Universal fortification of staple foods with iron has been widely promoted as a cost-effective strategy to reduce iron deficiency in developing-country populations. 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 randomized, 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 samples.
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.
De MaeyerEM. Preventing and controlling iron deficiency anaemia through primary health care. A guide for health administrators and programme managers. Geneva: World Health Organization, 1989.
2.
PollittE. Effects of a diet deficient in iron on the growth and development of preschool and school-age children. Food Nutr Bull1991;13:110–8.
3.
WalterTArredondoSArevaloMStekelA. Effect of iron therapy on phagocytosis and bactericidal activity in neutrophils of iron deficient infants. Am J Clin Nutr1986;44:877–82.
4.
KrugerMBadenhortsCJMansweltEPGLaubscherJASpinnler BenadéAJ. Effects of iron fortification in a school feeding scheme and anthelmintic therapy on the iron status and growth of six- to eight-year-old schoolchildren. Food Nutr Bull1996;17:11–21.
5.
RowlandTWDisrothMBGreenGMKelleherJF. The effect of iron therapy on the exercise capacity of non anemic iron-deficient adolescent runners. Am J Dis Child1988;142:165–9.
6.
GarnSFRidellaSAPetzoldASFalknerF. Maternal hematologic levels and pregnancy outcomes. Semin Perinatol1981;5:155–62.
7.
RossJHortonS. Economic consequences of iron deficiency. Ottawa: Micronutrient Initiative, 1998.
8.
Flour Fortification Initiative. Wheat flour fortification: Current knowledge and practical applications. Summary report of an international technical workshop. Cuernavaca, Mexico: 2004. Available at: http://www.sph.emory.edu/wheatflour/CKPAFF/indexforFFI.htm. Accessed online 29 March 2008.
9.
MannarVBoy GallegoE. Iron fortification: Country level experiences and lessons learned. J Nutr2002;132:856S–8S.
10.
HaskellMJPandeyPGrahamJMPersonJMShresthaRKBrownKH. Recovery from impaired dark adaptation in nightblind pregnant Nepali women who receive small daily doses of vitamin A as amaranth leaves, carrots, goat liver, vitamin A-fortified rice, or retinyl palmitate. Am J Clin Nutr2005;81:461–71.
MorettiDLeeT-CZimmermannMBNuessliJHurrellRF. Development and evaluation of iron-fortified extruded rice grains. J Food Sci2005;70:S330–6.
13.
WegmüllerRZimmermannMBMorettiDArnoldMLanghansWHurrellRF. Particle size reduction and encapsulation affect the bioavailability of ferric pyrophosphate in rats. J Nutr2004;134:3301–4.
14.
CookJDMinnichVMooreCVRasmussenABradleyWBFinchCA. Absorption of fortification iron in bread. Am J Clin Nutr1973;26:861–72.
15.
FidlerMCWalczykTDavidssonLZederCSakaguchiNJunejaLRHurrellRF. A micronised, dispersible ferric pyrophosphate with high relative bioavailability in man. Br J Nutr2004;91:107–12.
16.
MorettiDZimmermannMBWegmullerRWalczykTZederCHurrellRF. Iron status and food matrix strongly affect the relative bioavailability of ferric pyrophosphate in humans. Am J Clin Nutr2006;83:632–8.
17.
ZimmermannMBWegmuellerRZederCChaoukiNRohnerFSaissiMTorresaniTHurrellRF. Dual fortification of salt with iodine and micronized ferric pyrophosphate: A randomized, double-blind, controlled trial. Am J Clin Nutr2004;80:952–9.
18.
WegmullerRCamaraFZimmermannMBAdouPHurrellRF. Salt dual-fortified with iodine and micronized ground ferric pyrophosphate affects iron status but not hemoglobin in children in Cote d'Ivoire. J Nutr2006;135:1814–20.
19.
MorettiDZimmermannMBMuthayyaSThankachanPLeeTCKurpadAVHurrellRF. Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: A double-blind randomized controlled trial. Am J Clin Nutr2006;84:822–9.
20.
Centers for Disease Control and Prevention. Criteria for anemia in children and childbearing-age women. Morb Mortal Wkly Rep1989;38:400–4.
21.
Rivera DommarcoJHotzCRodríguez RamírezSGarcía-GuerraAPeréz-ExpósitoABMartínez SalgadoHGonzález UnzagaMA. Iron. In: BourgesHCasanuevaERosadoJL, eds. Nutrient intake recommendations for the Mexican population. Physiological basis. Vol 1. [Hierro. En: Recomendaciones de ingestión de nutrimentos para la población mexicana. bases fisiológicas] Mexico City: Editorial Médica Panamericana, SA de CV; 2005:245–64. (in Spanish)
22.
NeufeldLGarcía-GuerraASánchez-FranciaDNewton SánchezORamírez VillalobosMDRivera DommarcoJ. Hemoglobin measured by Hemocue and a reference method in venous and capillary blood. Salud Publica Mex2002;44:219–27.
23.
World Health Organization. Iron deficiency anaemia: Assessment, prevention and control. A guide for programme managers. Document WHO/NHD/01.3. Geneva: WHO, 2001.
24.
MeiZCogswellMEParvantaILynchSBeardJLStoltzfusRJGrummer-StrawnLM. Hemoglobin and ferritin are currently the most efficient indicators of population response to iron interventions: An analysis of nine randomized controlled trials. J Nutr2005;135:1974–80.
25.
CookJDFlowersCHSkikneBS. The quantitative assessment of body iron. Blood2003;101:3359–64.
26.
ThuyPVBergerJDavidssonLKhanNCLamNTCookJDHurrellRFKhoiHH. Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women. Am J Clin Nutr2003;78:284–90.
27.
Food and Nutrition Board, Institute of Medicine. Dietary reference intakes of vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2002.
28.
ThuyPVBergerJNakanishiYKhanNCLynchSDixonP. The use of naFeEDTA-fortified fish sauce is an effective tool for controlling iron deficiency in women of childbearing age in rural Vietnam. J Nutr2005;135:2596–601.
29.
BarqueraSRiveraJAEspinosa-MonteroJSafdieMCampiranoFMonterrubioEA. Energy and nutrient consumption in Mexican women 12–49 years of age: Analysis of the National Nutrition Survey, 1999. Salud Publica Mex2003:45:S530–9.
30.
VillalpandoSGarcía-GuerraARamírez SilvaCIMejía-RodríguezFMatuteGShamah-LevyTRiveraJA. Iron, zinc and iodide status in Mexican children under 12 years and women 12–49 years of age. A probabilistic national survey. Salud Publica Mex2003;45:S520–9.
31.
Shamah-LevyTVillalpandoSRiveraJAMejía-RodríguezFCamacho-CisnerosMMonterrubioEA. Anemia in Mexican women: A public health problem. Salud Publica Mex2003;45:S499–507.
32.
Imhoff-KunschBFloresRDaryOMartorellR. Wheat flour fortification is unlikely to benefit the neediest in Guatemala. J Nutr2007;137:1017–22.
