module contained nutrition calculators, a health tracker, and nutrition education materials. Discussion: The developed HELP Online Website was used for online users to easily access nutrition information and services offered by Department of Science and Technology (DOST)-FNRI. The user-centered design focus in combination with a responsive Web platform resulted in improved user satisfaction. In terms of content, use of the current and accepted scientific information translated to simpler and easier messages were found to be more effective among the target group. Although many issues exist with the continuous use of ICT-based tools, the main purpose is to improve the delivery of evidence-based information to the public.

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Iron Amino Acid Chelates

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.74.6.435 ◽

2004 ◽

Vol 74 (6) ◽

pp. 435-443 ◽

Cited By ~ 29

Author(s):

Hertrampf ◽

Olivares

Keyword(s):

Amino Acid ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Ferrous Sulfate ◽

Iron Absorption ◽

Iron Status ◽

Deficiency Anemia ◽

Efficacy Trials ◽

Food Matrices ◽

The Cost

Iron amino acid chelates, such as iron glycinate chelates, have been developed to be used as food fortificants and therapeutic agents in the prevention and treatment of iron deficiency anemia. Ferrous bis-glycine chelate (FeBC), ferric tris-glycine chelate, ferric glycinate, and ferrous bis-glycinate hydrochloride are available commercially. FeBC is the most studied and used form. Iron absorption from FeBC is affected by enhancers and inhibitors of iron absorption, but to a lesser extent than ferrous sulfate. Its absorption is regulated by iron stores. FeBC is better absorbed from milk, wheat, whole maize flour, and precooked corn flour than is ferrous sulfate. Supplementation trials have demonstrated that FeBC is efficacious in treating iron deficiency anemia. Consumption of FeBC-fortified liquid milk, dairy products, wheat rolls, and multi-nutrient beverages is associated with an improvement of iron status. The main limitations to the widespread use of FeBC in national fortification programs are the cost and the potential for promoting organoleptic changes in some food matrices. Additional research is required to establish the bioavailability of FeBC in different food matrices. Other amino acid chelates should also be evaluated. Finally there is an urgent need for more rigorous efficacy trials designed to define the relative merits of amino acid chelates when compared with bioavailable iron salts such as ferrous sulfate and ferrous fumarate and to determine appropriate fortification levels

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Spectroscopic Evaluation of Red Blood Cells of Thalassemia Patients with Confocal Microscopy: A Pilot Study

Sensors ◽

10.3390/s20144039 ◽

2020 ◽

Vol 20 (14) ◽

pp. 4039

Author(s):

Laura Rey-Barroso ◽

Mónica Roldán ◽

Francisco J. Burgos-Fernández ◽

Susanna Gassiot ◽

Anna Ruiz Llobet ◽

...

Keyword(s):

Iron Deficiency ◽

Confocal Microscopy ◽

Red Blood Cells ◽

Blood Cells ◽

Pediatric Patients ◽

Single Gene ◽

Public Health Problem ◽

Major Public Health Problem ◽

Globin Genes ◽

Molecular Tests

Hemoglobinopathies represent the most common single-gene defects in the world and pose a major public health problem, particularly in tropical countries, where they occur with high frequency. Diagnosing hemoglobinopathies can sometimes be difficult due to the coexistence of different causes of anemia, such as thalassemia and iron deficiency, and blood transfusions, among other factors, and requires expensive and complex molecular tests. This work explores the possibility of using spectral confocal microscopy as a diagnostic tool for thalassemia in pediatric patients, a disease caused by mutations in the globin genes that result in changes of the globin chains that form hemoglobin—in pediatric patients. Red blood cells (RBCs) from patients with different syndromes of alpha-thalassemia and iron deficiency (including anemia) as well as healthy (control) subjects were analyzed under a Leica TCS SP8 confocal microscope following different image acquisition protocols. We found that diseased RBCs exhibited autofluorescence when excited at 405 nm and their emission was collected in the spectral range from 425 nm to 790 nm. Three experimental descriptors calculated from the mean emission intensities at 502 nm, 579 nm, 628 nm, and 649 nm allowed us to discriminate between diseased and healthy cells. According to the results obtained, spectral confocal microscopy could serve as a tool in the diagnosis of thalassemia.

