Enhancing the absorption of fortification iron. A SUSTAIN Task Force report

Cyclodextrins and their potential applications for delivering vitamins, iron, and iodine for improving micronutrient status

Cyclodextrins (CDs) have been investigated as potential biopolymeric carriers that can form inclusion complexes with numerous bioactive ingredients. The inclusion of micronutrients (e.g. vitamins or minerals) into cyclodextrins can enhance their solubility and provide oxidative or thermal stability. It also enables the formulation of products with extended shelf-life. The designed delivery systems with CDs and their inclusion complexes including electrospun nanofibers, emulsions, liposomes, and hydrogels, show potential in enhancing the solubility and oxidative stability of micronutrients while enabling their controlled and sustained release in applications including food packaging, fortified foods and dietary supplements. Nano or micrometer-sized delivery systems capable of controlling burst release and permeation, or moderating skin hydration have been reported, which can facilitate the formulation of several personal and skin care products for topical or transdermal delivery of micronutrients. This review highlights recent developments in the application of CDs for the delivery of micronutrients, i.e. vitamins, iron, and iodine, which play key roles in the human body, emphasizing their existing and potential applications in the food, pharmaceuticals, and cosmeceuticals industries.

Reactivity of Fe(III)-containing pyrophosphate salts with phenolics: complexation, oxidation, and surface interaction

Mixed pyrophosphate salts with the general formula Ca_2(1-x)Fe_4x(P₂O₇)_(1+2x) potentially possess less iron-phenolic reactivity compared to ferric pyrophosphate (FePP), due to decreased soluble Fe in the food-relevant pH range 3-7. We investigated reactivity (i.e., complexation, oxidation, and surface interaction) of FePP and mixed salts (with x = 0.14, 0.15, 0.18, and 0.35) in presence of structurally diverse phenolics. At pH 5-7, increased soluble iron from all salts was observed in presence of water-soluble phenolics. XPS confirmed that water-soluble phenolics solubilize iron after coordination at the salt surface, resulting in increased discoloration. However, color changes for mixed salts with x ≤ 0.18 remained acceptable for slightly water-soluble and insoluble phenolics. Furthermore, phenolic oxidation in presence of mixed salts was significantly reduced compared to FePP at pH 6. In conclusion, these mixed Ca-Fe(III) pyrophosphate salts with x ≤ 0.18 can potentially be used in designing iron-fortified foods containing slightly water-soluble and/or insoluble phenolics.

Food fortification strategies to deliver nutrients for the management of iron deficiency anaemia

A rising trend in the global prevalence of anaemia is still prevailing. To combat micronutrient deficiencies, World Health Organisation/Food Agriculture Organisation (2006) guidelines recommended four chief strategies - supplementation, fortification, nutrition education and dietary diversity. Of the four strategies, food fortification has been considered as the most efficacious and economical approach. However, it is the directives themselves that highlight two major bottlenecks associated with conventional fortification - uniform dissemination of the fortifier in food vehicle that mostly include staple foods, and internal and external compliance evaluation of fortification regulations and standards by the producers. As a result, researchers envisaged a new strategy - Food-to-food fortification that complements conventional fortification. This strategy involves fortification of food vehicles with nutrient-rich food-based fortifiers. The major advantage of utilising food-based fortifiers is that they hold the potential of enhancing the bioavailability of the fortified food and providing additional nutrients and thus, resulting in dietary diversification. It also facilitates the utilisation of underutilised crops as food-based fortifiers. Underutilised crops have been recognised as potential beneficial food source accounting to their nutritional, ecological, and fiscal benefits. This review paper delves into the strengths and shortcomings of conventional iron fortification. It delineates the concept of food-to-food fortification, while precisely discussing about the best practices to be followed to address the possible challenges associated with this strategy. It also promotes the utilisation of underutilised iron rich foods to develop fortified foods and avert global food insecurity. Furthermore, it provides a summary of the studies conducted around the world to develop fortified foods using iron compounds and iron-rich foods, and to investigate their efficacy in managing iron deficiency anaemia.

Dietary Supplementation of Ferrous Glycine Chelate Improves Growth Performance of Piglets by Enhancing Serum Immune Antioxidant Properties, Modulating Microbial Structure and Its Metabolic Function in the Early Stage

