Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Efficacy of Iron-Fortified Ultra Rice in Improving the Iron Status of Women in Mexico Effect of Daily versus Once-Weekly Home Fortification with Micronutrient Sprinkles on Hemoglobin and Iron Status among Young Children in Rural Bangladesh Dual fortification of salt with iodine and micronized ferric pyrophosphate: a randomized, double-blind, controlled trial. Iron fortification of domestic drinking water to prevent anemia among low socioeconomic families in Brazil. Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. The use of NaFeEDTA-fortified fish sauce is an effective tool for controlling iron deficiency in women of childbearing age in rural Vietnam. Maize porridge enriched with a micronutrient powder containing low-dose iron as NaFeEDTA but not amaranth grain flour reduces anemia and iron deficiency in Kenyan preschool children. Dual fortification of salt with iodine and microencapsulated iron: a randomized, double-blind, controlled trial in Moroccan schoolchildren. 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. A comparative intervention trial on fish sauce fortified with NaFe-EDTA and FeSO4+citrate in iron deficiency anemic school children in Kampot, Cambodia. Studies of the elderly in Boston. I. The effects of iron fortification on moderately anemic peole. Iron-fortified bread. A long-term controlled therapeutic community-based experiment with ferrous sulphate-enriched flour. Effect of iron fortification of nursery complementary food on iron status of infants in the DPRKorea. Oxidative Stress among Non-Anemic Adults following Flour Fortification with Iron: Baseline Data 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. Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women. Characterization and Differentiation of Iron Status in Anemic Very Low Birth Weight Infants Using a Diagnostic Nomogram A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. Domestic Drinking Water—An Effective Way to Prevent Anemia among Low Socioeconomic Families in Brazil Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. NaFeEDTA fortified soy sauce showed higher iron absorption rate in Chinese females. Effect of Consuming Zinc-fortified Bread on Serum Zinc and Iron Status of Zinc-deficient Women: A Double Blind, Randomized Clinical Trial Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Repleting hemoglobin in iron deficiency anemia in young children through liquid milk fortification with bioavailable iron amino acid chelate. Prevention of iron-deficiency anemia: comparison of high- and low-iron formulas in term healthy infants after six months of life. Fortification of curry powder with NaFe(111)EDTA in an iron-deficient population: report of a controlled iron-fortification trial. The effects of short-term oral iron therapy on developmental deficits in iron-deficient anemic infants. Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial Triple fortification of salt with microcapsules of iodine, iron, and vitamin A. Iron Fortification Reduces Blood Lead Levels in Children in Bangalore, India Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: a double-blind randomized controlled trial. Use of iron-fortified rice reduces anemia in infants. Anemia reduction in preschool children with the addition of low doses of iron to school meals. Multi-micronutrient-fortified biscuits decreased prevalence of anemia and improved micronutrient status and effectiveness of deworming in rural Vietnamese school children. Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India. Whole cowpea meal fortified with NaFeEDTA reduces iron deficiency among Ghanaian school children in a malaria endemic area. Fortification of sugar with iron sodium ethylenediaminotetraacetate (FeNaEDTA) improves iron status in semirural Guatemalan populations. Micronutrient Fortified Milk Improves Iron Status, Anemia and Growth among Children 1–4 Years: A Double Masked, Randomized, Controlled Trial Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. Effect of iron fortification on malaria incidence in infants and young children in Ghana: a randomized trial. Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial A randomized trial investigating an iron-rich bread as a prophylaxis against iron deficiency in pregnancy The use of iron-fortified wheat flour to reduce anemia among the estate population in Sri Lanka. 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 Comparison of response between food supplemented with powdered iron and iron in syrup form for iron deficiency anemia. 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. [Effect of iron supplementation on iron deficiency anemia of childbearing age women in Shanghai]. Helicobacter pylori infection does not influence the efficacy of iron and vitamin B12 fortification in marginally nourished Indian children The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren. A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. 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 Double Fortified Salt Intervention Improved Iron Intake But Not Energy and Other Nutrient Intakes in Female Tea Plantation Workers From West Bengal, India [Effect of biscuits fortified with haem iron on the intellectual status of pre-school children]. Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children. Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren Iron supplementation of breastfed infants from an early age. [Prevalence of iron deficiency in healthy 12-month-old infants]. Daily Use of Sprinkles Micronutrient Powder for 2 Months Reduces Anemia among Children 6 to 36 Months of Age in the Kyrgyz Republic: A Cluster-Randomized Trial Fortified juice drink improved iron and zinc status of schoolchildren. Addition of microencapsulated iron to iodized salt improves the efficacy of iodine in goitrous, iron-deficient children: a randomized, double-blind, controlled trial. Sirolimus Interferes with Iron Homeostasis in Renal Transplant Recipients Iron deficiency anemia and the productivity of adult males in Indonesia. Iron deficiency anemia and iron therapy effects on infant developmental test performance. The effects of iron fortification on the gut microbiota in African children: a randomized controlled trial in Cote d'Ivoire. Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women. Relationship between iron deficiency and anemia in children younger than 4 years. Impact of micronutrient fortification of yoghurt on micronutrient status markers and growth – a randomized double blind controlled trial among school children in Bangladesh Low dose 'Sprinkles'-- an innovative approach to treat iron deficiency anemia in infants and young children. Complementary foods fortified with micronutrients prevent iron deficiency and anemia in Vietnamese infants. Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. Controlled, household-randomized, open-label trial of the effect of treatment of Helicobacter pylori infection on iron deficiency among children in rural Alaska: results at 40 months. Daily multivitamins with iron to prevent anemia in high-risk infants: a randomized clinical trial. Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial Treatment of iron-deficiency anemia in patients with subclinical hypothyroidism. The use of sweet rolls fortified with iron bis-glycinate chelate in the prevention of iron deficiency anemia in preschool children. Food-based strategies improve iron status in toddlers: a randomized controlled trial12. Elimination of Iron Deficiency Anemia and Soil Transmitted Helminth Infection: Evidence from a Fifty-four Month Iron-Folic Acid and De-worming Program Micronutrient Fortification to Improve Growth and Health of Maternally HIV-Unexposed and Exposed Zambian Infants: A Randomised Controlled Trial Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial. Efficacy of different iron fortificants in wheat flour in controlling iron deficiency. Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand. Improving iron absorption from a Peruvian school breakfast meal by adding ascorbic acid or Na2EDTA. Improvement in iron deficiency anemia through therapy with ferric ammonium citrate and vitamin C and the effects of aerobic exercise. Randomized placebo-controlled trial of Helicobacter pylori eradication for iron-deficiency anemia in preadolescent children and adolescents. Effect of anti-Helicobacter pylori therapy on outcome of iron-deficiency anemia: a randomized, controlled study. Iron treatment normalizes cognitive functioning in young women. Persistence of goiter despite oral iodine supplementation in goitrous children with iron deficiency anemia in Côte d'Ivoire. Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. [Effect of weekly rice fortification with iron on anemia prevalence and hemoglobin concentration among children attending public daycare centers in Rio de Janeiro, Brazil]. Supplementation with iron and riboflavin enhances dark adaptation response to vitamin A-fortified rice in iron-deficient, pregnant, nightblind Nepali women. Efficacy of iron-fortified whole maize flour on iron status of schoolchildren in Kenya: a randomised controlled trial Comparison trial of iron succinylprotein complex or iron gluconate complex in the treatment of iron deficiency anemia. Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial Effectiveness of Intermittent Iron Treatment of Two- to Six-Year-Old Jordanian Children with Iron-Deficiency Anemia Iron-deficiency anemia and infant development: effects of extended oral iron therapy. The impact of systematic dietary counseling during the first year of life on prevalence rates of anemia and iron deficiency at 12-16 months. Dynamics of anemia in relation to parasitic infections, micronutrient status, and increasing age in South-Central Côte d'Ivoire. Randomized Controlled Trial of Iron-Fortified Drinking Water in Preschool Children Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial Anemia, Iron Deficiency and Iodine Deficiency among Nepalese School Children Prevention of iron deficiency by milk fortification. II. A field trial with a full-fat acidified milk. Comparison of a Combination Ferrous Fumarate Product and a Polysaccharide Iron complex as Oral Treatments of Iron Deficiency Anemia: A Taiwanese Study Iron deficiency anemia: adverse effects on infant psychomotor development. TREATMENT OF ANEMIA AND IMPROVEMENT OF QUALITY OF LIFE AMONG PATIENTS WITH CROHN'S DISEASE: experience using ferric carboxymaltose. Combined iron and zinc supplementation in infants improved iron and zinc status, but interactions reduced efficacy in a multicountry trial in southeast Asia. Iron Absorption from Iron-Enriched Aspergillus oryzae Is Similar to Ferrous Sulfate in Healthy Female Subjects A controlled, household-randomized, open-label trial of the effect that treatment of Helicobacter pylori infection has on iron deficiency in children in rural Alaska. Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. Daily Multivitamins with Iron to Prevent Anemia in Infancy: A Randomized Clinical Trial Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico.
Although iron deficiency is the most common single-nutrient deficiency in infants and children , other deficiencies may develop concurrently , including zinc deficiency . In previous studies , we used home-fortification with " Sprinkles , " single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods , to successfully treat anemia . This mode of micronutrient delivery is amenable to the delivery of other micronutrients . However , the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions . Thus , we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants , compared with Sprinkles formulated with iron alone . We studied 304 anemic infants ( mean age 10.3 + /- 2.5 mo ; hemoglobin 87.4 + /- 8.4 g/L ) in rural Ghana . A combined supplementation group ( FeZn ) received daily Sprinkles containing 80 mg iron and 10 mg zinc ; a comparison group ( Fe ) received Sprinkles ( 80 mg iron ) without zinc for 2 mo . The rate of recovery from anemia was higher in the Fe group compared with the FeZn group ( 74.8 vs. 62.9 % ; P = 0.048 ) . The plasma zinc concentration decreased significantly in both groups ( P < 0.05 ) . A significant decline in the height for age Z-score was observed in the FeZn group ( P = 0.0011 ) , but there was no change in the Fe group . These results suggest that in a controlled setting , home-fortification using micronutrient Sprinkles with iron , or iron and zinc , was very successful in treating anemia ; however , this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population 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 Background The effectiveness of commonly suggested public health interventions to control  childhood iron- deficiency anemia  has been low . Objective To determine whether iron provided in Sprinkles daily or in a higher dose once weekly affected hemoglobin , serum ferritin levels , and serum transferrin receptor levels , and to determine whether there were dif- ferences in the effects of the two regimens . Methods In this cluster-r and omized , community- based trial conducted in rural areas of Bangladesh , 136 children aged 12 to 24 months with mild to moderate anemia ( hemoglobin 70–109 g/L ) were r and omly allo- cated to receive Sprinkles daily ( 12.5 mg of elemental iron , n = 79 ) or once weekly ( 30 mg of elemental iron , n = 73 ) for 8 weeks . Hemoglobin , serum ferritin , and serum transferrin receptor were assessed at the start and end of the intervention . Results In both groups , there were significant increases in hemoglobin and serum ferritin and a significant decrease in serum transferrin receptor ( p < .01 ) . There were no significant differences between the groups in the increases in hemoglobin ( 16.1 ± 13.2 g/L for the group receiving Sprinkles daily and 12.3 ± 13.3 g/L for the group receiving Sprinkles once weekly ) and serum ferritin ( 10.6 and 5.7 μg/L , respectively ) . The decrease in serum transferrin receptor also did not significantly differ between the groups ( median , −2.5 and −1 . 