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Zinc Deficiency Is Associated with Anemia Among Children Under 24 Months-of-age in Rural Guatemala (P10-111-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-111-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Ana Palacios ◽

Kristen Hurley ◽

Silvia De Ponce ◽

Victor Alfonso ◽

Nicholas Tilton ◽

...

Keyword(s):

Iron Deficiency ◽

Vitamin B12 ◽

Maternal Education ◽

Controlled Trial ◽

Venous Blood ◽

Public Health Problem ◽

York Academy ◽

Major Public Health Problem ◽

Micronutrient Deficiencies ◽

Cross Sectional

Abstract Objectives Anemia is a major public health problem among young children. In addition to iron deficiency, other micronutrient deficiencies have been associated with anemia. The purpose of this study was to identify biomarkers associated with anemia in children <5 years from rural Guatemala. Methods A total of 182 infants (6–24 m) and 207 preschoolers (36–60 m) were recruited from community surveillance to participate in a randomized controlled trial of nutrition and child development. Methods included measured weight, length/height and venous blood draws. Inclusion criteria were length/height-for-age z-score <-1.0 and Hb >7.0 g/dL. Cross-sectional analyses using generalized linear mixed models of baseline data examined associations between anemia (Hb <11.0 g/dL) and micronutrient deficiencies, adjusting for maternal, child and sociodemographic variables. Iron deficiency was defined as low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L. Deficiencies for other parameters were designated as: zinc <65 µg/dL; vitamin B12 < 200 pg/mL; and plasma folate <3 ng/mL or erythrocyte folate <100 ng/mL. Results Prevalence of anemia was 56% in infants and 12% in preschoolers. Among anemic infants/preschoolers, rates of iron, zinc, folate and vitamin B12 deficiencies were 83/75%; 63/18%; 3/4%; and 9/0%, respectively. For infants, the odds of anemia were higher when children were zinc deficient [OR = 3.59;95%CI (1.64–7.85)], after adjusting for community cluster, sex, age, maternal education and household size. No biomarkers were associated with anemia in preschoolers. Conclusions Iron and zinc are common micronutrient deficiencies in children from low- and middle-income countries. These findings suggest that micronutrient deficiencies coexist among children in Guatemala, and that zinc should be considered as part of the prevention strategies to reduce anemia. In preschoolers, no biomarkers were associated with anemia, suggesting that other biological and psychosocial factors could be influencing anemia in this age group. Funding Sources The Mathile Institute for the Advancement of Human Nutrition, Sackler Institute for Nutrition Science of the New York Academy of Sciences.

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Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

ISRN Public Health ◽

10.5402/2012/765476 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 14

Author(s):