The present research aimed to explore the effect of dietary ferrous glycine chelate supplementation on performance, serum immune-antioxidant parameters, fecal volatile fatty acids, and microbiota in weaned piglets. A total of 80 healthy piglets (weaned at 28 day with an initial weight of 7.43 ± 1.51 kg) were separated into two treatments with five replicates of eight pigs each following a completely randomized block design. The diet was a corn-soybean basal diet with 2,000 mg/kg ferrous glycine chelates (FGC) or not (Ctrl). The serum and fecal samples were collected on days 14 and 28 of the experiment. The results indicated that dietary FGC supplementation improved (p < 0.05) the average daily gain and average daily feed intake overall, alleviated (p < 0.05) the diarrhea rate of piglets at the early stage, enhanced (p < 0.05) the levels of superoxide dismutase and catalase on day 14 and lowered (p < 0.05) the MDA level overall. Similarly, the levels of growth hormone and serum iron were increased (p < 0.05) in the FGC group. Moreover, dietary FGC supplementation was capable of modulating the microbial community structure of piglets in the early period, increasing (p < 0.05) the abundance of short-chain fatty acid-producing bacteria Tezzerella, decreasing (p < 0.05) the abundance of potentially pathogenic bacteria Slackia, Olsenella, and Prevotella as well as stimulating (p < 0.05) the propanoate and butanoate metabolisms. Briefly, dietary supplemented FGC ameliorates the performance and alleviated the diarrhea of piglets by enhancing antioxidant properties, improving iron transport, up-regulating the growth hormone, modulating the fecal microbiota, and increasing the metabolism function. Therefore, FGC is effective for early iron supplementation and growth of piglets and may be more effective in neonatal piglets.

Fighting Iron-Deficiency Anemia: Innovations in Food Fortificants and Biofortification Strategies

Iron deficiency remains one of the main nutritional disorders worldwide and low iron intake and/or bioavailability are currently the major causes of anemia. To fight this public health problem, the scientific challenge is to find an iron form with sufficient bioavailability to increase its levels in humans through food fortification. In turn, biofortification appears as a comparatively advantageous and bearable strategy for the delivery of vitamins and other micronutrients for people without access to a healthy and diverse diet. This approach relies on plant breeding, transgenic techniques, or agronomic practices to obtain a final food product with a higher iron content. It is also known that certain food constituents are able to favor or inhibit iron absorption. The management of these compounds can thus successfully improve the absorption of dietary iron and, ultimately, contribute to fight this disorder present all over the world. This review describes the main causes/manifestations of iron-deficiency anemia, forms of disease prevention and treatment, and the importance of a balanced and preventive diet. A special focus was given to innovative food fortification and biofortification procedures used to improve the iron content in staple food crops.

Speciation of essential nutrient trace elements in coconut water

Coconut water (Cocos Nucifera) is shown to be a source of essential elements present in the form of low-molecular weight stable complexes known for their bio-availability. The total element concentrations were in the range of 0.2-2.7, 0.3-1, 3-14 and 0.5-2 ppm for Fe, Cu, Mn, and Zn, respectively, and varied as a function of the origin of the nut and its maturity. Speciation was investigated by size-exclusion chromatography - inductively coupled plasma mass spectrometry (ICPMS), and hydrophilic interaction liquid chromatography (HILIC) - electrospray-OrbitrapMS. The metal species identified included: iron complexes with citrate and malate: Fe^III(Cit)₃(Mal), Fe^III(Cit)₂(Mal)₂, Fe^III(Mal)₂, glutamine: Fe^III(Glu)₂ and nicotianamine: Fe^II(NA); copper complexes with phenylanine: Cu^II(Phe)₂ and Cu^II(Phe)₃ and nicotianamine: Cu^II(NA); zinc complexes with citrate: Zn^II(Cit)₂ and nicotianamine Zn^II(NA) and manganese complex with asparagine Mn^II(Asp)₂. The contributions of the individual species to the total elements concentrations could be estimated by HILIC - ICP MS.

Mucoadhesive microspheres of ferrous sulphate - A novel approach for oral iron delivery in treating anemia

Ferrous sulphate is a widely used oral iron supplement with low bioavailability and substantial side effects. In this study ferrous sulphate has been coated with highly mucoadhesive polymers such as hydroxypropylmethyl cellulose (HP), chitosan (CS) and carbopol (CP) by spray drying technique to produce mucoadhesive polymer coated microspheres with good yield and high encapsulation efficiency. Mucoadhesive coating may allow these microspheres to get attached to the intestine and hence better absorption of ferrous sulphate may be achieved. in vitro release studies from the microspheres show that the release follows non-Fickian zero order drug release. CP and CSHP coated microspheres showed good swelling(∼1200 to 2400 %) and mucoadhesion properties (58-95 %) indicating that they can swell and get attached to the intestine for longer time period as compared to free ferrous sulphate. All the microspheres were found to be non-cytotoxic in Caco2 cell lines and fibroblast cell lines. Cell uptake studies conducted on Caco2 cell lines showed that uptake of microspheres containing ferrous sulphate has an increased and sustained release to the cell as compared to free ferrous sulphate. Though cell uptake studies showed an increase in uptake for ferrous sulphate microspheres, comparable efficacy was observed upon administering ferrous sulphate microspheres and ferrous sulphate to phenyl hydrazine induced anemic rats.