8 mg/L , respectively ) . The prevalence rates of iron-deficiency anemia , depleted iron stores , and tissue iron deficiency decreased significantly within each group ( p < .01 ) , with no significant differences between the groups . Conclusions Home fortification of complementary foods with Sprinkles given either daily or once weekly improved iron-deficiency anemia and iron status among young children 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 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 Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia 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 Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder ( MNP ) containing low doses of highly bioavailable iron to control iron deficiency anemia ( IDA ) in children . We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children . In a 16-wk intervention trial , children ( n = 279 ; 12 - 59 mo ) were r and omly assigned to : unrefined maize porridge ( control ; 4.1 mg of iron/meal ; phytate : iron molar ratio 5:1 ) ; unrefined maize ( 30 % ) and amaranth grain ( 70 % ) porridge ( amaranth group ; 23 mg of iron/meal ; phytate : iron molar ratio 3:1 ) ; or unrefined maize porridge with MNP ( MNP group ; 6.6 mg iron/meal ; phytate : iron molar ratio 2.6:1 ; 2.5 mg iron as NaFeEDTA ) . Primary outcomes were anemia and iron status with treatment effects estimated relative to control . At baseline , 38 % were anemic and 30 % iron deficient . Consumption of MNP reduced the prevalence of anemia [ -46 % ( 95 % CI : -67 , -12 ) ] , iron deficiency [ -70 % ( 95 % CI : -89 , -16 ) ] , and IDA [ -75 % ( 95 % CI : -92 , -20 ) ] . The soluble transferrin receptor [ -10 % ( 95 % CI : -16 , -4 ) ] concentration was lower , whereas the hemoglobin ( Hb ) [ 2.7 g/L ( 95 % CI : 0.4 , 5.1 ) ] and plasma ferritin [ 40 % ( 95 % CI : 10 , 95 ) ] concentrations increased in the MNP group . There was no significant change in Hb or iron status in the amaranth group . Consumption of maize porridge fortified with low-dose , highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children . In contrast , fortification with amaranth grain did not improve iron status despite a large increase in iron intake , likely due to high ratio of phytic acid : iron in the meal 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 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 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 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 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 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 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 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 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 : In the early weeks of life , very low birth weight ( VLBW ) infants experience intense laboratory blood sampling leading to clinical ly significant anemia and the need for red blood cell transfusion . Although controversial , treatment with recombinant human erythropoietin ( EPO ) and iron has been recommended to stimulate erythropoiesis ; optimal dosing of EPO and iron is still uncertain . Objectives : To assess the validity of a four-quadrant diagnostic plot of iron availability ( ferritin index ) versus iron dem and for erythropoiesis ( reticulocyte hemoglobin content , CHr ) for differentiating iron status in anemic VLBW infants . Methods : Study subjects were enrolled in a previously reported r and omized controlled trial of clinical ly stable VLBW infants < 31 weeks ’ gestation and < 1,300 g at birth to receive 18 days of treatment with : group 1 : oral iron ; group 2 : EPO + oral iron , and group 3 : EPO + intravenous + oral iron . Results : At the end of treatment the ferritin index was significantly higher in both EPO groups compared to the control group . By day 18 , CHr of the control group declined into the quadrant of the diagnostic plot characteristic of functional iron deficiency and anemia of chronic disease . Both EPO groups ended in the quadrants that are characteristic for latent iron deficiency and iron deficiency anemia , respectively . Conclusions : The diagnostic plot for differentiating anemia in VLBW infants may be an informative , clinical ly useful tool for iron status assessment under different physiologic and therapeutic erythropoietic states . Larger additional studies in difficult patient population s are needed before the clinical utility of this diagnostic procedure can be unequivocally confirmed Micronutrient-fortified , cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries , but their nutritional quality is not always optimal . In a double-blind r and omized trial , we compared the efficacy of a locally produced porridge based on maize , beans , bambaranuts , and groundnuts fortified with 19 ( rich ) or 9 ( basal ) micronutrients .  Infants aged 6 mo from Lusaka , Zambia were r and omized to receive the richly fortified ( n = 373 ) or basal ( n = 370 ) porridge daily for 12 mo along with routine vitamin A supplements .  Baseline and final micronutrient status and inflammation ( based on α-1-glycoprotein ) were assessed using nonfasting blood sample s. Baseline prevalence of anemia ( 39 % ) and zinc deficiency ( 51 % ) were a public health concern . There were overall treatment effects on hemoglobin ( Hb ) ( P = 0.001 ) , serum transferrin receptor ( P < 0.001 ) , serum ferritin ( P < 0.001 ) , and serum selenium ( P = 0.009 ) ; biomarker responses for iron and zinc were modified by baseline concentrations , and for Hb and iron by socioeconomic status . At 18 mo , the adjusted odds of anemia , iron deficiency anemia ( Hb < 105 g/L and transferrin receptor > 11.0 mg/L ) , and iron deficiency were 0.37 ( 95 % CI = 0.25 , 0.55 ) , 0.18 ( 0.09 , 0.35 ) , and 0.30 ( 0.18 , 0.50 ) times those in the basal group , respectively . The rich level of fortification had no overall treatment effect on serum zinc ( 1.09 ; 0.66 , 1.80 ) but improved serum zinc in children with lower Hb concentrations at baseline ( P = 0.024 ) . A locally produced cereal- and legume-based infant food richly fortified with micronutrients  reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian 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 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 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 After iron deficiency , zinc deficiency is the major micronutrient deficiency in developing countries , and staple food fortification is an effective strategy to prevent and improve it among at-risk- population s. No action has been taken to reduce zinc deficiency via flour fortification so far in Iran , and little is known about the influence of zinc fortification of flour on serum zinc and the iron status , and also about the optimum and effective amount of zinc compound that is used in food fortification . The objective of this study is to evaluate the influence of consuming zinc-fortified breads on the zinc and iron status in the blood serum . In this study , three types of bread were prepared from non-fortified and fortified flours , with 50 and 100 ppm elemental zinc in the form of sulfate .  Eighty zinc-deficient women aged 19 to 49 years were r and omly assigned to three groups ; The volunteers received , daily , ( 1 ) a non-fortified bread , ( 2 ) a high-zinc bread , and ( 3 ) a low-zinc bread for one month .  Serum zinc and iron were measured by Atomic Absorption before and after the study . Results showed a significant increase in serum zinc and iron levels in all groups ( p < 0.001 ) except in the control ( p > 0.05 ) . Absorption of zinc and iron in the group that consumed high-zinc bread was significantly greater than that in the group that received low-zinc bread ( p < 0.01 ) . It was concluded that fortification of flour with 50–100 ppm zinc was an effective way to achieve adequate zinc intake and absorption in zinc-deficient people . It also appeared that consuming zinc-fortified bread improved iron absorption 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 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 ) 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 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 To assess the effects of iron therapy on developmental test scores in infants with iron deficiency anemia , 68 Guatemalan babies 6 to 24 months of age , with and without mild iron deficiency anemia , were tested with the Bayley Scales of Infant Development before and after one week of oral iron treatment . The two major findings of the study were developmental deficits in the anemic group prior to treatment , and lack of rapid improvement with short-term oral iron therapy . The mean pretreatment Mental Development Index of the anemic group was significantly lower than that of nonanemic infants . The anemic group 's pretreatment Psychomotor Development Index was also lower than that of the nonanemic control group . In a double-blind r and omized study , six to eight days of oral iron therapy did not reverse these deficits . Consequently , the deficits of the anemic group can not be unequivocably attributed to iron lack . However , no significant differences were found between anemic and nonanemic groups in birth histories , socioeconomic level , or general nutritional status which might otherwise explain the lower developmental test scores of the anemic babies Background Iron deficiency without anemia is related to adverse symptoms that can be relieved by supplementation . Since a blood donation can induce such an iron deficiency , we investigated the clinical impact of iron treatment after a blood donation . Methods One week after donation , we r and omly assigned 154 female donors with iron deficiency without anemia , aged below 50 years , to a four-week oral treatment of ferrous sulfate versus a placebo . The main outcome was the change in the level of fatigue before and after the intervention . Aerobic capacity , mood disorder , quality of life , compliance and adverse events were also evaluated . Hemoglobin and ferritin were used as biological markers . Results The effect of the treatment from baseline to four weeks of iron treatment was an increase in hemoglobin and ferritin levels to 5.2 g/L ( P < 0.01 ) and 14.8 ng/mL ( P < 0.01 ) , respectively . No significant clinical effect was observed for fatigue ( -0.15 points , 95 % confidence interval -0.9 points to 0.6 points , P = 0.697 ) or for other outcomes . Compliance and interruption for side effects was similar in both groups . Additionally , blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces . Conclusions These data are valuable as they enable us to conclude that donors with iron deficiency without anemia after a blood donation would not clinical ly benefit from iron supplementation . Trial Registration Clinical Trials.gov : BACKGROUND In many developing countries , children are at high risk of goiter , vitamin A deficiency , and iron deficiency anemia . OBJECTIVE We aim ed to develop a stable , efficacious salt fortified with iodine , iron , and vitamin A. DESIGN A novel spray-cooling technique was used with hydrogenated palm oil to package potassium io date , micronized ferric pyrophosphate , and retinyl palmitate into microcapsules ( mean particle size : 100 mum ) . We used the microcapsules to create triple-fortified salt ( TFS ) with 30 mug I , 2 mg Fe , and 60 mug vitamin A/g salt . After storage trials , we compared the efficacy of TFS with that of iodized salt in a 10-mo , r and omized , double-blind trial in goitrous schoolchildren ( n = 157 ) who had a high prevalence of vitamin A deficiency and iron deficiency anemia . RESULTS After storage for 6 mo , losses of iodine and vitamin A from the TFS were approximately 12 - 15 % , and color was stable . In the TFS group , mean hemoglobin increased by 15 g/L at 10 mo ( P < 0.01 ) , iron status indexes and body iron stores improved significantly ( P < 0.05 ) , and mean serum retinol , retinol-binding protein , and the ratio of retinol-binding protein to prealbumin increased significantly ( P < 0.01 ) . At 10 mo , prevalences of vitamin A deficiency and iron deficiency anemia were significantly lower in the TFS group than in the iodized salt group ( P < 0.001 ) . CONCLUSION Newly developed microcapsules containing iodine , iron , and vitamin A are highly stable when added to local African salt . TFS was efficacious in reducing the prevalence of iron , iodine , and vitamin A deficiencies in school-age children 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 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 Food fortification is advocated to tackle iron deficiency in anemic population s. Our objective was to evaluate the impact of iron-fortified rice ( Ultrarice ( ® ) ) weekly on hemoglobin and anemia levels compared with st and ard rice ( control ) . This cluster-r and omized study deals with infants ( 10 - 23 months ) from two public child day care centers in Brazil , n = 216 , in an 18 week intervention . The intervention group received individual portions of fortified rice ( 50 g ) provided 56.4 mg elemental/Fe . For intervention center : baseline mean hemoglobin was 11.44 ± 1.07 g/dl , and after intervention 11.67 ± 0.96 g/dl , p < 0.029 ; for control : baseline mean hemoglobin value was 11.35 ± 4.01 g/dl , and after intervention 11.36 ± 2.10 g/dl , p = 0.986 . Anemia prevalence for intervention center was 31.25 % at baseline , and 18.75 % at end of study , p = 0.045 ; for control 43.50 % were anemic at baseline , and 37.1 % at the end of study , p = 0.22 . Number Needed to Treat was 7 . Iron-fortified rice was effective in increasing hemoglobin levels and reducing anemia in infants BACKGROUND In developing countries there is high prevalence of iron deficiency anemia , which causes negative impact on growth , development and quality of life for infant population . Currently several strategies are being elaborated and tested to tackle this problem . OBJECTIVE To measure anemia prevalence in preschool children . To evaluate fortification effectiveness with 5 or 10 mg of elemental iron/daily added to school meals by increasing hemoglobin levels in anemic children . METHODS Double-blind , cluster r and omized intervention study with 728 students from public network . Blood count was taken at beginning of study , to evaluate anemia prevalence , those anemic were selected for intervention , after intervention new blood count was taken to evaluate fortification effectiveness . Ferrous Sulphate was added in individual dosage of 5 or 10 mg of elemental iron/daily to usual school meal . From 35 schools 3 were r and omized to receive 5 mg/daily ( group A ) and 3 to receive 10 mg/daily ( group B ) . Hemoglobin and hematocrit averages before and after intervention were compared in each group and between them . RESULTS In group A , the anemia prevalence reduced 34.9 to 12.4 % , and in group B 39.0 to 18.7 % . In both groups a significant increase in hemoglobin was observed : in group A from 10.1 to 11.5 g/dl ( p < 0.01 ) and in group B from 10.0 to 11.0 g/dl ( p < 0.01 ) . There was no statistically significant difference in final levels of hemoglobin among groups . CONCLUSIONS Both dosages of elemental iron were equally effective in increasing hemoglobin levels , and reducing anemia prevalence . Fortification of school meals was shown to be an effective , low cost and easy to manage intervention Concurrent micronutrient deficiencies are prevalent among Vietnamese school children . A school-based program providing food fortified with multiple micronutrients could be a cost-effective and sustainable strategy to improve health and cognitive function of  school children . However , the efficacy of such an intervention may be compromised by the high prevalence of parasitic infestation . To evaluate the efficacy of school-based intervention using multi-micronutrient-fortified biscuits with or without deworming on anemia and micronutrient status in Vietnamese schoolchildren , a r and omized , double-blind , placebo-controlled trial was conducted among 510 primary schoolchildren , aged 6 - 8 y , in rural Vietnam .  Albendazole ( Alb ) ( 400 mg ) or placebo was given at baseline . Nonfortified or multi-micronutrient-fortified biscuits including iron ( 6 mg ) , zinc ( 5.6 mg ) , iodine ( 35 microg ) , and vitamin A ( 300 microg retinol equivalents ) were given 5 d/wk for 4 mo . Multi-micronutrient fortification significantly improved the concentrations of hemoglobin ( + 1.87 g/L ; 95 % CI : 0.78 , 2.96 ) , plasma ferritin ( + 7.5 microg/L ; 95 % CI : 2.8 , 12.6 ) , body iron ( + 0.56 mg/kg body weight ; 95 % CI : 0.29 , 0.84 ) , plasma zinc ( + 0.61 micromol/L ; 95 % CI : 0.26 , 0.95 ) , plasma retinol ( + 0.041 micromol/L ; 95 % CI : 0.001 , 0.08 ) , and urinary iodine ( + 22.49 micromol/L ; 95 % CI : 7.68 , 37.31 ) . Fortification reduced the risk of anemia and deficiencies of zinc and iodine by > 40 % . Parasitic infestation did not affect fortification efficacy , whereas fortification significantly enhanced deworming efficacy , with the lowest reinfection rates in children receiving both micronutrients and Alb . Multi-micronutrient fortification of biscuits is an effective strategy to improve the micronutrient status of Vietnamese schoolchildren and enhances effectiveness of deworming Anemia and micronutrient deficiencies are common among Indian schoolchildren . We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India . In this placebo-controlled , cluster-r and omized study , 499 schoolchildren ( 6 - 10 y ) received either multiple micronutrients ( treatment group ) or placebo ( control group ) as part of school meals ( 6 d/wk ) for 8 mo . Both groups were dewormed at the beginning of the study . The micronutrient premix provided 10 mg iron , 375 microg vitamin A , 4.2 mg zinc , 225 microg folic acid , and 1.35 microg vitamin B-12 for each child per day ( approximately 75 % recommended dietary allowance ) . Blood sample s drawn before and after the intervention were analyzed for hemoglobin , ferritin , retinol , zinc , folate , and vitamin B-12 . Baseline prevalence of anemia ( 37 % ) , iron deficiency anemia ( 10 % ) , low serum ferritin ( 24 % ) , retinol ( 56 % ) , zinc ( 74 % ) , folate ( 68 % ) , and vitamin B-12 ( 17 % ) did not differ between groups . Postintervention , fewer in the treatment group had lower serum retinol [ odds ratio ( OR ) ( 95 % CI ) : 0.57 ( 0.33 - 0.97 ) ] and folate [ OR ( 95 % CI ) : 0.47 ( 0.26 - 0.84 ) ] than the control group . The serum vitamin B-12 concentration decreased in both groups , but the magnitude of change was less in the treatment than in the control group ( P < 0.05 ) . Total body iron ( TBI ) increased in both groups ; however , the change was greater in the treatment than in the control group ( P < 0.05 ) . Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A , folate , and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status Cowpeas , like other legumes , contain high amounts of native iron but are rich in phytic acid ( PA ) and polyphenols ( PP ) that inhibit iron absorption . NaFeEDTA may overcome the combined inhibitory effect of PA and PP . Our objective was to test the efficacy of NaFeEDTA-fortified cowpea meal in improving iron status of school children in a malaria endemic area . We conducted a double-blind , controlled trial with 5- to 12-y-old school children from 2 rural communities in northern Ghana ( n = 241 ) . Eligible children were r and omly assigned to 2 treatment groups to receive either cowpea meal fortified with 10 mg Fe/meal as NaFeEDTA , or an identical but nonfortified cowpea meal . Meals were provided 3 d/wk for a period of ~7 mo under strict supervision . Mass deworming and malaria antigenemia screening and treatment were carried out at baseline and 3.5 mo into the trial . Consumption of cowpea flour fortified with NaFeEDTA result ed in improvement of hemoglobin ( P < 0.05 ) , serum ferritin ( P < 0.001 ) , and body iron stores ( P < 0.001 ) and reduction of transferrin receptor ( P < 0.001 ) compared with nonfortified flour . Fortification result ed in a 30 and 47 % reduction in the prevalence of iron deficiency ( ID ) and iron deficiency anemia ( IDA ) ( P < 0.05 ) , respectively . The results indicate that fortification of cowpea flour with NaFeEDTA overcomes the combined inhibitory effect of PA and PP and , when used for targeted school-based fortification of cowpea flour , is effective in reducing the prevalence of ID and IDA among school children in malaria endemic rural northern Ghana 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 Background Multiple micronutrient deficiencies are highly prevalent among preschool children and often lead to anemia and growth faltering . Given the limited success of supplementation and health education programs , fortification of foods could be a viable and sustainable option . We report results from a community based double-masked , r and omized trial among children 1–4 years evaluating the effects of micronutrients ( especially of zinc and iron ) delivered through fortified milk on growth , anemia and iron status markers as part of a four group study design , running two studies simultaneously . Methods and Findings Enrolled children ( n = 633 ) were r and omly allocated to receive either micronutrients fortified milk ( MN = 316 ) or control milk ( Co = 317 ) . Intervention of MN milk provided additional 7.8 mg zinc , 9.6 mg iron , 4.2 µg selenium , 0.27 mg copper , 156 µg vitamin A , 40.2 mg vitamin C , and 7.5 mg vitamin E per day ( three serves ) for one year . Anthropometry was recorded at baseline , mid- and end- study . Hematological parameters were estimated at baseline and end- study . Both groups were comparable at baseline . Compliance was over 85 % and did not vary between groups . Compared to children consuming Co milk , children consuming MN milk showed significant improvement in weight gain ( difference of mean : 0.21 kg/year ; 95 % confidence interval [ CI ] 0.12 to 0.31 , p<0.001 ) and height gain ( difference of mean : 0.51 cm/year ; 95 % CI 0.27 to 0.75 , p<0.001 ) . Mean hemoglobin ( Hb ) ( difference of 13.6 g/L ; 95 % CI 11.1 to 16.0 , p<0.001 ) and serum ferritin levels ( difference of 7.9 µg/L ; 95 % CI 5.4 to 10.5 , p<0.001 ) also improved . Children in MN group had 88 % ( odds ratio = 0.12 , 95 % CI 0.08 to 0.20 , p<0.001 ) lower risk of iron deficiency anemia . Conclusions / Significance Milk provides an acceptable and effective vehicle for delivery of specific micronutrients , especially zinc and iron . Micronutrient bundle improved growth and iron status and reduced anemia in children 1–4 years old . Trial Registration Clinical Trials.gov Wheat is the primary staple food for nearly one-third of the world 's population . NaFeEDTA is the only iron ( Fe ) compound suitable for fortifying high extraction flours . We tested the hypothesis that NaFeEDTA-fortified , whole wheat flour reduces Fe deficiency ( ID ) and improves body Fe stores ( BIS ) and cognitive performance in Indian children . In a r and omized , double-blind , controlled , school feeding trial , 6- to 15-y-old , Fe-depleted children ( n = 401 ) were r and omly assigned to either a daily wheat-based lunch meal fortified with 6 mg of Fe as NaFeEDTA or an otherwise identical unfortified control meal .  Hemoglobin ( Hb ) and Fe status were measured at baseline , 3.5 mo , and 7 mo . Cognitive performance was evaluated at baseline and 7 mo in children ( n = 170 ) at one of the study sites . After 7 mo , the prevalence of ID and ID anemia in the treatment group significantly decreased from 62 to 21 % and 18 to 9 % , respectively . There was a time x treatment interaction for Hb , serum ferritin , transferrin receptor , zinc protoporphyrin , and BIS ( all P < 0.0001 ) . Changes in BIS differed between the groups ; it increased in the treatment group ( 0.04 ± 0.04 mmol/kg body weight ) and decreased in the control group ( -0.02 ± 0.04 mmol/kg body weight ) ( P < 0.0001 ) . In sensory tests , NaFeEDTA-fortified flour could not be differentiated from unfortified flour . There were no significant differences in cognitive performance tests between the groups . NaFeEDTA-fortified wheat flour markedly improved BIS and reduced ID  in Fe-depleted children . It may be recommended for wider use in national school feeding programs IMPORTANCE In sub-Saharan Africa , malaria is a leading cause of childhood morbidity and iron deficiency is among the most prevalent nutritional deficiencies . In 2006 , the World Health Organization and the United Nations Children 's Fund released a joint statement that recommended limiting use of iron supplements ( tablets or liquids ) among children in malaria-endemic areas because of concern about increased malaria risk . As a result , anemia control programs were either not initiated or stopped in these areas . OBJECTIVE To determine the effect of providing a micronutrient powder ( MNP ) with or without iron on the incidence of malaria among children living in a high malaria-burden area . DESIGN , SETTING , AND PARTICIPANTS Double-blind , cluster r and omized trial of children aged 6 to 35 months ( n = 1958 living in 1552 clusters ) conducted over 6 months in 2010 in a rural community setting in central Ghana , West Africa . A cluster was defined as a compound including 1 or more households . Children were excluded if iron supplement use occurred within the past 6 months , they had severe anemia ( hemoglobin level < 7 g/dL ) , or severe wasting ( weight-for-length z score < -3 ) . INTERVENTIONS Children were r and omized by cluster to receive a MNP with iron ( iron group ; 12.5 mg/d of iron ) or without iron ( no iron group ) . The MNP with and without iron were added to semiliquid home-prepared foods daily for 5 months followed by 1-month of further monitoring . Insecticide-treated bed nets were provided at enrollment , as well as malaria treatment when indicated . MAIN OUTCOMES AND MEASURES Malaria episodes in the iron  group compared with the no iron group during the 5-month intervention period . RESULTS In intention-to-treat analyses , malaria incidence overall was significantly lower in the iron group compared with the no iron group ( 76.1 and 86.1 episodes/100 child-years , respectively ; risk ratio ( RR ) , 0.87 [ 95 % CI , 0.79 - 0.97 ] ) , and during the intervention period ( 79.4 and 90.7 episodes/100 child-years , respectively ; RR , 0.87 [ 95 % CI , 0.78 - 0.96 ] ) . In secondary analyses , these differences were no longer statistically significant after adjusting for baseline iron deficiency and anemia status overall ( adjusted RR , 0.87 ; 95 % CI , 0.75 - 1.01 ) and during the intervention period ( adjusted RR , 0.86 ; 95 % CI , 0.74 - 1.00 ) . CONCLUSION AND RELEVANCE In a malaria-endemic setting in which insecticide-treated bed nets were provided and appropriate malaria treatment was available , daily use of a MNP with iron did not result in an increased incidence of malaria among young children . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01001871 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 OBJECTIVE : To increase knowledge on iron status and growth during the first 6 months of life . We hypothesized that iron status would be better in infants who received complementary foods in addition to breast milk compared with those exclusively breastfed . METHODS : One hundred nineteen healthy term ( ≥37 weeks ) singleton infants were r and omly assigned to receive either complementary foods in addition to breast milk from age 4 months ( CF ) or to exclusive breastfeeding for 6 months ( EBF ) . Dietary data were collected by 3-day weighed food records , and data on iron status and growth were also collected . RESULTS : One hundred infants ( 84 % ) completed the trial . Infants in the CF group had higher mean serum ferritin levels at 6 months ( P = .02 ) , which remained significant when adjusted for baseline characteristics . No difference was seen between groups in iron deficiency anemia , iron deficiency , or iron depletion . The average daily energy intake from complementary foods of 5-month-olds in the CF group was 36.8 kJ per kg body weight . Infants in both groups grew at the same rate between 4 and 6 months of age . CONCLUSIONS : In a high-income country , adding a small amount of complementary food in addition to breast milk to infants ’ diets from 4 months of age does not affect growth rate between 4 and 6 months , but has a small and positive effect on iron status at 6 months . The biological importance of this finding remains to be determined The iron-rich bread ( 2.2 mg iron per 50 g slice ) used in the study was developed using Eragrostis tef flour , naturally rich in iron . Iron deficiency is prevalent in pregnancy and compliance with supplements can be low . In this double-blind , r and omized trial 34 Caucasian , primiparous antenatal patients were r and omized to receive intervention bread or a placebo for 6 weeks . Women consumed on an average of 2.3 slices per day , providing a total of 5.0 mg iron . Using haemoglobin cut-offs , 12 % of participants eating the iron-rich bread were iron deficient by the end of the study compared with 27 % in the control group . For other markers of iron status , these were improved in the placebo versus the treatment group . For example , a significant decline in serum iron and transferrin saturation was not observed in this group . Findings demonstrate that other modes of delivery , i.e. food fortification , may be needed to generate ‘ physiological effects ’ , or further measures are taken to improve intervention compliance 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 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 OBJECTIVE To evaluate and compare the response between food supplemented with iron in powdered and iron in syrup forms for the treatment of iron deficiency anemia in children aged 1 - 5 years . DESIGN Quasi-experimental study . PLACE AND DURATION OF STUDY This study was conducted at Combined Military Hospital , Multan , from January 2000 to December 2000 . PATIENTS AND METHODS Consecutive 200 cases of iron deficiency anemia , aged 1 - 5 years , were included in the study . Diagnosis was based on history , physical examination , complete blood counts ( CBC ) and serum ferritin levels . The patients were r and omized to receive either iron in syrup form ( Group A ) or equivalent doses of iron powder sprinkled over food ( Group B ) . The patients were followed up with  hemoglobin estimation ( Hb ) and reticulocyte response at 2 weeks , 4 weeks and 6 weeks .  CBC and serum ferritin were repeated at 6 weeks . RESULTS Over half ( 51 % ) of the patients were between 1 - 2 years of age . One hundred thirty-two were males and 68 females . Most of the patients belonged to poor socioeconomic class . The iron in powder form was better tolerated than iron syrup as this group witnessed fewer episodes of gastrointestinal disturbances . The rise in mean Hb level after 6 weeks of treatment in group A and B was 1.6 g/dl and 1.9 g/dl respectively . Hemoglobin rise in group B was more than group A but this was statistically non-significant ( p > 0.05 ) . There was small but significant ( p < 0.05 ) rise in serum ferritin in both the groups . There was no significant difference between the two groups for response to the two forms of iron administration . CONCLUSION The powdered form of iron is a cost-effective and better tolerated method of iron administration in children and can be considered as an alternate option for the treatment of iron deficiency anemia in children 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 OBJECTIVE To investigate the effect of iron supplementation on iron deficiency anemia of childbearing age women , and to find out the optimal amount of iron intake for maintaining their health . METHODS 74 childbearing age women aged 21 to 45 years with anemia were r and omly assigned to intervention or control group by hemoglobin content , and a iron nutrition packet ( mainly composed of ferric pyrophosphate and ferrous fumarate , containing iron 8 mg ) or a placebo packet was given daily for six months , respectively . Hemoglobin , serum ferritin , food frequency and 24h dietary recall survey were performed before intervention and three and six months after intervention . RESULTS Hemoglobin and serum ferritin of the intervention group were significantly higher ( P < 0.01 ) than that in control group after six months . The number of women with hemoglobin > or = 120 g/L in intervention and control group was 15 ( 44.1 % ) and 5 ( 14.3 % ) , respectively ( P < 0.01 ) . The number of women with serum ferritin > or = 15 micro g/L in intervention and control group was 11 ( 34.4 % ) and 4 ( 12.5 % ) , respectively ( P < 0.05 ) . The average dietary iron intake was 14.0 mg/d , mainly from plant foods . There was a positive correlation of total iron intake  ( dietary iron plus iron supplements ) with hemoglobin ( r = 0.57 , P < 0.01 ) . More menstrual blood and dietary fiber were the risk factors for iron deficiency anemia ( P < 0.05 ) . CONCLUSION The anemic status in childbearing age women could be improved by providing iron 8 mg daily for six months consecutively . Daily dietary intake of iron 23.2 mg can meet the requirement of maintaining normal iron storage for childbearing age women Background / Objectives : Helicobacter pylori infection and iron and vitamin B12 deficiencies are widespread in economically disadvantaged population s. There is emerging evidence that H. pylori infection has a negative effect on the absorption of these micronutrients . The aim of this study was to evaluate the effect of H. pylori infection on the efficacy of micronutrient ( including iron and vitamin B12)-fortified foods supplied for 1 year in marginally nourished children . Subjects/ Methods : In all , 543 Indian children , aged 6–10 years , participated in a double-blind , r and omized controlled intervention trial , receiving foods fortified with either high ( 100 % Recommended Dietary Allowances ( RDA ) ) or low ( 15 % RDA ) amounts of iron , vitamin B12 and other micronutrients . The presence of H. pylori infection was diagnosed by the 13C-labeled urea breath test at 11 months after the start of the intervention . Blood hemoglobin , serum ferritin ( SF ) , total body iron and plasma vitamin B12 were estimated at baseline and 12 months , and differences between these time points were assessed using an independent t-test . Results : Overall , the prevalence of H. pylori infection in this group of children was 79 % . Baseline hemoglobin , SF , body iron and vitamin B12 concentrations were not associated with H. pylori infection . The response to the intervention ( either high or low amounts of iron and vitamin B12 fortification ) in terms of change in iron markers and vitamin B12 status did not differ between children with and without H. pylori infection . Conclusions : This study shows that the presence of H. pylori infection did not affect the efficacy of long-term iron and vitamin B12 fortification in these marginally nourished children 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 Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries , despite longst and ing efforts to fortify foods or to distribute medicinal supplements to pregnant women . The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients ( iron , iodine , zinc , vitamin A , vitamin C , niacin , riboflavin , folate , vitamin B-12 , vitamin B-6 and vitamin E ) on the hemoglobin , iron and vitamin A status of pregnant women in Tanzania . A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a r and omized double-blind controlled trial in which study women received 8 wk of supplementation .  