Researchers have investigated which type of iron fortification improves iron absorption. The results may help to reduce iron deficiency in women and children.
Iron-deficiency anemia is a major, global public health concern. The World Health Organization estimates that 800 million women and preschool-aged children were anemic in 2011, and states that approximately half of global anemia could be eliminated by improved iron intake. Iron, however, is one of the most challenging nutrients in terms of food fortification. To be effective, iron compounds added to food must be water-soluble, but these types of compounds often cause negative changes in the taste, smell, or color of the food. Two compounds, sodium iron EDTA (NaFeEDTA) and ferrous fumarate (FeFum), have been found to be more stable in foods, while still offering bioavailable iron, which is iron that the body will be able to absorb and use.
A study by Isabelle Herter-Aeberli and colleagues, published in the British Journal of Nutrition, examined the iron absorption from flour fortified with both NaFeEDTA and FeFum in women and children in Haiti. Anemia is widespread in Haiti, affecting as many as 62% of children and 37% of women of reproductive age. Twenty-two mother-child pairs in Port-au-Prince, Haiti were included in the study. The mothers were between 18 and 45 years old, generally healthy, were not pregnant or breastfeeding, and weighed less than 65 kg or about 143 lbs. The children were between 2 and 5 years old, were generally healthy, and were not wasted or stunted. Blood samples were taken at the time of screening to establish baseline iron levels and examine levels of proteins related to gut inflammation (C-reactive protein, alpha1-acid glycoprotein). Presence of Helicobacter pylori infection was also noted as it is often associated with anemia.
The study had a randomized cross-over design where each woman and child served as their own control. After overnight fasting, participants were fed test meals consisting of a white bread roll with cream cheese and a carbonated beverage. The test meals were fortified with isotopically enriched FeFum on study day one and with enriched NaFeEDTA on study day two. This enrichment allowed investigators measure iron absorption in blood samples, which were taken two weeks after the second test meal (study day 16). Additionally, women received a third test meal on study day 16 enriched with both FeFum and NaFeEDTA.
Overall, iron absorption from bread fortified with NaFeEDTA was 40% higher than from FeFum. The combination of both compounds did not significantly increase iron absorption compared to FeFum alone. Subjects with high levels of gut inflammation did have lower iron absorption. However, the presence of H. pylori infection did not appear to influence iron absorption in children.
Because NaFeEDTA is, unfortunately, considerably more expensive than FeFum, investigators recommend the use of FeFum for flour enrichment in Haiti. However, they calculate that flour should be fortified at 60 mg iron/kg flour to achieve adequate supplementation for women and children. These findings may help improve iron fortification programs in developing countries.
Written by Cindi A. Hoover, Ph.D.
Source: Herter-Aeberli I, Eliancy K, Rathon Y, Loechl CU, Marhône Pierre J, Zimmermann MB. In Haitian women and preschool children, iron absorption from wheat flour-based meals fortified with sodium iron EDTA is higher than that from meals fortified with ferrous fumarate, and is not affected by Helicobacter pylori infection in children. 2017. British Journal of Nutrition 118:273-279.