Peptide-metal complexes: obtention and role in increasing bioavailability and decreasing the pro-oxidant effect of minerals

Bioactive peptides derived from food protein sources have been widely studied in the last years, and scientific researchers have been proving their role in human health, beyond their nutritional value. Several bioactivities have been attributed to these peptides, such as immunomodulatory, antimicrobial, antioxidant, antihypertensive, and opioid. Among them, metal-binding capacity has gained prominence. Mineral chelating peptides have shown potential to be applied in food products so as to decrease mineral deficiencies since peptide-metal complexes could enhance their bioavailability. Furthermore, many studies have been investigating their potential to decrease the Fe pro-oxidant effect by forming a stable structure with the metal and avoiding its interaction with other food constituents. These complexes can be formed during gastrointestinal digestion or can be synthesized prior to intake, with the aim to protect the mineral through the gastrointestinal tract. This review addresses: (i) the amino acid residues for metal-binding peptides and their main protein sources, (ii) peptide-metal complexation prior to or during gastrointestinal digestion, (iii) the function of metal (especially Fe, Ca, and Zn)-binding peptides on the metal bioavailability and (iv) their reactivity and possible pro-oxidant and side effects.

Iron bioavailability from bouillon fortified with a novel ferric phytate compound: a stable iron isotope study in healthy women (part II)

Bouillon cubes are widely consumed and when fortified with iron could contribute in preventing iron deficiency. We report the development (part I) and evaluation (current part II) of a novel ferric phytate compound to be used as iron fortificant in condiments such as bouillon. Ferric pyrophosphate (FePP), is the compound of choice due to its high stability in foods, but has a modest absorption in humans. Our objective was to assess iron bioavailability from a novel iron fortificant consisting of ferric iron complexed with phytic acid and hydrolyzed corn protein (Fe-PA-HCP), used in bouillon with and without an inhibitory food matrix. In a randomised single blind, cross-over study, we measured iron absorption in healthy adult women (n = 22). In vitro iron bioaccessibility was assessed using a Caco-2 cell model. Iron absorption from Fe-PA-HCP was 1.5% and 4.1% in bouillon with and without inhibitory matrix, respectively. Relative iron bioavailability to FeSO4 was 2.4 times higher than from FePP in bouillon (17% vs 7%) and 5.2 times higher when consumed with the inhibitory meal (41% vs 8%). Similar results were found in vitro. Fe-PA-HCP has a higher relative bioavailability versus FePP, especially when bouillon is served with an inhibitory food matrix.

A blood-based nutritional risk index explains cognitive enhancement and decline in the multidomain Alzheimer prevention trial

Introduction

Multinutrient approaches may produce more robust effects on brain health through interactive qualities. We hypothesized that a blood-based nutritional risk index (NRI) including three biomarkers of diet quality can explain cognitive trajectories in the multidomain Alzheimer prevention trial (MAPT) over 3-years.

Methods

The NRI included erythrocyte n-3 polyunsaturated fatty acids (n-3 PUFA 22:6n-3 and 20:5n-3), serum 25-hydroxyvitamin D, and plasma homocysteine. The NRI scores reflect the number of nutritional risk factors (0–3). The primary outcome in MAPT was a cognitive composite Z score within each participant that was fit with linear mixed-effects models.

Results

Eighty percent had at lease one nutritional risk factor for cognitive decline (NRI ≥1: 573 of 712). Participants presenting without nutritional risk factors (NRI=0) exhibited cognitive enhancement (β = 0.03 standard units [SU]/y), whereas each NRI point increase corresponded to an incremental acceleration in rates of cognitive decline (NRI-1: β = −0.04 SU/y, P = .03; NRI-2: β = −0.08 SU/y, P < .0001; and NRI-3: β = −0.11 SU/y, P = .0008).

Discussion

Identifying and addressing these well-established nutritional risk factors may reduce age-related cognitive decline in older adults; an observation that warrants further study.

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Multi-nutrient approaches may produce more robust effects through interactive properties

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Nutritional risk index can objectively quantify nutrition-related cognitive changes

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Optimum nutritional status associated with cognitive enhancement over 3-years

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Suboptimum nutritional status associated with cognitive decline over 3-years

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Optimizing this nutritional risk index may promote cognitive health in older adults

Evaluating the efficacy of a ferrous-ion-chelating peptide from Alaska pollock frame for the improvement of iron nutritional status in rats

This study aimed to investigate the effects of ferrous-ion-chelating peptides from Alaska pollock frames (APFP-Fe) on iron deficiency in anaemic rats. We hydrolysed the Alaska pollock frames to obtain a peptide with an average molecular weight of 822 Da. The bioavailability of APFP-Fe was tested using animal experiments. Wistar rats were randomly divided into six groups: an iron deficiency control group, a normal control group, and iron deficiency groups treated with ferrous sulfate (FeSO₄) or low-, medium-, or high-dose APFP-Fe. Rats in the iron deficiency groups were fed an iron-deficient diet to establish the iron deficiency anaemia (IDA) model. After the model was established, different iron supplements were given to rats once per day via intragastric administration for 21 days. The results showed that APFP-Fe had restorative effects, returning the body weight, weight gain, height, and haematological parameters in IDA rats to normal levels. In addition, compared with FeSO₄, APFP-Fe promoted significant weight gain and effectively improved haemoglobin, serum iron and transferrin levels, and recovery of the capacity of iron binding with transferrin, especially at the medium and high doses. These findings suggest that APFP-Fe is an effective source of iron for improving the iron nutritional status in IDA rats and shows promise as a new source of iron supplementation.