Hemoglobin , ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period . The supplement result ed in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56 % , respectively . The risk of iron deficiency was reduced by 70 % among those who had iron deficiency at baseline and by 92 % among those who had adequate stores . The micronutrient-fortified beverage may be a useful and convenient preventative measure , one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies 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 Background : Iron deficiency is a global public health concern and has implication s on the health status of women in reproductive age . Objective : We hypothesized that improving iron intake with double fortified salt would improve food intake , result ing in higher energy , nutrient intakes , and weight indicators of female tea plantation workers . Methods : In this r and omized double-masked study , the participants ( n = 245 ) were assigned to receive salt double fortified with iron and iodine ( DFS ; treatment ) or salt fortified with iodine ( control ) and followed for 7.5 to 9 months . Dietary intakes were measured at three time points , baseline , midpoint , and end line using ( 1 ) food frequency question naire , ( 2 ) 24-hour recall , and ( 3 ) weighed lunch intake . Anthropometric measures of height ( cm ) , weight ( kg ) , and mid-upper arm circumference ( cm ) were also recorded at three time points . Mixed-model repeated- measures approach was used to detect group differences across time . Results : Double fortified salt improved dietary iron intake in the treatment group compared to the control group ( P < .001 ) . No other dietary or anthropometric differences could be attributed to treatment . Significant effect of time was observed in the intake frequency of major food groups and calcium , vitamin A and C ( P < .001 for all ) , suggesting an equal effect of seasonality in both the groups . Conclusion : Addition of DFS in the diet improved dietary iron intake but did not affect the intake of energy , other nutrients , or nutritional status indicators . The improvement observed in the dietary iron intake demonstrates that fortification is an effective strategy to address iron deficiency in at-risk population 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 BACKGROUND Iron deficiency is a major nutritional concern in developing countries , and food fortification is a common strategy to treat it . In Indonesia  wheat flour is fortified with 60 mg Fe/kg , but because of increasing concerns about marginal zinc status in at-risk population s , consideration is being given to cofortifying flour with zinc . However , little is known about the effect of zinc fortification of flour on iron bioavailability or about the optimum form of zinc supplementation . OBJECTIVE We measured iron and zinc bioavailability from wheat-flour dumplings containing 25 g flour fortified with 60 mg Fe/kg , either alone or with 60 mg Zn/kg as zinc oxide or as zinc sulfate . DESIGN Ninety children aged 4 - 8 y were recruited and assigned r and omly to the 3 groups ; 86 completed the study .  Iron and zinc absorption were measured with established stable-isotope methods . RESULTS Iron absorption from the flour fortified with iron only was good ( 15.9 + /- 6.8 % ) , but when corrections were made for hemoglobin concentrations , it was significantly lower from the flour cofortified with zinc sulfate ( 11.5 + /- 4.9 % ; P < 0.05 ) but not from the flour cofortified with zinc oxide ( 14.0 + /- 8.9 % ) . Zinc absorption was not significantly different between the zinc oxide and zinc sulfate cofortified flours ( 24.1 + /- 8.2 % compared with 23.7 + /- 11.2 % ; P = 0.87 ) . CONCLUSIONS Iron and zinc appear to be highly bioavailable from foods made from fortified flour , but zinc sulfate cofortification may have a detrimental effect on iron absorption 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 BACKGROUND In breastfed infants , iron deficiency at < 6 mo of life , although uncommon , is observed in industrialized countries . Iron supplementation starting at an early age may prevent iron deficiency . OBJECTIVE The study assessed the effect of early iron supplementation of breastfed infants and tested the hypothesis that iron supplementation enhances iron status . Potential adverse effects ( tolerance and growth ) were monitored . DESIGN The prospect i ve , placebo-controlled study involved exclusively breastfed infants who were r and omly assigned at 1 mo of age to iron ( n = 37 ) or placebo ( n = 38 ) .  Iron ( 7 mg/d as multivitamin preparation with ferrous sulfate ) or placebo ( multivitamin preparation without iron ) was given from 1 to 5.5 mo of age . Complementary foods were allowed at > 4 mo . Infants were followed to 18 mo . Blood concentrations of ferritin , transferrin receptor , hemoglobin , and red cell indexes were determined at bimonthly intervals . Stool consistency and color and feeding behavior were recorded . RESULTS Iron supplementation caused modest augmentation of iron status during the intervention at 4 and 5.5 mo but not thereafter . Iron supplements were well tolerated and had no measurable effect on growth . One infant developed iron deficiency anemia by 5.5 mo of age . Plasma ferritin and hemoglobin tracked over time . CONCLUSION Early iron supplementation of breastfed infants is feasible and transiently increases iron status but not hematologic status . Iron is tolerated by most infants . The prevalence of iron deficiency anemia is low ( 3 % ) among unsupplemented breastfed infants in the first 6 mo of life BACKGROUND Iron deficiency is the most prevalent nutritional deficiency among infants in industrialized countries . There is ample documentation of both short- and long-term adverse effects of iron deficiency . OBJECTIVE To study the prevalence of iron deficiency in 12-month-old infants and to investigate the influence of several factors ( dietary , growth , etc . ) on iron status . MATERIAL AND METHODS A r and om sample of 94 healthy infants from a basic health district was studied . Maternal and perinatal variables , dietary intake and anthropometry were assessed at regular intervals from birth to the age of 12 months . Hemoglobin , mean corpuscular volume , transferrin saturation and serum ferritin were also evaluated . RESULTS The prevalence of iron deficiency was 9.6 % and that of iron deficiency anemia was 4.3 % . Of the nine infants with iron deficiency , four had been breast-fed for more than 6 months with late introduction of complementary foods and another had not been fed an iron-fortified formula while the 85 children without iron deficiency had received an appropriate diet ( p < 0.05 ) . Weight increase in the first year of life was significantly and positively correlated with hemoglobin and serum ferritin . CONCLUSIONS Iron deficiency is relatively common in 12-month-old-infants but is limited to groups with inadequate feeding practice s. Iron deficiency screening should be performed only in children with risk factors and /or inadequate diets Background Iron-deficiency anemia is widespread among young children in the Kyrgyz Republic , and there is an urgent need to identify an effective intervention to address this significant public health problem . Objective To test the effectiveness of a 2-month intervention with daily home fortification of complementary food using micronutrient powder ( Sprinkles ) in reducing anemia  among children 6 to 36 months of age in the Kyrgyz Republic . Methods In this cluster-r and omized , community-based effectiveness trial conducted in three regions of the Kyrgyz Republic , 24 clusters of children aged 6 to 36 months were r and omly assigned to two groups . The intervention group ( 12 clusters , n = 1,103 ) received 60 sachets of micronutrient powder ( 12.5 mg elemental iron ) , which were taken as one sachet daily for 2 months . The control group ( 12 clusters , n = 1,090 ) did not receive micronutrient powder until after the study period . Blood hemoglobin concentration was assessed at the start and end of the intervention . Results From baseline to follow-up , the mean hemoglobin concentration in the intervention group increased by 7 g/L , whereas it decreased by 2 g/L in the control group ( p < .001 ) . The prevalence of anemia ( hemoglobin < 110 g/L ) in the intervention group decreased from 72 % at baseline to 52 % at follow-up , whereas it increased from 72 % to 75 % in the control group ( p < .001 ) . Compliance with the intervention was high , with children consuming on average 45 of the 60 sachets given . Conclusions A course of 60 Sprinkles micronutrient powder sachets taken daily for 2 months is effective in improving hemoglobin levels and reducing the prevalence of anemia among young children in the Kyrgyz Republic Energy and micronutrient deficiency remain prevalent among Filipino children .  Juice drinks are commonly consumed and could be a viable vehicle for fortification to supplement the nutrient gap . This study determined the effects of a newly developed non-carbonated fortified juice drink on the iron , zinc and nutritional status of schoolchildren . One hundred r and omly selected anemic children were r and omly allocated into two groups in a doubly-masked placebo controlled manner : Group 1 received the fortified juice , Group 2 received the non-fortified juice for 100 days , five days a week under strict supervision . The juice drink was fortified with vitamin A , zinc , iron , vitamin C and lysine . The non-fortified juice was fortified only with vitamin C.  All children were dewormed prior to the intervention . Hemoglobin , plasma ferritin and plasma zinc , weight and height were assessed using st and ard methods before and after intervention . A two-day 24-hour food recall was also collected . The basal prevalence of anemia was significantly reduced in both the fortified group ( 100 % to 13 % ) and the non-fortified group ( 100 % to 40 % ) at endline . The mean plasma ferritin levels were similar in both groups at baseline and endline . At endline , mean plasma zinc in the fortified group has significantly increased by 20 μg/dL from a baseline value of 83.9 μg/dL to 103.9 μg/dL , while the non-fortified group remained at similar levels with baseline . Basal weight and height significantly increased among all children at endline . The fortified juice drink was effective in reducing the prevalence of anemia and improved the zinc status of children 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 . Sirolimus is an immunosuppressive drug whose use is frequently associated with anemia . A pathogenic link between sirolimus-induced anemia and the appearance of an inflammatory state was recently suggested . Because inflammation-related anemia is characterized by a functional iron deficiency , we investigated whether sirolimus may influence iron homeostasis and serum levels of hepcidin , a key mediator of inflammation-related anemia . Methods . To this purpose , 42 consecutive transplanted patients with biopsy-proven chronic allograft nephropathy were r and omized ( 2:1 ratio ) to receive either a  40 % cyclosporine reduction ( group A , 14 patients )  or immediate cyclosporine withdrawal and sirolimus introduction  ( group B , 28 patients ) . Hemoglobin levels and iron status were evaluated 6 months before and after r and omization . Results . The two groups had similar hemoglobin levels and iron status at baseline . We did not observe any significant change in hemoglobin and iron status in group A patients after r and omization . On the contrary , we observed a significant reduction of hemoglobin without any change of red blood cell count after sirolimus introduction , with a significant reduction of mean corpuscular volume and mean corpuscular hemoglobin . Serum iron and transferrin saturation ( TSAT ) levels were markedly reduced after the switch , while ferritin serum concentrations remained stable . Although sirolimus-induced anemia was recently suggested to resemble inflammation-related anemia , hepcidin serum levels were similar in the two groups after r and omization . None of group A and eight of group B patients presented a TSAT < 20 and were given iron supplementation after r and omization , in all of them oral iron therapy did not influence either hemoglobin or serum iron levels . Conclusion . We demonstrated that sirolimus-induced anemia is independent of the drug antiproliferative effect and does not present the features of inflammation-related anemia . This event may be due to the direct influence of sirolimus on iron homeostasis In order to quantify the effects of anemia , a study was undertaken in which an attempt was made to correct this nutritional deficiency since it was found that the productivity of non-anemic laborers was approximately 20 % greater than the productivity of anemic laborers . Treatment was elemental iron for a period of 60 days ( at a cost of US$ .0013 per laborer per day ) this result ed in an increase in productivity of approximately 15 % for tappers and 20 % for weeders as compared to control groups . These findings are highly significant . The benefit cost ratio in terms of latex production alone , for example , of correcting this deficiency could be 260:1 . The high rate of anemia in the adult male population is almost doubled in the population of females and children . The effects of anemia on women and on the learning behavior patterns of school children is documented in other studies . In Indonesia it would cost approximately US$ 0.50 per year per person to cure the anemia and US$ 0.75 per year per person to reduce hookworm infestation in a given area , including distribution costs . The evidence suggests that an increase in the consumption of some local foods whose supply is plentiful , could lead to significant improvement in blood iron status The behavioral effects of iron deficiency and its treatment were evaluated in a double-blind r and omized controlled community-based study of 191 Costa Rican infants , 12 to 23 months of age , with various degrees of iron deficiency . The Bayley Scales of Infant Development were administered before and both 1 week and 3 months after IM or oral administration of iron . Appropriate placebo-treated control infants were also tested . Infants with iron deficiency anemia showed significantly lower mental and motor test scores , even after considering factors relating to birth , nutrition , family background , parental IQ , and the home environment . After 1 week , neither IM nor oral iron treatments differed from placebo treatment in effects on scores . After 3 months , lower mental and motor test scores were no longer observed among iron-deficient anemic infants whose anemia and iron deficiency were both corrected ( 36 % ) . However , significantly lower mental and motor test scores persisted among the majority of initially anemic infants ( 64 % ) who had more severe or chronic iron deficiency . Although no longer anemic , they still showed biochemical evidence of iron deficiency after 3 months of treatment . These persistent lower scores suggest either that iron therapy adequate for correcting anemia is insufficient to reverse behavioral and developmental disturbances in many infants or that certain ill effects are long-lasting , depending on the timing , severity , or chronicity of iron deficiency anemia in infancy 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 Iron deficiency without anemia has been shown to reduce both muscle-tissue oxidative capacity and endurance in animals . However , the consequences of iron deficiency in humans remain unclear . OBJECTIVE We investigated the effects of iron supplementation on adaptation to aerobic training among marginally iron-depleted women . We hypothesized that iron supplementation for 6 wk would significantly improve iron status and maximal oxygen uptake ( VO(2)max ) after 4 wk of concurrent aerobic training . DESIGN Forty-one untrained , iron-depleted , nonanemic women were r and omly assigned to receive either 50 mg FeSO(4 ) or a placebo twice daily for 6 wk in a double-blind trial . All subjects trained on cycle ergometers 5 d/wk for 4 wk , beginning on week 3 of the study . RESULTS Six weeks of iron supplementation significantly improved serum ferritin and serum transferrin receptor ( sTfR ) concentrations and transferrin saturation without affecting hemoglobin concentrations or hematocrit . Average VO(2)max and maximal respiratory exchange ratio improved in both the placebo and iron groups after training ; however , the iron group experienced significantly greater improvements in VO(2)max . Both iron-status and fitness outcomes were analyzed after stratifying by baseline sTfR concentration ( > and < or = 8.0 mg/L ) , which showed that the previously observed treatment effects were due to iron-status and fitness improvements among subjects with poor baseline iron status . CONCLUSIONS Our findings strongly suggest that iron deficiency without anemia but with elevated sTfR status impairs aerobic adaptation among previously untrained women and that this can be corrected with iron supplementation OBJECTIVE To evaluate the prevalence of anemia , iron deficiency and iron deficiency anemia in a cohort of children . METHODS A cohort study nested in a r and omized field trial . Children were recruited at birth at the maternity unit of the only public hospital in the city of São Leopoldo , southern Brazil . This study assessed  iron status ( hemoglobin and serum ferritin ) when children were 12 - 16 months old and later at the age of 3 - 4 years .  