Anu Rammohan ◽

Niyi Awofeso ◽

Marie-Claire Robitaille

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Large Scale ◽

Public Health Problem ◽

Cost Effective ◽

Vegetarian Diet ◽

Major Public Health Problem ◽

Daily Consumption ◽

Indian Women ◽

Deficiency Anaemia

Objectives. We examined the influence of vegetarian diet on the risk of developing anaemia among Indian women and suggest initiatives for addressing diet-related iron-deficiency anaemia. Methods. We analysed data on diet, social class, and haemoglobin levels from the nationally representative Indian National Family and Health Survey 2005/06 for a sample of 81,301 women aged 15–49 years using logistic regression models. Results. After controlling for individual-level factors and household level socioeconomic characteristics, daily consumption of meat, fish, and eggs was associated with lower odds of being moderately or severely anaemic. Our analysis also revealed that economic characteristics such as being from higher wealth quintiles, being in paid employment, and rural residence reduced the odds of having iron-deficiency anaemia among Indian women. Discussion. As a large proportion of Indians subsist on iron-poor vegetarian diets for religious, economic, and cultural reasons, large-scale iron supplementation and fortification of commonly consumed vegetarian foodstuffs constitute a feasible, culturally appropriate, and cost-effective strategy for addressing this major public health problem. Consumption of cheap iron-rich foodstuffs should be promoted. Effective poverty alleviation and hookworm prevention programs are also important. Large-scale cohort and intervention studies are urgently required to further define the influence of vegetarianism on iron deficiency anaemia in India.

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A Life Course Approach to the Prevention of Iron Deficiency Anemia in Indonesia

Nutrients ◽

10.3390/nu14020277 ◽

2022 ◽

Vol 14 (2) ◽

pp. 277

Author(s):

Ali Sungkar ◽

Saptawati Bardosono ◽

Rima Irwinda ◽

Nurul R. M. Manikam ◽

Rini Sekartini ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Life Stage ◽

Public Health Problem ◽

Nutritional Intervention ◽

Deficiency Anemia ◽

Clinical Psychologist ◽

Major Public Health Problem ◽

Nutritional Interventions ◽

Long Term Impact

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable worldwide.

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Urinary schistosomiasis and iron deficiency anemia among Malian school children

African Journal of Food, Agriculture, Nutrition and Development ◽

10.18697/ajfand.30.3785 ◽

2009 ◽

Vol 9 (30) ◽

pp. 1845-1858

Author(s):

Mohamed Ayoya ◽

◽

KM Koné ◽

AK Traoré ◽

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

School Children ◽

Schistosoma Haematobium ◽

Public Health Problem ◽

Capital City ◽

Deficiency Anemia ◽

Sample Population ◽

Major Public Health Problem ◽

Urinary Schistosomiasis

Anemia continues to be a major public health problem in many countries. The prevalence and intensity of urinary schistosomiasis, which contributes to anemia, often peak at school age adding to that age group’s nutrition and disease burdens. However, unlike malaria and hookworm infections, little is known on the role of urinary schistosomiasis in iron deficiency anemia. The objective of this study was to assess the prevalence of iron deficiency anemia and the effect of iron supplementation on hemoglobin (Hb) and serum ferritin (SF) levels among school children infected with Schistosoma haematobium in Bamako, the capital city of Mali. A total of 150 anemic school children between 7 and 12 years were randomly assigned to receive either 40mg/kg of praziquantel or 40mg/kg of praziquantel (P) + daily 66 mg of iron (Fe), five days a week for three months. Hb and SF were measured at baseline and at 6 and 12 weeks of the intervention. Only children who had complete Hb and SF data at each stage of the trial were included in the statistical analyses (n = 74 in the P+Fe group; n = 66 in the P group). At baseline, mean Hb (g/dl) was 10.53±0.93 in the P group and 10.47±1.17 in the Fe+P group; mean SF (µg/l) was 34.39±37.58 in the P group and 29.82±23.34 in the Fe+P group, and the prevalence of iron deficiency was 17.2%. At 6 and 12 weeks of the intervention, there was an important reduction in anemia and in iron deficiency in both treatment groups. Mean Hb (g/dl) was higher in the Fe+P group (11.63±0.88 and 11.55±0.94) than in the P group (11.14±0.98 and 10.84±0.86) at 6 and 12 weeks, respectively. Mean SF (µg/l) was also higher in the P+Fe group (74.26±40 and 100.29±53.92) than in the P group(40.65±35.63 and 40.70±29.57) at 6 and 12 weeks, respectively. In these Schistosoma haematobium infected children, iron deficiency was prevalent and treatments with P alone or in combination with Fe supplementation were able to increase hemoglobin and iron stores. Neither P nor P+Fe by alone completely reversed anemia in this sample population.

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