Efecto del consumo del extracto de alfalfa (medicago sativa) en anemia ferropénica inducida, en ratones (mus musculus)

Objetivos Determinar el efecto del consumo del extracto de alfalfa en anemia ferropénica inducida, en ratones.Materiales y Métodos Se utilizaron treinta ratones albinos M. musculus de la cepa Balb/c, machos de peso promedio 23±33,7 g. Se formaron tres grupos de diez ratones cada uno: a) grupo control negativo hierro suficiente (HS), recibió 40g/d de alimento balanceado durante siete semanas; b) grupo control positivo hierro deficiente (HD), recibió 40g/d de dieta ferropénica durante siete semanas y; c) grupo experimental hierro deficiente (HD), recibió 40g/d de dieta ferropénica durante siete semanas y a partir de la semana cinco se agregó 20g/d de extracto de alfalfa (EA).Resultados Al finalizar el tratamiento se observó diferencia significativa en los niveles de hemoglobina entre los grupos control positivo (8.41±3.9 g/dL) y experimental (13.4±3.3 g/dL) (t student, p<0,05). No se encontró diferencia significativa en los niveles de hemoglobina, al término del periodo de inducción entre los grupos control positivo (8.76±3.9 g/dL) y experimental (8.59± 3.1 g/dL) (t student, p>0,05).Conclusiones En condiciones experimentales, la alfalfa presenta efecto antianémico, sustentado en los resultados de los niveles de hemoglobina.

Estimating nutrient fortification levels in condiments and seasonings for public health programs: considerations and adaptations

Condiments and seasonings have been considered as potential vehicles for fortification in place of, or in addition to, fortifiable staple foods. Methodologies for establishing fortification programs focus primarily on use of staple foods, which are consumed in larger portions than condiments and seasonings. Some fortification models assume self-limiting consumption relative to the maximum energy consumed by target populations. However, this assumption may prove incorrect for estimating fortification concentrations of condiments and seasonings because they may only provide negligible energy. Although flavor or color may limit consumption, these limits would vary across each condiment or seasoning vehicle. In addition, the small volume of condiments and seasonings consumed relative to staple foods can lead to proportionally larger potential errors than with staple foods when measuring usual dietary intakes for establishing safe and effective fortification concentrations. This paper reviews available methods for setting fortification levels, whether or how available methods or conceptual frameworks could be adapted to condiments and seasonings, and gaps in knowledge for appropriately using condiments and seasonings as vehicles for fortification in public health.

Element distribution and iron speciation in mature wheat grains (Triticum aestivum L.) using synchrotron X-ray fluorescence microscopy mapping and X-ray absorption near-edge structure (XANES) imaging

Several studies have suggested that the majority of iron (Fe) and zinc (Zn) in wheat grains are associated with phytate, but a nuanced approach to unravel important tissue-level variation in element speciation within the grain is lacking. Here, we present spatially resolved Fe-speciation data obtained directly from different grain tissues using the newly developed synchrotron-based technique of X-ray absorption near-edge spectroscopy imaging, coupling this with high-definition μ-X-ray fluorescence microscopy to map the co-localization of essential elements. In the aleurone, phosphorus (P) is co-localized with Fe and Zn, and X-ray absorption near-edge structure imaging confirmed that Fe is chelated by phytate in this tissue layer. In the crease tissues, Zn is also positively related to P distribution, albeit less so than in the aleurone. Speciation analysis suggests that Fe is bound to nicotianamine rather than phytate in the nucellar projection, and that more complex Fe structures may also be present. In the embryo, high Zn concentrations are present in the root and shoot primordium, co-occurring with sulfur and presumably bound to thiol groups. Overall, Fe is mainly concentrated in the scutellum and co-localized with P. This high resolution imaging and speciation analysis reveals the complexity of the physiological processes responsible for element accumulation and bioaccessibility.

Sodium pyrophosphate enhances iron bioavailability from bouillon cubes fortified with ferric pyrophosphate

Fe fortification of centrally manufactured and frequently consumed condiments such as bouillon cubes could help prevent Fe deficiency in developing countries. However, Fe compounds that do not cause sensory changes in the fortified product, such as ferric pyrophosphate (FePP), exhibit low absorption in humans. Tetra sodium pyrophosphate (NaPP) can form soluble complexes with Fe, which could increase Fe bioavailability. Therefore, the aim of this study was to investigate Fe bioavailability from bouillon cubes fortified with either FePP only, FePP+NaPP, ferrous sulphate (FeSO4) only, or FeSO4+NaPP. We first conducted in vitro studies using a protocol of simulated digestion to assess the dialysable and ionic Fe, and the cellular ferritin response in a Caco-2 cell model. Second, Fe absorption from bouillon prepared from intrinsically labelled cubes (2·5 mg stable Fe isotopes/cube) was assessed in twenty-four Fe-deficient women, by measuring Fe incorporation into erythrocytes 2 weeks after consumption. Fe bioavailability in humans increased by 46 % (P<0·005) when comparing bouillons fortified with FePP only (4·4 %) and bouillons fortified with FePP+NaPP (6·4 %). Fe absorption from bouillons fortified with FeSO4 only and with FeSO4+NaPP was 33·8 and 27·8 %, respectively (NS). The outcome from the human study is in agreement with the dialysable Fe from the in vitro experiments. Our findings suggest that the addition of NaPP could be a promising strategy to increase Fe absorption from FePP-fortified bouillon cubes, and if confirmed by further research, for other fortified foods with complex food matrices as well.