Anemia was defined as hemoglobin concentration < 11.0 g/dL ; iron deficiency as serum ferritin < 15.0 µg/L ; and iron deficiency anemia as hemoglobin concentration < 11.0 g/dL with iron deficiency . RESULTS At age 12 - 16 months , the overall prevalence of anemia , iron deficiency and iron deficiency anemia was 63.7 , 90.3 and 58.8 % , respectively . The values for age group 3 - 4 years were 38.1 , 16.1 and 7.4 % , respectively . At age 12 - 16 months , 95 % of anemia cases were associated with iron deficiency against only 19.3 % of cases at age 3 - 4 years . CONCLUSIONS Iron deficiency was the main cause of anemia in the second year of life , but not at age 3 - 4 years . Thus , we point out that anemia in preschool children may have other causes and deserves careful assessment Background Interventions providing foods fortified with multiple micronutrients can be a cost-effective and sustainable strategy to improve micronutrient status and physical growth of school children . We evaluated the effect of micronutrient-fortified yoghurt on the biochemical status of important micronutrients ( iron , zinc , iodine , vitamin A ) as well as growth indicators among school children in Bogra district of Bangladesh . Methods In a double-masked r and omized controlled trial ( RCT ) conducted in 4 primary schools , 1010 children from classes 1–4 ( age 6–9 years ) were r and omly allocated to receive either micronutrient fortified yoghurt ( FY , n = 501 ) or non-fortified yoghurt ( NFY , n = 509 ) . For one year , children were fed with 60 g yoghurt everyday providing 30 % RDA for iron , zinc , iodine and vitamin A.  Anthropometric measurements and blood/urine sample s were collected at base- , mid- and end-line . All children ( FY , n = 278 , NFY , n = 293 ) consenting for the end-line blood sample were included in the present analyses . Results Both groups were comparable at baseline for socio-economic status variables , micronutrient status markers and anthropometry measures . Compliance was similar in both the groups . At baseline 53.4 % of the population was anemic ; 2.1 % was iron deficient ( ferritin < 15.0 μg/L and TfR > 8.3 mg/L ) . Children in the FY group showed improvement in Hb ( mean difference : 1.5 ; 95 % CI : 0.4 - 2.5 ; p = 0.006 ) as compared to NFY group . Retinol binding protein ( mean diff : 0.05 ; 95 % CI : 0.002 - 0.09 ; p = 0.04 ) and iodine levels ( mean difference : 39.87 ; 95 % CI : 20.39 - 59.35 ; p < 0.001 ) decreased between base and end-line but the decrease was significantly less in the FY group . Compared to NFY , the FY group had better height gain velocity ( mean diff : 0.32 ; 95 % CI : 0.05 - 0.60 ; p = 0.02 ) and height-for-age z-scores ( mean diff : 0.18 ; 95 % CI : 0.02 - 0.33 ; p = 0.03 ) . There was no difference in weight gain velocity , weight-for-age z-scores or Body Mass Index z-scores . Conclusion In the absence of iron deficiency at baseline the impact on iron status would not be expected to be observed and hence can not be evaluated . Improved Hb concentrations in the absence of a change in iron status suggest improved utilization of iron possibly due to vitamin A and zinc availability . Fortification improved height gain without affecting weight gain . Trial registration Clinical Trial.gov : UNLABELLED Iron supplementation programs using pediatric tablets or drops have not been successful in the control of anemia amongst infants and children in India .  Sprinkles is an innovative multi-micronutrient home fortification strategy to control iron deficiency and anemia . OBJECTIVE We aim ed to determine the hematologic response to different doses and forms of iron in Sprinkles and iron drops . SETTING Twenty two villages of Vadu Rural Health Program , KEM Hospital , Pune . DESIGN Double blind clustered r and omized community-based trial . SUBJECTS Children ( n=432 ) aged 6 to 18 mo age with Hb between 70 to 100 g/L were enrolled . METHODS Selected villages were r and omized into 5 groups : Sprinkles 12.5 , 20 or 30 mg ferrous fumarate , Sprinkles 20 mg micronized ferric pyrophosphate or drops 20 mg ferrous glycine sulphate ( DROPS ) for 8 weeks . Household socio-demographic information was collected at baseline . Side effects and compliance were monitored through weekly visits . Hemoglobin was estimated at baseline , 3 and 8 weeks . Ferritin was assessed at baseline and 8 weeks . RESULTS Baseline characteristics were similar across all groups . Hemoglobin increased significantly ( P<0.0001 ) in all groups at 8 weeks with no difference between groups . Ferritin increased ( P<0.0001 ) significantly in all groups with no difference across the groups . Compliance ( overall range : 42 to 62 % ) was lowest for DROPS . Side effects were significantly higher among DROPS compared to Sprinkles ( p>0.05 ) . CONCLUSIONS Sprinkles 12.5 mg FF dose is as efficacious as higher doses of iron in Sprinkles or DROPS in increasing hemoglobin . Sprinkles FF 12.5 mg is recommended as it has fewer reported side effects and better compliance compared to DROPS To investigate whether an intervention including micronutrient-fortified complementary foods can improve iron status , we conducted a r and omized controlled trial in 5-mo-old Vietnamese infants ( n = 246 ) . Villages ( n = 29 ) were r and omly divided into those receiving instant flour ( FF ) or a food complement ( FC ) both fortified with micronutrients or nothing [ control ( C ) ] . FF and FC infants received daily for 6 mo at least 2 meals of fortified complementary foods . Micronutrient status was assessed by measurement of hemoglobin ( Hb ) and plasma ferritin ( PF ) , transferrin receptor , zinc , and retinol . Final Hb ( mean ± SD ) was higher in the FF ( 112.5 ± 8.0 g/L ) and FC ( 114.0 ± 7.0 g/L ) groups compared with C ( 109.0 ± 8.0 g/L ; P = 0.006 ) . PF ( geometric mean [ 95 % CI ] ) was also higher in FF ( 19.8 μg/L [ 17.5 - 22.3 ] ) and FC ( 20.8 μg/L [ 18.3 - 23.6 ] ) compared with C ( 11.1 μg/L [ 9.8 - 12.5 ] ; P < 0.0001 ) . Anemia prevalence decreased more in the FC group ( -43.6 % ) compared with C ( -10.3 % ; P = 0.006 ) . The change in prevalence of PF < 12 μg/L was different in the FF ( -16.4 % ) and FC ( -6.7 % ) groups compared with C ( + 30.4 % ; P < 0.01 ) . Endpoint prevalence of iron deficiency ( ID ) and ID anemia ( IDA ) were lower in the FF ( 13.4 and 6.7 % , respectively ) and FC ( 15.2 and 3.8 % ) groups compared with C ( 57.5 and 37.5 % ) ( P < 0.0001 ) . Retinol and zinc concentrations did not differ among groups , but endpoint prevalence of zinc deficiency was lower in FF infants ( 36.1 % ) than in C infants ( 52.9 % ; P = 0.04  ) . Micronutrient-fortified complementary foods  significantly improved iron status and decreased the prevalence of anemia , ID , and IDA  in Vietnamese infants and can be an important tool to reduce ID in infancy in developing countries In this study the effects of supplementation of iron and zinc , alone or combined , on iron status , zinc status and growth in Indonesian infants is investigated . Micronutrient deficiencies are prevalent in infants in developing countries , and deficiencies often coexist ; thus , combined supplementation is an attractive strategy . However , little is known about interactions between micronutrients . In a r and omized , double-blind , placebo-controlled supplementation trial , 478 infants , 4 mo of age , were supplemented for 6 mo with iron ( 10 mg/d ) , zinc ( 10 mg/d ) , iron + zinc ( 10 mg of each/d ) or placebo . Anthropometry was assessed monthly , and micronutrient status was assessed at the end of supplementation . Supplementation significantly reduced the prevalence of anemia , iron deficiency anemia and zinc deficiency . Iron supplementation did not negatively affect plasma zinc concentrations , and zinc supplementation did not increase the prevalence of anemia or iron deficiency anemia . However , iron supplementation combined with zinc was less effective than iron supplementation alone in reducing the prevalence of anemia ( 20 % vs. 38 % reduction ) and in increasing hemoglobin and plasma ferritin concentrations . There were no differences among the groups in growth . The growth of all groups was insufficient to maintain the same Z-scores for height for age and weight for height . There is a high prevalence of deficiencies of iron and zinc in these infants , which can be overcome safely and effectively by supplementation of iron and zinc combined . However , overcoming these deficiencies is not sufficient to improve growth performance in these infants BACKGROUND Helicobacter pylori infection treatment was found not to reduce the prevalence of iron deficiency or anemia among Alaska Native children at 14 months after treatment initiation . We hypothesized that 14 months was to early to resolve H. pylori-induced gastric damage . Consequently , we conducted a 40-month follow-up . METHODS We enrolled 219 children 7 - 11 years old who had H. pylori infection ( as diagnosed by (13)C-labeled urea breath test ) and iron deficiency ( serum ferritin level , < 22.47 pmol/L ) in a controlled , household-r and omized trial of the effect of treatment of H. pylori on iron deficiency and anemia ( hemoglobin level , < 115 g/L ) . At 40 months , 176 children were evaluated . RESULTS Forty-four ( 52 % ) of 85 children in the intervention group and 53 ( 58 % ) of 91 in the control group had iron deficiency ( adjusted relative risk [ ARR ] , 0.92 [ 95 % confidence interval { CI } , 0.68 - 1.26 ] ) , versus 4 ( 5 % ) and 17(19 % ) , respectively , with both iron deficiency and anemia ( ARR , 0.25 [ 95 % CI , 0.09 - 0.73 ] ) . Reinfection occurred among 33 ( 52 % ) of 64 children who had cleared their infection . H. pylori-negative children had lower prevalences of iron deficiency ( ARR , 0.62 [ 95 % CI , 0.38 - 1.01 ] ) and iron deficiency and anemia ( ARR , 0.22 [ 95 % CI , 0.03 - 1.50 ] ) , compared with H. pylori -positive children . CONCLUSIONS The resolution of H. pylori infection for > 14 months modestly reduced the prevalence of iron deficiency and substantially reduced the prevalence of iron deficiency and anemia . H. pylori likely plays a casual role in hematological outcomes for some children OBJECTIVE The goal of this study was to assess the effectiveness of multivitamins with iron as prophylaxis against  iron deficiency and anemia in infancy . METHODS The study was a double-blinded , r and omized , pragmatic , clinical trial conducted at 3 urban primary care clinics . Subjects included healthy , full-term infants who were enrolled at their 6-month well-child visit . Infants were r and omly assigned to receive st and ard-dose multivitamins with or without iron ( 10 mg/day ) . Parents administered multivitamins by mouth daily for 3 months . Laboratory results at 9 months of age were analyzed for the presence of anemia and /or iron deficiency . Anemia was defined as hemoglobin level < 11.0 g/dL. Iron deficiency was initially defined as any abnormal laboratory value of the following : mean corpuscular volume combined with red cell distribution width or zinc protoporphyrin ( with blood lead level < 10 microg/dL ) for most subjects and ferritin , transferrin saturation , or reticulocyte hemoglobin content for a subset . Subsequent analyses defined iron deficiency as any 2 abnormalities of the above laboratory outcomes , except hemoglobin . RESULTS The control ( n = 138 ) and intervention ( n = 146 ) groups were equivalent with respect to all important sociodemographic and nutritional variables . At 9 months of age , anemia was found in 21 % of infants ( n = 58 ) . A total of 229 ( 81 % ) had iron deficiency on the basis of 1 abnormal laboratory indicator and 139 ( 49 % ) on the basis of 2 abnormal laboratory indicators . No difference existed in the occurrence of anemia and iron deficiency between the intervention and control groups . In the intervention group , 22 % and 78 % of 138 , respectively , were anemic or had 1 abnormal laboratory outcome indicative of iron deficiency . In the control group , 19 % and 84 % of 144 were anemic or iron deficient . When stratified by adherence , no differences in hematologic outcomes between groups were noted . However , in multivariate logistic regression , infants whose mothers were anemic during pregnancy were 2.15 times more likely than others to have any laboratory abnormality ( 95 % confidence interval : 1.14 - 4.07 ) . Increasing adherence , regardless of group assignment , was associated with a 0.56 times reduced risk of any abnormality ( 95 % confidence interval : 0.41 - 0.76 ) . CONCLUSION On the basis of intention-to-treat analysis , multivitamins with iron was not effective in preventing iron deficiency or anemia in 9-month-old infants . However , effective prevention and treatment of maternal anemia during pregnancy and giving multivitamins with or without additional iron during infancy may prove to be important approaches to the prevention of iron deficiency among high-risk children . Because of the consequences of iron deficiency and its high prevalence among low-income infants , additional investigation in these areas is warranted 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 Sub clinical hypothyroidism is a health state that is associated with hypercholesterolemia , infertility , iron-deficiency anemia , and poor obstetric outcome . This article summarizes the results of a prospect i ve clinical investigation of whether treatment of sub clinical hypothyroidism and iron-deficiency anemia with a combination of levothyroxine plus iron salt would be superior to each treatment alone . METHODS In a r and omized , double-blind , active-controlled trial , 60 patients with sub clinical hypothyroidism and iron-deficiency anemia received iron salt+placebo ( 20 patients ) , levothyroxine+placebo ( 20 patients ) , or levothyroxine+iron salt ( 20 patients ) for 3 months . Change from baseline ( before ) to end of study ( after ) in hemoglobin , ferritin , and thyroid-stimulating hormone levels were compared among groups . RESULTS The increase from baseline in hemoglobin and ferritin in the levothyroxine+iron group