Iron-fortified flour: can it induce lipid peroxidation?

Iron deficiency anemia status in Iranian pregnant women and children: an umbrella systematic review and meta-analysis

BACKGROUND

Iron deficiency anemia (IDA) is a global health challenge, especially affecting females and children. We aimed to conduct an umbrella systematic review of available evidence on IDA's prevalence in Iranian pregnant women and children.

METHODS

We searched the Web of Science, Science Direct, PubMed, Scopus, and Google Scholar databases for articles published by April 2023. Meta-analyses investigating the status of IDA in Iran were included. The findings of seven meta-analyses comprising 189,627 pregnant women with a mean age of 26 and 5,890 children under six years old were included in this study. The methodological quality of each study was evaluated with the Assessment of Multiple Systematic Reviews (AMSTAR2) instrument.

RESULTS

We estimated the prevalence of IDA at 15.71% in pregnant women and 19.91% in young children. According to our subgroup analysis of pregnant women, IDA's prevalence in urban and rural regions was 16.32% and 12.75%; in the eastern, western, central, southern, and northern regions of Iran, it was estimated at 17.8%, 7.97%, 19.97%, 13.45%, and 17.82%, respectively.

CONCLUSION

IDA is common in young children and pregnant females and is a significant public health concern in Iran. The present umbrella review results estimated that Iran is in the mild level of IDA prevalence based on WHO classification. However, due to sanctions and high inflation in Iran, the prevalence of anemia is expected to increase in recent years. Multi-sectoral efforts are required to improve the iron status of these populations and reduce the burden of IDA in the country.

Measurement of Iron in Flour and Commonly-Used Breads Baked in Isfahan, Iran: A Risk Assessment Study with Monte Carlo Simulation

Fortification of highly-consumed foods such as bread is an easy and cheap strategy to combat the iron deficiency anemia. However, there have sometimes been some side effects such as iron overload and digestive problems. Accordingly, this study aimed to examine the amount of iron as well as its non-carcinogenic risks in commonly-used types of Iranian flour and breads (Barbary, Lavash, and Tafton) in Isfahan, Iran. Iron concentration of 100 samples of flour and breads were measured by Inductively Coupled Plasma Optical Emission Spectrometer. Moreover, the non-carcinogenic health risk of iron in fortified breads was estimated by Target Hazard Quotient (THQ) in Monte Carlo Simulation technique. The limit of detection (LOD) and limit of quantification (LOQ), with a recovery level of 95%, were 1.8 × 10-5 and 5.9 × 10-5 mg/kg, respectively. The total mean concentration of iron in flour (53.48 ± 22.49 mg/kg) and bread (39.02 ± 22.63 mg/kg) samples was within the standard recommended range (40-85 mg/kg) in Iran. THQ for adults and children was equal to 0.53 and 2.48. respectively. Hence, non-carcinogenic risk of iron through bread consumption was acceptable for adults, while it was not acceptable for children as a sensitive group. Consequently, it is required to rescreen the flour and bread fortification program in Iran according to the comprehensive risk assessment studies.

Bio-efficacy of iron and zinc fortified wheat flour along with bio-assessment of its hepatic and renal toxic potential

Abstract Study was planned to assess the bio-efficiency along with toxicity of iron and zinc fortified whole wheat flour in Sprague dawley albino rats. Whole wheat flour was fortified with different dosage of sodium iron EDTA (NaFeEDTA), ferrous sulphate (FeSO4), zinc oxide (ZnO) and zinc sulphate (ZnSO4). The rats (n=3) in each group were fed on fortified wheat flour for 2 months. Liver biomarkers including alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST) and bilirubin were recorded from serum samples. Increased concentration of ZnSO4 affected the liver biomarkers to be highest among all whereas, bilirubin levels were less than the rats fed on control diet. The above mentioned fortificants have negligible effect on renal biomarkers including creatinine and urea. Moreover, hematological parameters were also checked and reportedly, sodium iron EDTA fed rats presented highest amount of hemoglobin, iron and total iron binding capacity. Highest zinc level was observed in rats fed on whole wheat flour fortified with 60mg/Kg Zinc oxide. Microscopic observation of liver tissue depicted that rats fed on iron and zinc fortified wheat flour have more toxic effects whereas, histopathology presentation of kidney tissue has least toxic impact. It has been concluded that mandatory fortification of wheat flour with iron and zinc may cause increased serum biomarkers along with toxicity of vital organs like liver, hence fraction of wheat flour may be fortified to fulfill the requirements of deprived and vulnerable group.

Brazilians' experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy

OBJECTIVE

To assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a population-based study, reflecting before and after the mandatory fortification of flour with Fe.

DESIGN

Two cross-sectional population-based studies conducted in 2003 and 2008. Dietary intake was evaluated by 24 h recall and the Software for Intake Distribution Estimation (PC-SIDE) was used to estimate within-person variance and prevalence of inadequate Fe intake. The statistical analysis was conducted considering the complex survey design.

SETTING

São Paulo, Brazil.

SUBJECTS

Adolescents, adults and elderly adults of both sexes, interviewed in 2003 (n 2386) and 2008 (n 1661).

RESULTS

The Fe intake mean increased in all populations in the post-fortification period. A reduction of over 90 % was observed in the prevalence of inadequate Fe intake among men for all age groups analysed. When evaluating women, despite the substantial reduction (over 63 %), prevalence of inadequate Fe intake remained high (34 %) in those aged 19-50 years. Major food contributors to Fe intake before fortification were beans, beef, vegetables and dairy. There was an alteration in the contributors in the post-fortification period, with bread, beef, beans and biscuits as main contributors.

CONCLUSIONS

The mandatory fortification with Fe significantly furthered the reduction in the prevalence of inadequacy, except among women of reproductive age, and changed the main contributors to this nutrient in the studied population. Therefore, monitoring of Fe addition in flour is essential to assess compliance to the fortified flour policy and to guarantee a safe Fe intake for all the population.