The effect of timing of iron supplementation on iron absorption and haemoglobin in post-malaria anaemia: a longitudinal stable isotope study in Malawian toddlers

Background

In sub-Saharan Africa, children with Plasmodium falciparum malaria and anaemia are often given iron supplementation at the time of malaria treatment. Inflammation during and after malaria may decrease iron absorption, thus, absorption might be improved if the start of supplementation is delayed. The study objective was to measure iron absorption from iron supplements started immediately or delayed by two weeks after completion of therapy against uncomplicated P. falciparum malaria.

Methods

Malawian toddlers (n = 48; age 12–24 months) were alternatively assigned to two groups according to their appearance at the health centre: group A was provided iron supplements (30 mg Fe daily) as a FeSO₄-containing syrup for eight weeks starting immediately after malarial treatment; group B was given the iron after a two-week delay. Iron absorption from the syrup was measured on the first day of iron supplementation, and after two and eight weeks in both groups. Haemoglobin (Hb), iron status and inflammation were assessed every two weeks. Fractional iron absorption at each time point and cumulative absorption was quantified by measuring erythrocyte incorporation of ⁵⁷Fe and compared using mixed models.

Results

Comparing group A and B, geometric mean iron absorption did not differ on the first day of supplementation (9.0% vs. 11.4%, P = 0.213) and cumulative iron absorption from the three time points did not differ (6.0% vs. 7.2%, P = 0.124). Hb concentration increased in both groups two weeks after malaria treatment (P < 0.001) and did not differ after eight weeks of supplementation (P = 0.542).

Conclusions

In anaemic toddlers after uncomplicated malaria, a two-week delay in starting iron supplementation did not significantly increase iron absorption or Hb concentration. Iron absorption is sufficiently high in the immediate post-malaria period to warrant supplementation. These findings suggest there is no need to change the current practice of immediate iron supplementation in this setting.

Trial registration

This trial was registered at Pan African Clinical Trials Registry (pactr.org) as PACTR2010050002141682.

Fortification: new findings and implications

This article reviews the current landscape regarding food fortification in the United States; the content is based on a workshop sponsored by the North American Branch of the International Life Sciences Institute. Fortification of the food supply with vitamins and minerals is a public health strategy to enhance nutrient intakes of the population without increasing caloric intake. Many individuals in the United States would not achieve recommended micronutrient intakes without fortification of the food supply. The achievement and maintenance of a desirable level of nutritional quality in the nation's food supply is, thus, an important public health objective. While the addition of nutrients to foods can help maintain and improve the overall nutritional quality of diets, indiscriminate fortification of foods could result in overfortification or underfortification in the food supply and nutrient imbalances in the diets of individuals. Any changes in food fortification policy for micronutrients must be considered within the context of the impact they will have on all segments of the population and of food technology and safety applications and their limitations. This article discusses and evaluates the value of fortification, the success of current fortification efforts, and the future role of fortification in preventing or reversing nutrient inadequacies.

Ascorbyl palmitate/DSPE-PEG nanocarriers for oral iron delivery: preparation, characterisation and in vitro evaluation

The objective of this study was to encapsulate iron in nanocarriers formulated with ascorbyl palmitate and 1,2-distearoyl-sn-glycero-3-phosphoethanolamine polyethylene glycol (DSPE-PEG) for oral delivery. Blank and iron (Fe) loaded nanocarriers were prepared by a modified thin film method using ascorbyl palmitate and DSPE-PEG. Surface charge of the nanocarriers was modified by the inclusion of chitosan (CHI) during the formulation process. Blank and iron loaded ascorbyl palmitate/DSPE nanocarriers were visualised by transmission electron microscopy (TEM) and physiochemical characterisations of the nanocarriers carried out to determine the mean particle size and zeta potential. Inclusion of chitosan imparted a net positive charge on the nanocarrier surface and also led to an increase in mean particle size. Iron entrapment in ascorbyl palmitate-Fe and ascorbyl palmitate-CHI-Fe nanocarriers was 67% and 76% respectively, suggesting a beneficial effect of chitosan on nanocarrier Fe entrapment. Iron absorption was estimated by measuring Caco-2 cell ferritin formation using ferrous sulphate as a reference standard. Iron absorption from ascorbyl palmitate-Fe (592.17±21.12 ng/mg cell protein) and ascorbyl palmitate-CHI-Fe (800.12±47.6 ng/mg, cell protein) nanocarriers was 1.35-fold and 1.5-fold higher than that from free ferrous sulphate, respectively (505.74±23.73 ng/mg cell protein) (n=6, p<0.05). This study demonstrates for the first time preparation and characterisation of iron loaded ascorbyl palmitate/DSPE PEG nanocarriers, and that engineering of the nanocarriers with chitosan leads to a significant augmentation of iron absorption.