was superior to the other groups , in which a decrease in thyroid-stimulating hormone in the 2 groups that received levothyroxine was superior to the group treated with iron salt . CONCLUSION Sub clinical hypothyroidism was investigated in iron-deficient patients with no acceptable response to iron salt alone . A combination of levothyroxine and iron salt is better than each one alone The effectiveness of bread fortified with iron bis-glycinate chelate for the control of iron deficiency and iron deficiency anemia was evaluated in 89 preschool children from families of low socioeconomic level attending 2 day nurseries of the Sao Paulo City Council . During the intervention 's time of 6 months the children received besides their usual center 's diet , a daily supplement of two sweet rolls fortified with 2 mg each of iron from the chelate for a total daily iron intake of 4 mg . After six months of intervention there was a significant decrease in the prevalence of iron deficiency anemia from 62 to 22 % . There was a mean hemoglobin improvement of 1.1 g/dL , and in children with initial hemoglobin levels < 11 g/dL the mean increase in hemoglobin was 1.42 g/dL. The total mean plasma ferritin values increased from 11.34 to 20.2 micrograms/L , and in those children originally iron depleted the ferritin values normalized . A significant increase in the " z " score for weight/height was also observed . We concluded that the use of sweet rolls fortified with 2 mg of iron from the bis-glycinate chelate is highly effective for the control of iron deficiency and iron deficiency anemia in young children 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 Intermittent iron-folic acid supplementation and regular de-worming are effective initiatives to reduce anemia , iron deficiency , iron deficiency anemia , and soil transmitted helminth infections in women of reproductive age . However , few studies have assessed the long-term effectiveness of population -based interventions delivered in re source -constrained setting s. Methodology /Principal Findings The objectives were to evaluate the impact of weekly iron-folic acid supplementation and de-worming on mean hemoglobin and the prevalence of anaemia , iron deficiency , and soil transmitted helminth infection in a rural population of women in northern Vietnam and to identify predictive factors for hematological outcomes . A prospect i ve cohort design was used to evaluate a population -based supplementation and deworming program over 54 months . The 389 participants were enrolled just prior to commencement of the intervention . After 54 months 76 % ( 95 % CI [ 68 % , 84 % ] ) were taking the iron-folic acid supplement and 95 % ( 95 % CI [ 93 % , 98 % ] ) had taken the most recently distributed deworming treatment . Mean hemoglobin rose from 122 g/L ( 95 % CI [ 120 , 124 ] ) to 131 g/L ( 95 % CI [ 128 , 134 ] ) and anemia prevalence fell from 38 % ( 95 % CI [ 31 % , 45 % ] ) to 18 % ( 95 % CI [ 12 % , 23 % ] ) ; however , results differed significantly between ethnic groups . Iron deficiency fell from 23 % ( 95 % CI [ 17 % , 29 % ] ) to 8 % ( 95 % CI [ 4 % , 12 % ] ) , while the prevalence of iron deficiency anemia was reduced to 4 % ( 95 % CI [ 1 % , 7 % ] ) . The prevalence of hookworm infection was reduced from 76 % ( 95 % CI [ 68 % , 83 % ] ) to 11 % ( 95 % CI [ 5 % , 18 % ] ) . The level of moderate or heavy infestation of any soil-transmitted helminth was reduced to less than 1 % . Conclusions / Significance Population -based interventions can efficiently and effectively reduce anemia and practically eliminate iron deficiency anemia and moderate to heavy soil transmitted helminth infections , maintaining them below the level of public health concern Background The period of complementary feeding , starting around 6 months of age , is a time of high risk for growth faltering and morbidity . Low micronutrient density of locally available foods is a common problem in low income countries . Children of HIV-infected women are especially vulnerable . Although antiretroviral prophylaxis can reduce breast milk HIV transmission in early infancy , there are no clear feeding guidelines for after 6 months . There is a need for acceptable , feasible , affordable , sustainable and safe ( AFASS by WHO terminology ) foods for both HIV-exposed and unexposed children after 6 months of age . Methods and Findings We conducted in Lusaka , Zambia , a r and omised double-blind trial of two locally made infant foods : porridges made of flour composed of maize , beans , bambaranuts and groundnuts . One flour contained a basal and the other a rich level of micronutrient fortification .  Infants ( n = 743 ) aged 6 months were r and omised to receive either regime for 12 months . The primary outcome was stunting ( length-for-age Z<−2 ) at age 18 months . No significant differences were seen between trial arms overall in proportion stunted at 18 months ( adjusted odds ratio 0.87 ; 95 % CI 0.50 , 1.53 ; P = 0.63 ) , mean length-for-age Z score , or rate of hospital referral or death . Among children of HIV-infected mothers who breastfed < 6 months ( 53 % of HIV-infected mothers ) , the richly-fortified porridge  increased length-for-age and reduced stunting ( adjusted odds ratio 0.17 ; 95 % CI 0.04 , 0.84 ; P = 0.03 ) . Rich fortification improved iron status at 18 months as measured by hemoglobin , ferritin and serum transferrin receptors . Conclusions In the whole study population , the rich micronutrient fortification did not reduce stunting or hospital referral but did improve iron status and reduce anemia . Importantly , in the infants of HIV-infected mothers who stopped breastfeeding before 6 months , the rich fortification improved linear growth . Provision of such fortified foods may benefit health of these high risk infants . Trial registration Controlled-Trials.com IS RCT BACKGROUND The objective was to evaluate efficacy and safety of rapid , large-dose intravenous ( IV ) administration of ferric carboxymaltose compared to oral iron in correcting iron deficiency anemia due to heavy uterine bleeding . STUDY DESIGN AND METHODS In a r and omized , controlled trial , 477 women with anemia , iron deficiency , and heavy uterine bleeding were assigned to receive either IV ferric carboxymaltose ( < or=1000 mg over 15 min , repeated weekly to achieve a total calculated replacement dose ) or 325 mg of ferrous sulfate ( 65 mg elemental iron ) prescribed orally thrice daily for 6 weeks . RESULTS Compared to those assigned to ferrous sulfate , more patients assigned to ferric carboxymaltose responded with a hemoglobin ( Hb ) increase of 2.0 g/dL or more ( 82 % vs. 62 % , 95 % confidence interval for treatment difference 12.2 - 28.3 , p < 0.001 ) , more achieved a 3.0 g/dL or more increase ( 53 % vs. 36 % , p < 0.001 ) , and more achieved correction ( Hb > or= 12 g/dL ) of anemia ( 73 % vs. 50 % , p < 0.001 ) . Patients treated with ferric carboxymaltose compared to those prescribed ferrous sulfate reported greater gains in vitality and physical function and experienced greater improvement in symptoms of fatigue ( p < 0.05 ) . There were no serious adverse drug events . CONCLUSIONS In patients with iron deficiency anemia due to heavy uterine bleeding , rapid IV administration of large doses of a new iron agent , ferric carboxymaltose , is more effective than oral iron therapy in correcting anemia , replenishing iron stores , and improving quality of life 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 Iron deficiency is prevalent in children and infants worldwide . Zinc deficiency may be prevalent , but data are lacking . Both iron and zinc deficiency negatively affect growth and psychomotor development . Combined iron and zinc supplementation might be beneficial , but the potential interactions need to be verified . In a r and omized , placebo-controlled trial using 2 x 2 factorial design , 609 Thai infants aged 4 - 6 mo were supplemented daily with 10 mg of iron and /or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth . Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined . Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined .  Baseline iron deficiency was very low , and iron deficiency anemia was almost nil . After supplementation , prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc .  Serum zinc was higher in infants receiving zinc ( 16.7 + /- 5.2 micromol/L ) , iron and zinc ( 12.1 + /- 3.8 micromol/L ) or iron alone ( 11.5 + /- 2.5 micromol/L ) than in the placebo group ( 9.8 + /- 1.9 micromol/L ) . Iron and zinc interacted to affect iron and zinc status , but not hemoglobin . Iron supplementation had a small but significant effect on ponderal growth , whereas zinc supplementation did not . To conclude , in Thai infants , iron supplementation improved hemoglobin , iron status , and ponderal growth , whereas zinc supplementation improved zinc status . Overall , for infants , combined iron and zinc supplementation is preferable to iron or zinc supplementation alone 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 In 781 female college students , there were 41 cases of iron deficiency anemia , 209 of latent iron deficiency , 3 of other anemias , and 528 normal cases . Fifty-four volunteers recruited from the iron deficiency anemia and severe latent iron deficiency groups were r and omly divided into 4 study groups . Groups I and III received 500 mg of vitamin C daily , and groups II and IV received ferric ammonium citrate ( FeAC ; equivalent to 6 mg iron ) in addition to vitamin C for 9 weeks . Groups I and II were loaded by aerobic exercise at 50 % VO2 max . Significant differences between groups were noted in serum ferritin ( SF ) in III/IV , hematocrit ( Ht ) in II/III and III/IV , and reticulocytes ( RET ) in I/II , I/IV , and III/IV . Hemoglobin ( Hb ) and other iron-related blood indices tended to normalize in groups II and IV when compared with the pre-values . VO2 max was elevated in groups I and II regardless of iron treatment , but was augmented more in group II than group BACKGROUND A few cases relating H. pylori infection to iron-deficiency anemia have been described recently . We investigated the role of H. pylori infection in iron-deficiency anemia in preadolescent children and adolescents . PATIENTS AND METHODS We conducted a double-blind , placebo-controlled therapeutic trial in 43 subjects ( mean age , 15.4 years ) with iron-deficiency anemia . Endoscopy was performed , and biopsy specimens were examined by urease test and histological analysis . Twenty-two of 25 H. pylori-positive patients were assigned r and omly to three groups . Group A patients were given oral ferrous sulfate and a 2-week course of bismuth subcitrate , amoxicillin , and metronidazole . Group B patients were given placebo for iron and a 2-week course of triple therapy . Group C patients were given oral ferrous sulfate and a 2-week course of placebo .  Iron status was reassessed 4 weeks and 8 weeks after the 2-week regimen ended . RESULTS Of the 43 subjects with iron-deficiency anemia , 25 ( 58.1 % ) had H. pylori in the antrum . Group A and B subjects , who received eradication therapy , showed a significant increase in hemoglobin level as compared with group C subjects at 8 weeks after therapy ( p = .0086 ) . CONCLUSIONS Treatment of H. pylori infection was associated with more rapid response to oral iron therapy as compared with the use of iron therapy alone . Such treatment also led to enhanced iron absorption even in those subjects who did not receive oral iron therapy BACKGROUND Helicobacter pylori infection may play a role in iron-deficiency anemia . METHODS In 52 patients with iron-deficiency anemia , H. pylori status was determined using rapid urease test and histology . H. pylori -positive patients were r and omly assigned to receive anti- H. pylori treatment either immediately ( Group I ) or after a delay of one month ( Group II ) ; in addition , all patients received oral ferrous sulfate for three months .  Patients testing negative for H. pylori ( Group III ) received only oral ferrous sulfate .  Hematological parameters were tested every month . RESULTS Of 52 patients , 32 ( 61.5 % ) had H. pylori infection . At the end of one month , median increase in hemoglobin level was lower in Group II than in Groups I and III ( 1.1 g/dL vs. 3.6 g/dL and 1.9 g/dL , respectively ; p=0.025 ) , as were that in serum iron ( 19 mcg/dL vs. 55.5 mcg/dL and 41 mcg/dL ; p=0.019 ) . During the second month , after H. pylori infection in Group II had been treated , median increase in hemoglobin in this group was comparable to those in Groups I and III ( 3.7 g/dL vs. 2.5 g/dL and 2.5 g/dL. CONCLUSION In patients with iron-deficiency anemia , presence of H. pylori infection is associated with a poorer response to  oral iron therapy  , which improves with treatment for H. pylori infection BACKGROUND Evidence suggests that brain iron deficiency at any time in life may disrupt metabolic processes and subsequently change cognitive and behavioral functioning . Women of reproductive age are among those most vulnerable to iron deficiency and may be at high risk for cognitive alterations due to iron deficiency . OBJECTIVE We aim ed to examine the relation between iron status and cognitive abilities in young women . DESIGN A blinded , placebo-controlled , stratified intervention study was conducted in women aged 18 - 35 y of varied iron status who were r and omly assigned to receive iron supplements or a placebo .  Cognition was assessed by using 8  cognitive performance tasks  ( from Detterman 's Cognitive Abilities Test ) at baseline ( n = 149 ) and after 16 wk of treatment ( n = 113 ) . RESULTS At baseline , the iron-sufficient women ( n = 42 ) performed better on cognitive tasks ( P = 0.011 ) and completed them faster ( P = 0.038 ) than did the women with iron deficiency anemia ( n = 34 ) . Factors representing performance accuracy and the time needed to complete the tasks by the iron-deficient but nonanemic women ( n = 73 ) were intermediate between the 2 extremes of iron status . After treatment , a significant improvement in serum ferritin was associated with a 5 - 7-fold improvement in cognitive performance , whereas a significant improvement in hemoglobin was related to improved speed in completing the cognitive tasks . CONCLUSIONS Iron status is a significant factor in cognitive performance in women of reproductive age . Severity of anemia primarily affects processing speed , and severity of iron deficiency affects accuracy of cognitive function over a broad range of tasks . Thus , the effects of iron deficiency on cognition are not limited to the developing brain BACKGROUND In developing countries , many children are at high risk of goiter and iron deficiency anemia . Because iron deficiency can have adverse effects on thyroid metabolism , iron deficiency may influence the response to supplemental iodine in areas of endemic goiter . OBJECTIVE The aim of this study was to determine whether goitrous children with iron deficiency anemia would respond to oral iodine supplementation . DESIGN A trial of oral iodine supplementation was carried out in an area of endemic goiter in western Côte d'Ivoire in goitrous children ( n = 109 ) aged 6 - 12 y. Group 1 ( n = 53 ) consisted of goitrous children who were not anemic . Group 2 ( n = 56 ) consisted of goitrous children who had iron deficiency anemia . At baseline , thyroid gl and volume and urinary iodine , thyrotropin , and thyroxine were measured by using ultrasound . Each child received 200 mg I orally and was observed for 30 wk , during which urinary iodine , thyrotropin , thyroxine , hemoglobin , and thyroid gl and volume were measured . RESULTS The prevalence of goiter at 30 wk was 12 % in group 1 and 64 % in group 2 . The mean percentage change from baseline in thyroid volume 30 wk after administration of oral iodine was -45.1 % in group 1 and -21.8 % in group 2 ( P < 0.001 ) . Among the anemic children , there was a strong correlation between the percentage decrease in thyroid volume and hemoglobin concentration ( r(2 ) = 0.65 ) . CONCLUSION The therapeutic response to oral iodine was impaired in goitrous children with iron deficiency anemia , suggesting that the presence of iron deficiency anemia in children limits the effectiveness of