Citric acid mediates the iron absorption from low molecular weight human milk fractions

Previously, we have demonstrated increased iron absorption from low molecular weight (LMW) human milk whey fractions. In the present study, we investigated the effect of heat denaturation, zinc (a competitor of iron), duodenal cytochrome b (DcytB) antibody neutralization and citrate lyase treatment on LMW human milk fraction (>5 kDa referred as 5kF) induced ferric iron reduction, solubilization, and uptake in Caco-2 cells. Heat denaturation and zinc inhibited the 5kF fraction induced ferric iron reduction. In contrast, zinc but not heat denaturation abrogated the ferric iron solubilization activity. Despite inhibition of ferric iron reduction, iron uptake in Caco-2 cells was similar from both native and heat denatured 5kF fractions. However, iron uptake was higher from native compared to heat denatured 5kF fractions in the cells preincubated with the DcytB antibody. Citrate lyase treatment inhibited the ferric iron reduction, solubilization, and uptake in Caco-2 cells. These findings demonstrate that citric acid present in human milk solubilizes the ferric iron which could be reduced by other heat labile components leading to increased uptake in intestinal cells.

Iron bioavailability from a lipid-based complementary food fortificant mixed with millet porridge can be optimized by adding phytase and ascorbic acid but not by using a mixture of ferrous sulfate and sodium iron EDTA

Home fortification with lipid-based nutrient supplements (LNSs) is a promising approach to improve bioavailable iron and energy intake of young children in developing countries. To optimize iron bioavailability from an LNS named complementary food fortificant (CFF), 3 stable isotope studies were conducted in 52 young Beninese children. Test meals consisted of millet porridge mixed with CFF and ascorbic acid (AA). Study 1 compared iron absorption from FeSO4-fortifed meals with meals fortified with a mixture of FeSO4 and NaFeEDTA. Study 2 compared iron absorption from FeSO4-fortifed meals without or with extra AA. Study 3 compared iron absorption from FeSO4-fortified meals with meals containing phytase added prior to consumption, once without or once with extra AA. Iron absorption was measured as erythrocyte incorporation of stable isotopes. In study 1, iron absorption from FeSO4 (8.4%) was higher than that from the mixture of NaFeEDTA and FeSO4 (5.9%; P < 0.05). In study 2, the extra AA increased absorption (11.6%) compared with the standard AA concentration (7.3%; P < 0.001). In study 3, absorption from meals containing phytase without or with extra AA (15.8 and 19.9%, respectively) increased compared with meals without phytase (8.0%; P < 0.001). The addition of extra AA to meals containing phytase increased absorption compared with the test meals containing phytase without extra AA (P < 0.05). These findings suggest that phytase and AA, and especially a combination of the two, but not a mixture of FeSO4 and NaFeEDTA would be useful strategies to increase iron bioavailability from a CFF mixed with cereal porridge.

Comparative study of the oral absorption of microencapsulated ferric saccharate and ferrous sulfate in humans

PURPOSE

Our objective was to compare the absorption of microencapsulated ferric saccharate (MFS) and ferrous sulfate (FS) in a fortified milk product, using a crossover design.

METHODS

Seventeen non-iron-deficient healthy adults from both sexes participated in the study. On each intervention day (days 1 and 8), after an overnight fast, the volunteers consumed one type of product (test or control) and blood sampling was carried out at different times. The interventions days were separated by 7-day washout periods. This study was double blinded, crossover and randomized for nature of the test meals. The primary outcomes of the study were total serum iron and transferrin saturation.

RESULTS

No significant differences could be observed in serum iron concentration during the 6-h postprandial study due to the type of milk product consumed, and there was neither an effect of time nor an interaction between the type of milk product and time. Transferrin saturation significantly increased after the intake of both products (P < 0.005), reaching a peak value between hours 2 and 4. No significant differences were detected between MFS and FS, indicating that iron absorption from MFS is equivalent to absorption from FS.

CONCLUSIONS

MFS is a new ingredient that allows the fortification of a wide range of food products, including heat-processed and non-acidic products with similar absorption to FS, designed to produce neither organoleptic changes nor off-color development during storage of fortified food.

Iron deficiency anemia: a common and curable disease

Iron deficiency anemia arises when the balance of iron intake, iron stores, and the body's loss of iron are insufficient to fully support production of erythrocytes. Iron deficiency anemia rarely causes death, but the impact on human health is significant. In the developed world, this disease is easily identified and treated, but frequently overlooked by physicians. In contrast, it is a health problem that affects major portions of the population in underdeveloped countries. Overall, the prevention and successful treatment for iron deficiency anemia remains woefully insufficient worldwide, especially among underprivileged women and children. Here, clinical and laboratory features of the disease are discussed, and then focus is placed on relevant economic, environmental, infectious, and genetic factors that converge among global populations.

Fortification of staple cereal flours with iron and other micronutrients: cost implications of following World Health Organization-endorsed recommendations

BACKGROUND

Wheat and maize flours are widely used delivery vehicles for mass fortification. In lower-income countries, most, if not all, national-level cereal flour fortification programs routinely fortify with iron; however, cofortification with other micronutrients is common. Little information is available on the cost implications programs face when considering current fortification practices versus what the World Health Organization (WHO) interim consensus statement recommends.