iodine intervention programs AIM Iron deficiency is a leading cause of anemia in pregnancy . The present study aim ed to compare the efficacy of oral and intravenous iron therapy in improving iron deficiency anemia in pregnancy and restoring iron stores , compare the obstetric outcome in the two groups and evaluate the safety of intravenous iron sucrose . MATERIAL AND METHODS This was a prospect i ve study , where 100 anemic antenatal women with hemoglobin 7 - 9 g/dL , mean corpuscular volume < 85 fL and serum ferritin < 15 ng/mL , were r and omized into two groups . In group A ( n=50 ) , the women received 200 mg tablets of ferrous sulphate , each containing 60 mg elemental iron , three times a day for 4 weeks . In group B ( n=50 ) , iron sucrose was given in divided doses of 200 mg each on alternate days by slow intravenous infusion . Primary outcome measure was treatment efficacy , assessed by measurement of hemoglobin , red blood cell indices and reticulocytes on days 7 , 14 , 21 , and 30 and at delivery , and of ferritin on day 30 and at delivery . Any side-effects of treatment and the neonatal outcome were studied as secondary outcome measures . RESULTS There was a statistically significant difference in increase of hemoglobin levels ( 3.1g/dL in group A vs 5.1 g/dL in group B ; P=0.002 ) and ferritin levels between the two groups on day 30 ( P=0.005 ) . The adverse effects from iron treatment were mild but more prominent in group A. Neonatal outcome was comparable in the two groups . CONCLUSION Intravenous administration of iron sucrose is a safe treatment for correction of anemia in pregnancy , without serious side-effects 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 BACKGROUND Nightblindness affects 16 - 52 % of pregnant women in areas of Nepal and in some cases persists after vitamin A treatment . Iron and riboflavin affect vitamin A utilization and photoreceptor function , respectively , and pilot data in the study population showed a high prevalence of iron and riboflavin deficiencies . OBJECTIVE The objective was to assess the effect of supplemental iron and riboflavin on pupillary threshold ( PT ) and plasma retinol in nightblind , pregnant Nepali women given vitamin A-fortified rice . DESIGN Nightblind pregnant women were r and omly assigned to receive , 6 d/wk under supervision for 6 wk , a vitamin A-fortified rice curry dish providing 850 microg retinal activity equivalents/d with either a 30-mg Fe and 6-mg riboflavin ( FeR + VA ) capsule or a placebo control ( VA only ) capsule . Hemoglobin , erythrocyte riboflavin , and plasma ferritin and retinol were measured before and after the intervention . Dark adaptation was assessed by PT score . RESULTS Women who were iron deficient at baseline ( n=38 ) had significantly greater improvement in PT score with  iron and riboflavin supplementation  than without ( P=0.05 ) . Iron and riboflavin supplements significantly reduced the prevalences of riboflavin deficiency ( from 60 % to 6 % ; P<0.0001 ) , iron deficiency anemia ( from 35 % to 15 % ; P<0.007 ) , and abnormal PT ( from 87 % to 30 % ; P<0.05 ) from baseline . Mean increases in erythrocyte riboflavin ( P<0.0001 ) and plasma ferritin ( P=0.01 ) were greater in the FeR + VA group than in the VA only group . CONCLUSIONS Iron deficiency may limit the efficacy of vitamin A to normalize dark adaptation in pregnant Nepali women . Further studies are needed to assess the effect of simultaneous delivery of iron and vitamin A for the treatment of nightblindness 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 Forty patients suffering from iron deficiency anemia were r and omly assigned to receive iron succinylprotein complex ( containing 80 mg of elemental iron daily ) or iron gluconate complex ( containing 125 mg of elemental iron daily ) for two months . Improvement , as measured by hematological variables , was noted in both groups , iron succinylprotein complex being superior to iron gluconate complex on some measures . Side effects were reported by two of the 20 patients treated with iron succinylprotein complex and by ten of the 20 patients treated with iron gluconate complex ABSTRACT Background Evidence on the effect of small-quantity lipid-based nutrient supplements ( SQ-LNSs ) on early child growth and development is mixed . Objective This study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth ( primary outcome ) , psychomotor development , iron status ( secondary outcomes ) , and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet . Methods Infants ( n = 750 ) were r and omly assigned to receive SQ-LNS , SQ-LNS-plus , or no supplement . Both SQ-LNS products contained micronutrients and essential fatty acids . SQ-LNS-plus contained , in addition , docosahexaenoic acid , arachidonic acid ( important for brain and eye development ) , lysine ( limiting amino acid in maize ) , phytase ( enhances iron absorption ) , and other nutrients . Infants ’ weight and length were measured bimonthly . At age 6 and 12 mo , psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin , plasma ferritin , C-reactive protein , and α1-acid glycoprotein were assessed . WHO Motor Milestone outcomes , adherence , and morbidity were monitored weekly through home visits . Primary analysis was by intention-to-treat , comparing each SQ-LNS group with the control . Results SQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo ( mean difference : 0.11 ; 95 % CI : 0.01 , 0.22 ; P = 0.032 ) and 10 mo ( 0.16 ; 95 % CI : 0.04 , 0.27 ; P = 0.008 ) but not at 12 mo ( 0.09 ; 95 % CI : −0.02 , 0.21 ; P = 0.115 ) , locomotor development score ( 2.05 ; 95 % CI : 0.72 , 3.38 ; P = 0.003 ) , and Parent Rating Score ( 1.10 ; 95 % CI : 0.14 , 2.07 ; P = 0.025 ) , but no effect for weight-for-age zscore . Both SQ-LNS ( P = 0.027 ) and SQ-LNS-plus ( P = 0.005 ) improved hemoglobin concentration and reduced the risk of anemia , iron deficiency , and iron-deficiency anemia  . Both SQ-LNS products reduced longitudinal prevalence of fever , coughing , and wheezing but increased incidence and longitudinal prevalence of diarrhea , vomiting , and rash/sores . Conclusions Point-of-use fortification with SQ-LNS-plus showed an early transient effect on linear growth and improved locomotor development . Both SQ-LNS products had positive impacts on anemia and iron status . This trial was registered at clinical trials.gov as NCT01845610 Background Iron deficiency is a common nutritional problem in young children among vulnerable population s in Jordan . Several studies have shown the effectiveness of intermittent iron supplementation in improving iron status . Such a study has not been carried out in 2- to-6-year-old Jordanian children diagnosed with iron deficiency anemia in a clinical setting . Objective To study the effectiveness of intermittent versus daily iron treatment in a clinical setting in 2- to 6-year-old Jordanian children with iron-deficiency anemia . Methods About 4,400 children aged 2 to 6 years who visited Prince Hashim Military Hospital in Zarqa , Jordan , from August 2000 to June 2001 were screened for age , general health , and birthweight . About 10 % of these children were screened for anemia , using complete blood count ( defined as a hemoglobin level ≤ 10.5 g/dL , and a mean corpuscular volume ≤ 75 fL ) . Anemic children underwent further screening for iron deficiency , defined as serum ferritin level ≤ 12 μ g/L. Children with iron-deficiency anemia , as indicated by hemoglobin ≤ 10.5 g/dL , mean corpuscular volume ≤ 75 fL , and serum ferritin ≤ 12 μ g/L , or as indicated by mean corpuscular volume ≤ 75 fL and hemoglobin ≤ 10.5 g/dL , were enrolled in the study after informed oral consent by their parents . Study children ( n = 134 ) were assigned r and omly to one of three groups . Subjects in group 1 ( n = 45 ) , group 2 ( n = 45 ) , and group 3 ( n = 44 ) received iron treatment daily , weekly , and twice weekly , respectively . Out of 134 children recruited for the study , only 63 ( 39 boys and 24 girls ) completed the 3-month treatment period . All of the children received medicinal iron drops at a dosage of 5 mg elemental iron as ferrous sulfate per kilogram of body weight . The parents also received nutritional counseling . Results At the end of treatment , hemoglobin , serum ferritin , hematocrit , mean corpuscular volume , mean corpuscular hemoglobin , and mean corpuscular hemoglobin concentration increased significantly in all groups with no significant differences between groups . The increases in hemoglobin in groups 1 , 2 , and 3 were 2.47 ± 0.17 , 2.12 ± 0.18 , and 2.18 ± 0.18 g/dL , respectively . Measurements of final serum ferritin concentration were available for only 12 , 12 , and 10 children in groups 1 , 2 , and 3 , respectively . In all children who completed the study , except for one in group 1 , hemoglobin , mean corpuscular volume , and serum ferritin reached normal values in response to iron treatment . Conclusions Weekly and twice-weekly iron therapy with 5 mg elemental iron as ferrous sulfate per kilogram of body weight accompanied by nutritional counseling was as effective as daily iron therapy in correcting iron-deficiency anemia in 2- to 6-year-old children under the clinical conditions of this study OBJECTIVE To determine whether extended oral iron therapy corrects lower developmental test scores in infants with iron-deficiency anemia . STUDY DESIGN Double-blind , controlled trial in Costa Rica involving 32 12- to 23-month-old infants with iron-deficiency anemia and 54 nonanemic control subjects . Anemic infants were treated with orally administered iron for 6 months ; half the nonanemic children were treated with iron and half with placebo .  Developmental test scores and hematologic status were evaluated before treatment , after 3 months , and after 6 months . RESULTS Iron-deficient anemic infants received lower mental test scores than nonanemic infants at all three time points ( p < 0.05 pretreatment and at 3 months , p = 0.07 at 6 months ) . There were no significant differences in motor test scores . More of the anemic infants were rated as unusually tearful and unhappy . Anemic infants came from families with lower maternal education and less support for child development and were less likely to be breast fed , were weaned earlier , and consumed more cow milk . CONCLUSIONS Lower mental test scores persisted in infants with iron-deficiency anemia despite extended oral iron therapy and an excellent hematologic response . Iron-deficiency anemia may serve as a marker for a variety of nutritional and family disadvantages that may adversely affect infant development OBJECTIVE To evaluate the impact that a program based on maternal dietary counseling covering breastfeeding and healthy complementary feeding had on the prevalence of  iron deficiency , anemia and iron deficiency anemia in children aged 12 to 16 months . METHODS Newborn infants were r and omized at birth to an intervention or a control group . Mothers in the intervention group received home visits during the children 's first year of life on a monthly basis up to 6 months , and at 8 , 10 and 12 months . The mothers in the control group received visits for data collection when children reached 6 and 12 months . All children were visited at ages between 12 and 16 months and 24-hour dietary recalls and hemoglobin and ferritin tests were conducted . RESULTS There was no evidence that the intervention had an effect on anemia incidence , which was 66.5 % in the intervention group and 61.8 % in the control group . There was also no evidence of any difference between the groups in the prevalence of iron deficiency anemia or of iron deficiency . However , a higher percentage of children in the intervention group were exclusively breastfed at 4 and 6 months , and breastfed at 6 and 12 months . Intervention group children also consumed more meat and were fed diets with better iron bioavailability and consumed less cow 's milk and calcium than children from the control group . CONCLUSION This intervention had no effect on the prevalence of anemia , iron deficiency or iron deficiency anemia . Clinical trial registry identification number : NCT00629629 BACKGROUND Parasitic diseases ( eg , malaria and helminthiases ) exert enormous burdens on public health and social well-being . Moreover , parasitic infections are important causes of anemia in tropical Africa , exacerbated by lack of a diversified diet and inflammatory and genetic diseases . There is a paucity of longitudinal studies monitoring the dynamics of anemia in relation to the aforementioned parameters . METHODS We design ed a 14-month prospect i ve longitudinal study in 3 cohorts ( ie , infants aged 6 - 23 months , children aged 6 - 8 years , and women aged 15 - 25 years ) in the Taabo health demographic surveillance system located in south- central Côte d'Ivoire .  Parasitological , hematological , and micronutrient data were obtained from repeated cross-sectional surveys , utilizing st and ardized , quality -controlled methods . RESULTS We found that young age , Plasmodium and Schistosoma infections , cellular iron deficiency , and stunting were significantly negatively associated with hemoglobin concentration . Moreover , iron status biomarkers ( ie , ferritin and soluble transferrin receptor ) were significantly associated with inflammatory parameters . CONCLUSIONS Based on our results , effective prevention and control measures that target parasitic diseases and iron deficiency are needed . These measures might include the distribution of long-lasting insecticidal nets , intermittent preventive treatment for malaria , regular anthelmintic drug administration , and improved intake of bioavailable iron , coupled with health and nutritional education and improved hygiene , water , and sanitation 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 In Cambodia , micronutrient deficiencies remain a critical public health problem . Our objective was to evaluate the impact of multi-micronutrient fortified rice ( MMFR ) formulations , distributed through a World Food Program school-meals program ( WFP-SMP ) , on the hemoglobin concentrations and iron and vitamin A ( VA ) status of Cambodian schoolchildren . The FORISCA-UltraRice+NutriRice study was a double-blind , cluster-r and omized , placebo-controlled trial . Sixteen schools participating in WFP-SMP were r and omly assigned to receive extrusion-fortified rice ( UltraRice Original , UltraRice New ( URN ) , or NutriRice ) or unfortified rice ( placebo ) six days a week for six months . Four additional schools not participating in WFP-SMP were r and omly selected as controls . A total of 2440 schoolchildren ( 6–16 years old ) participated in the biochemical study . Hemoglobin , iron status , estimated using inflammation-adjusted ferritin and transferrin receptors concentrations , and VA status , assessed using inflammation-adjusted retinol-binding protein concentration , were measured at the baseline , as well as at three and six months . Baseline prevalence of anemia , depleted iron stores , tissue iron deficiency , marginal VA status and VA deficiency were 15.6 % , 1.4 % , 51.0 % , 7.9 % , and 0.7 % , respectively . The strongest risk factors for anemia were hemoglobinopathy , VA deficiency , and depleted iron stores ( all p < 0.01 ) . After six months , children receiving NutriRice and URN had 4 and 5 times less risk of low VA status , respectively , in comparison to the placebo group . Hemoglobin significantly increased ( + 0.8 g/L ) after three months for the URN group in comparison to the placebo group ; however , this difference was no longer significant after six months , except for children without inflammation . MMFR containing VA effectively improved the VA status of schoolchildren . The impact on hemoglobin and iron status was limited , partly by sub- clinical inflammation . MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated Objectives To assess iodine and iron nutritional status among Nepalese school children . Methods A cross-sectional , community based study was conducted in the two districts , Ilam ( hilly region ) and Udayapur ( plain region ) of eastern Nepal . A total of 759 school children aged 6–13 y from different schools within the study areas were r and omly enrolled . A total