OBJECTIVE

The objectives of the present paper are to provide information on the costs of adding different chemical forms of iron and/or other micronutrients to premix formulations, and to discuss some of the issues that should be considered regarding which micronutrients to include in the premix.

METHODS

Nine countries in Latin America, Africa, and Asia (three countries per region) that currently cofortify with multiple micronutrients including iron were selected based on low (< 75 g/day), medium (75 to 149 g/day), and high (> or = 150 g/day) mean population flour consumption levels. Premix costs per metric ton of flour produced were estimated for improving iron formulations and for following WHO recommendations for other micronutrients.

RESULTS

For the selected programs to maintain current premix formulations and improve iron compounds, premix costs would increase by between 155% and 343% when the iron compound was switched from electrolytic iron to sodium iron ethylenediaminetetraacetate (NaFeEDTA), by 6% to 50% when it was switched from electrolytic iron to ferrous sulfate, and by 4% to 13 when iron addition rates were adjusted without switching the compound. To meet WHO recommendations for other micronutrients, premix costs would increase the most when the amounts of vitamins B12 and A were increased.

CONCLUSIONS

For programs that currently cofortify with iron and additional micronutrients, the quality of the iron fortificant should not be overlooked simply to be able to afford to add more micronutrients to the premix. Micronutrients should be selected according to population needs, costs, and potential beneficial synergistic reactions the added micronutrients may have.

A randomized, double-blind clinical study on the safety and tolerability of an iron multi-amino acid chelate preparation in premenopausal women

ABSTRACT Considerable risk of iron deficiency has been identified in premenopausal women because of the adverse effects associated with commercial iron preparations. This study examined the safety and tolerability of a novel iron multi-amino acid chelate (IMAAC) preparation in premenopausal women. A single-centre, randomized, double-blind, three-arm placebo-controlled (n = 60) study was conducted where subjects received one of three test materials: IMAAC (600 mg) or ferrous sulfate (600 mg) each containing 25 mg of elemental iron, or placebo as a single daily dose for 7 days. After testing, there were no significant differences found in any of the hematological outcomes between the different test groups. The safety analyses showed that a significantly (p = .044) higher number of patients reported adverse events when taking the ferrous sulfate supplement compared to IMAAC. A significantly lower number of adverse effects (p = .008) were reported by subjects on IMAAC. The current study demonstrated the superiority of the IMAAC preparation over ferrous sulfate with regards to tolerability and adverse effects.

Perception of Rural and Urban Mothers about Consumption of Targeted Fortified Products in Jaipur, Rajasthan - India: A Cross-Sectional Study

BACKGROUND

Food fortification is the addition of one or more essential nutrients to a food whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific population groups. The present cross-sectional study was conducted to obtain comprehensive information towards consumption of Targeted Fortified Products (TFP) among rural and urban mothers of children <3 years in Jaipur, India.

METHODS

In this cross-sectional study conducted in 2012, three hundred rural and urban mothers were selected from Primary Health Centre, Achrol Village and Uniara Hospital in Jaipur, Rajasthan. The data were collected using a selfadministered questionnaire. The current nutritional status of children was determined by anthropometric measurements.

RESULTS

A total of 53.33% rural and 65.33% urban mothers had knowledge (P=0.046), amongst which 52.67% rural and 66.00% urban mothers (P= 0.026) consumed TFP directed towards mothers. In addition, 56% rural and 94.67% urban mothers had knowledge (P=0.000) about TFP directed towards children, amongst which 19.33% rural and 50.67% urban mothers (P=0.000) fed their children with TFP.

CONCLUSION

There was significantly less awareness regarding consumption of TFP directed towards both pregnant women and children among rural when compared to urban population. Attitudes seemed to be governed by the traditional beliefs and family influences of region rather than the knowledge obtained. There is a need of intensive coordinated efforts to create awareness among mothers to enhance the maternal and child diets through TFP.

Mixture of ferric sodium ethylenediaminetetraacetate (NaFeEDTA) and ferrous sulfate: an effective iron fortificant for complementary foods for young Chinese children

BACKGROUND

Ferric sodium ethylenediaminetetraacetate (NaFeEDTA) enhances iron absorption in the presence of phytate. However, the amount of NaFeEDTA that would have to be added to a complementary food to provide the necessary intake of iron for an infant or young child if NaFeEDTA were the sole iron fortificant exceeds the Acceptable Daily Intake (ADI) of EDTA for this age group. EDTA increases iron absorption at a molar ratio EDTA:iron of less than 1:1.

OBJECTIVE

To determine whether iron absorption is enhanced with a mixture offerrous sulfate (FeSO₄) and NaFeEDTA.