of 759 urine sample s and 316 blood sample s were collected . Blood hemoglobin level , serum iron , total iron binding capacity and urinary iodine concentration was measured . Percentage of transferrin saturation was calculated using serum iron and total iron binding capacity values . Results The mean level of hemoglobin , serum iron , total iron binding capacity , transferrin saturation and median urinary iodine excretion were 12.29 ± 1.85 g/dl , 70.45 ± 34.46 μg/dl , 386.48 ± 62.48 μg/dl , 19.94 ± 12.07 % and 274.67 μg/L respectively . Anemia , iron deficiency and iodine deficiency ( urinary iodine excretion < 100 μg/L ) were present in 34.5 % , 43.4 % and 12.6 % children respectively . Insufficient urinary iodine excretion ( urinary iodine excretion < 100 μg/L ) was common in anemic and iron deficient children . Conclusions Iron deficiency and anemia are common in Nepalese children , whereas , iodine nutrition is more than adequate . Low urinary iodine excretion was common in iron deficiency and anemia 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 Despite efforts to improve iron supplements for iron deficiency anemia , there is no consensus on products that balance efficacy , safety and tolerability , and cost . Ferrous products are effective , but they are associated with more gastrointestinal side effects than ferric products . Ferric products tend to have lower absorption . We present results from a 12-week study that ran domized 72 people with uncomplicated iron deficiency anemia to receive a ferrous iron supplement ( Ferall , a combination of ferrous fumarate with ascorbic acid , folic acid , and cyanocobalamin ) or a ferric iron polysaccharide complex ( Niferex , ferro-glycine sulfate ) plus ascorbic acid . The ferrous product was significantly more effective , the primary and secondary endpoints including changes in levels of hemoglobin and serum ferritin . There was a slightly higher frequency of gastrointestinal side effects in patients taking the ferrous product , but both supplements were well tolerated . No participant withdrew from the study because of side effects . We concluded that the ferrous product is safe and effective for use in uncomplicated iron deficiency anemia . The lack of direct comparison between single-agent ferrous fumarate and the combination ferrous product limited interpretation of results in terms of possible effects due to other components , such as ascorbic acid In a double-blind , placebo-control prospect i ve cohort study of 196 infants from birth to 15 months of age , assessment was made at 12 months of age of the relationship between iron status and psychomotor development , the effect of a short-term ( 10-day ) trial of oral iron vs placebo , and the effect of long-term ( 3 months ) oral iron therapy . Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic , 30 control , and 127 nonanemic iron-deficient children . Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants ( one-way analysis of variance , P less than .0001 ) . Control infants and nonanemic iron-deficient infants performed comparably . No difference was noted between the effect of oral administration of iron or placebo after 10 days or after 3 months of iron therapy . Among anemic infants a hemoglobin concentration less than 10.5 g/dL and duration of anemia of greater than 3 months were correlated with significantly lower motor and mental scores ( P less than .05 ) . Anemic infants failed specifically in language capabilities and body balance-coordination skills when compared with controls . These results , in a design in which intervening variables were closely controlled , suggest that when iron deficiency progresses to anemia , but not before , adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy . If these impairments prove to be long st and ing , prevention of iron deficiency anemia in early infancy becomes the only way to avoid them OBJECTIVES Anemia is the most common hematological alteration in patients with Crohn 's disease , and is frequently related to intestinal inflammatory activity . Its cause is multifactorial and mostly associated with absolute iron deficiency ( iron deficiency anemia ) and /or functional iron deficiency ( inflammation anemia or anemia of chronic disease ) . It may also be identified through other causes , such as folic acid or vitamin B12 deficiency and secondary to adverse effects from medications ( salicylic derivatives and immunosuppressive drugs ) . In the present study , patients with active Crohn 's disease and anemia were evaluated and treated with intravenous ferric carboxymaltose . We discuss the therapeutic schemes ( doses ) , safety , results and improvement of quality of life . METHODS In the present prospect i ve study , 10 consecutive patients with Crohn 's disease , with moderate to severe activity , with anemia ( Hb : 6.7 to 10 g/dL ) , who were attended between March 2014 and March 2015 , were evaluated . Six ( 60 % ) were men and four were women , all with moderate or severe anemia ( hemoglobin < 10 g/dL ) . They were treated with a maximum of three intravenous infusions of 1000 mg of ferric carboxymaltose , of at least 15 minutes in duration . It was also sought to correlate the inflammatory Crohn 's disease activity degree ( measured using the Crohn 's Disease Activity Index , CDAI ) and C-reactive protein level with the severity of anemia . The primary outcome was an increase in Hb of ≥2 g/dL and the secondary outcome was the normalization of anemia ( Hb ≥12 g/dL for women and ≥13 g/dL for men ) and the improvement in quality of life seen 12 weeks after the last application of carboxymaltose . RESULTS Among the 10 patients studied , parenteral iron supplementation was administered in three cases during hospitalization and the others received this on an outpatient basis . The total iron dose ranged from 1,000 to 2,000 mg , with an average of 1,650 mg . Crohn 's disease activity measured using CDAI and C-reactive protein correlated with the intensity of anemia . An increase of 2 g/dL occurred in eight ( 80 % ) patients after 12 weeks and normalization of anemia was found in seven ( 70 % ) patients . Improvements in quality -of-life scores were found for all ( 100 % ) patients after 12 weeks . Carboxymaltose was well tolerated . Three patients presented adverse reactions ( two with nausea and one with headache ) of mild intensity . CONCLUSIONS Anemia is a frequent complication for Crohn 's disease patients . Intravenous iron therapy has been recommended for Crohn 's disease patients , because for these patients , oral iron absorption is very limited . This is because of the inflammatory state and " blocking " of iron entry into enterocytes through hepcidin action on ferroportin , along with the elevated rates of gastrointestinal adverse events that compromise adherence to treatment and possibly aggravate the intestinal inflammatory state . The degree of Crohn 's disease activity , as measured using CDAI and C-reactive protein , correlates with the severity of anemia .  Carboxymaltose is a safe drug , which can be administrated in high doses ( up to 1,000 mg per application per week ) and corrects anemia and iron stocks over a short period of time , with consequent improvement in quality of life Deficiencies of iron and zinc are prevalent worldwide . Interactions between these micronutrients therefore have important consequences , also for supplementation . To investigate effects on hemoglobin and zinc concentrations and interactions of iron and zinc supplementation in infants , data from 4 parallel , r and omized , placebo-controlled , double-blind trials in Indonesia , Thail and , and Vietnam were pooled . Infants ( n=2468 ) , aged 4 - 6 mo , were supplemented daily with iron ( 10 mg ) and /or zinc ( 10 mg ) for 6 mo . At 3 sites , infants were given vitamin A capsules ( VAC ) at recruitment . Combined supplementation reduced prevalences of anemia by 21 % ( P<0.01 ) and zinc deficiency by 10 % ( P<0.05 ) but was less effective ( P<0.05 ) than supplementation with either iron ( 28 % reduction in anemia ) or zinc alone ( 18 % reduction in zinc deficiency ) . Iron reduced the effect of zinc supplementation ( interaction P<0.01 ) , but had no separate effect on zinc status , whereas zinc supplementation had a negative effect on hemoglobin concentrations ( -2.5 g/L , P<0.001 ) , independent of iron supplementation ( Pinteraction=0.25 ) . The effect of iron supplementation on hemoglobin concentrations was almost twice as large in boys than in girls ( effect size 12.0 vs. 6.8 g/L , respectively ) . In infants not receiving iron , VAC administration tended to be associated with lower ( 3.2 % , P=0.07 ) hemoglobin concentrations .  Combined supplementation of iron and zinc was safe and effective in reducing the high prevalences of anemia and iron and zinc deficiencies . Zinc supplementation may negatively affect iron status but iron supplementation does not seem to affect zinc status . Furthermore , VAC administration in the absence of iron supplementation may increase the incidence of anemia Abstract Background Iron deficiency anemia ( IDA ) remains a global health issue , affecting mainly children and adolescent and pregnant women . Because of problems associated with current iron compounds used in both supplementation and fortification areas , there is an emerging interest in new natural iron sources to combat IDA . Objective The objective of this study was to compare the iron absorption of iron-enriched Aspergillus oryzae [ Aspiron ( ASP ) ] with FeSO4 in humans . Methods Iron absorption was assessed using stable isotope and serum iron response methods after oral intake of iron by healthy women in 2 separate studies . In the first study , ASP was intrinsically labelled with 58Fe into a dry form containing 8 % iron . Subjects ( n = 16 , 18–35 y ) were r and omly assigned to consume liquid semipurified meals labelled with 2 stable iron isotopes , 57FeSO4 ( 10 mg ) and ASP containing 2 mg 58Fe and 8 mg natural abundance iron , in 2 visits . Isotope enrichment was measured 2 wk after the last meal was eaten . In the second study , 17 subjects were r and omly assigned to consume a test meal with 3 iron supplements during 3 separate visits : FeSO4 , 10 mg Fe , and ASP in 2 iron doses , 10 mg and 20 mg . Changes in serum iron were measured at regular intervals for 4 h after supplementation . Results The first study showed that the difference in iron absorption from FeSO4 and ASP was not significant ( 17.18 % ± 14.2 % compared to 15.14 % ± 12.3 % ; P = 0.07 ) . The results of the second study suggested that the iron from ASP was released slowly compared to FeSO4 and the area under the curve did not reflect the absorption of ASP iron , but rather the rate of iron release . Conclusions Iron-enriched A. oryzae has high relative bioavailability and may cause lower iron surges into the blood compared to FeSO4 BACKGROUND Helicobacter pylori infection and iron deficiency are prevalent in disadvantaged population s worldwide . Previous small or uncontrolled studies have reported that successful treatment of H. pylori infection may resolve iron deficiency or anemia . METHODS We screened 68 % of children 7 - 11 years old living in 10 western Alaska villages . The 219 children with iron deficiency ( serum ferritin level , < 22.5 pmol/L [ < 10 microg/L ] ) and H. pylori infection ( diagnosed on the basis of (13)C-labeled urea breath tests ) were enrolled in a household-r and omized , unblinded trial . All children received iron supplementation for 6 weeks ; children in the intervention group also received a 2-week course of treatment for H. pylori infection plus another 2-week course of treatment if the infection had not resolved at 2 months after treatment initiation . RESULTS At 2 months after treatment initiation , 32 % of children in the intervention group and 39 % of children in the control group had iron deficiency . At 14 months after treatment initiation , 65 % of children in the intervention group and 72 % of children in the control group had iron deficiency ( adjusted relative risk [ ARR ] , 0.90 [ 95 % confidence interval [ CI ] , 0.74 - 1.1 ] ) ; in addition , 22 % of children in the intervention group and 14 % of children in the control group had anemia ( ARR , 1.6 [ 95 % CI , 0.86 - 2.9 ] ) . Results were similar when children were compared by H. pylori infection status . CONCLUSIONS In a high-prevalence population , treatment and resolution of H. pylori infection did not improve isolated iron deficiency or mild anemia up to 14 months after treatment initiation Iron deficiency anemia ( IDA ) is still a major nutritional and public health problem in developing countries . The prevalence among young children and pregnant women is particularly high . Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy . We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren . Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi , Pakistan and were divided into two equal groups , i.e. , daily and weekly supplementation groups . Hemoglobin ( Hb ) , hematocrit ( Hct ) , serum iron , total iron binding capacity ( TIBC ) , and serum ferritin were determined before the start of the study . Ferrous sulfate ( 200 mg ) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months . When post-supplementation values of the above-mentioned parameters were determined , a significant improvement was observed in all parameters in both groups . It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia . Moreover , weekly iron supplementation is cost effective and has no or fewer side-effects This study assessed the effectiveness of multivitamins ( MV ) with iron as prophylaxis against  iron deficiency ( ID ) and anemia in infancy . The study was a double-blind , r and omized trial at 2 urban primary care clinics . Subjects included healthy , full-term infants enrolled at their 6-month well-child visit . Parents administered MV , either with iron or without iron , by mouth daily for 3 months . At 9 months of age , 28.3 % of 310 had either anemia or ID without anemia . Among infants with any adherence , anemia was found in 11.1 % of the iron group and 21.7 % in the noniron group ( RR=0.5 , 95 % CI=0.3 - 1.0 ) . Iron deficiency without anemia was found in 18.5 % of the iron group ; 14.4 % of the noniron group ( p=0.46 ) . When administered daily starting at age 6 months , st and ard-dose multivitamins with iron appear to reduce anemia prevalence at 9 months of age PURPOSE Elderly patients are vulnerable to the dose-dependent adverse effects of iron replacement therapy . Our study examines whether low-dose iron therapy can efficiently resolve iron-deficiency anemia in patients over the age of 80 years and reduce adverse effects . SUBJECTS AND METHODS Ninety hospitalized patients with iron-deficiency anemia were r and omized to receive elemental iron in daily doses of 15 mg or 50 mg as liquid ferrous gluconate or 150 mg of ferrous calcium citrate tablets for 60 days . Thirty control patients without anemia were given 15 mg of iron for 60 days . A 2-hour iron absorption test was performed after the initial dose . Hemoglobin and ferritin levels were measured on day 1 , 30 , and 60 after initiating therapy . Each patient completed a weekly question naire regarding drug-induced adverse effects . RESULTS Serum iron rose significantly in the anemic patients beginning 15 minutes after the first dose but not in nonanemic patients . Two months of iron treatment significantly increased hemoglobin and ferritin concentrations similarly in all 3 groups of iron-deficiency anemia patients ( for example , hemoglobin levels rose from 10.0 g/dL to 11.3 g/dL with 15 mg/d of iron therapy and from 10.2 g/dL to 11.6 g/dL with 150 mg/d ) . Abdominal discomfort , nausea , vomiting , changes in bowel movements , and black stools were significantly more common at higher iron doses . CONCLUSIONS Low-dose iron treatment is effective in elderly patients with iron-deficiency anemia . It can replace the commonly used higher doses and can significantly reduce adverse effects 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
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 The utility of iron fortification of food to improve iron deficiency , anemia , and biological outcomes is not proven unequivocally .