METHODS

Two studies with a crossover design were conducted in separate groups of 14 and 15 children aged 24 to 31 months. A complementary food consisting of millet porridge with cabbage, tofu, and pork-filled wheat flour dumplings was fortified with 2 mg iron as either FeSO₄ or NaFeEDTA (study 1) or 4 mg iron as FeSO₄ or a mixture of 2 mg each of FeSO₄ and NaFeEDTA (study 2). Iron absorption was determined based on erythrocyte incorporation of stable iron isotopes.

RESULTS

In study 1, the geometric mean (± SD) iron absorption was 8.0% (3.1, 20.8) and 9.2% (3.1, 27.0) from food fortified with FeSO₄ and NaFeEDTA, respectively. In study 2, iron absorption was significantly higher from food fortified with 4 mg iron as 1:1 mixture of FeSO₄/NaFeEDTA than from food fortified with FeSO₄; the geometric mean iron absorption was 6.4% (3.0, 13.5) and 4.1% (1.9, 8.9), respectively.

CONCLUSIONS

The enhancing effect of EDTA on iron absorption is less strong in composite meals containing enhancers; nevertheless, the equal mixture of FeSO₄ and NaFeEDTA significantly enhanced iron absorption and can be a strategy to ensure adequate iron absorption from phytate-containing complementary foods.

Effect of iron-fortified foods on hematologic and biological outcomes: systematic review of randomized controlled trials

BACKGROUND

The utility of iron fortification of food to improve iron deficiency, anemia, and biological outcomes is not proven unequivocally.

OBJECTIVES

The objectives were to evaluate 1) the effect of iron fortification on hemoglobin and serum ferritin and the prevalence of iron deficiency and anemia, 2) the possible predictors of a positive hemoglobin response, 3) the effect of iron fortification on zinc and iron status, and 4) the effect of iron-fortified foods on mental and motor development, anthropometric measures, and infections.

DESIGN

Randomized and pseudorandomized controlled trials that included food fortification or biofortification with iron were included.

RESULTS

Data from 60 trials showed that iron fortification of foods resulted in a significant increase in hemoglobin (0.42 g/dL; 95% CI: 0.28, 0.56; P < 0.001) and serum ferritin (1.36 μg/L; 95% CI: 1.23, 1.52; P < 0.001), a reduced risk of anemia (RR: 0.59; 95% CI: 0.48, 0.71; P < 0.001) and iron deficiency (RR: 0.48; 95% CI: 0.38, 0.62; P < 0.001), improvement in other indicators of iron nutriture, and no effect on serum zinc concentrations, infections, physical growth, and mental and motor development. Significant heterogeneity was observed for most of the evaluated outcomes. 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.

CONCLUSION

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.

A re-analysis of the iron content of plant-based foods in the United Kingdom

In the UK contemporary estimates of dietary Fe intakes rely upon food Fe content data from the 1980s or before. Moreover, there has been speculation that the natural Fe content of foods has fallen over time, predominantly due to changes in agricultural practices. Therefore, we re-analysed common plant-based foods of the UK diet for their Fe content (the '2000s analyses') and compared the values with the most recent published values (the '1980s analyses') and the much older published values (the '1930s analyses'), the latter two being from different editions of the McCance and Widdowson food tables. Overall, there was remarkable consistency between analytical data for foods spanning the 70 years. There was a marginal, but significant, apparent decrease in natural food Fe content from the 1930s to 1980s/2000s. Whether this represents a true difference or is analytical error between the eras is unclear and how it could translate into differences in intake requires clarification. However, fortificant Fe levels (and fortificant Fe intake based upon linked national data) did appear to have increased between the 1980s and 2000s, and deserve further attention in light of recent potential concerns over the long-term safety and effectiveness of fortificant Fe. In conclusion, the overall Fe content of plant-based foods is largely consistent between the 1930s and 2000s, with a fall in natural dietary Fe content negated or even surpassed by a rise in fortificant Fe but for which the long-term effects are uncertain.

Efficacy of a microencapsulated iron pyrophosphate-fortified fruit juice: a randomised, double-blind, placebo-controlled study in Spanish iron-deficient women. Br J Nutr. 2011;105:1652-1659. [PMID: 21303569 DOI: 10.1017/s0007114510005490]

Fe-deficiency anaemia is a worldwide health problem. We studied the influence of consuming an Fe-fortified fruit juice on Fe status in menstruating women. A randomised, double-blind, placebo-controlled study of 16 weeks of duration was performed. Subjects were randomised into two groups: the P group (n 58) or the F group (n 64), and consumed, as a supplement to their usual diet, 500 ml/d of a placebo fruit juice or an Fe-fortified fruit juice, respectively. The Fe-fortified fruit juice, containing microencapsulated iron pyrophosphate, provided 18 mg Fe/d (100 % of the RDA). At baseline and monthly, dietary intake, body weight and Fe parameters were determined: total erythrocytes, haematocrit, mean corpuscular volume (MCV), red blood cell distribution width (RDW), Hb, serum Fe, serum ferritin, serum transferrin, transferrin saturation, soluble transferrin receptor (sTfR) and zinc protoporphyrin (ZnPP). The fruit juice consumption involved increased intake of carbohydrates and vitamin C, and increased BMI within normal limits. Ferritin was higher in the F group after week 4 (P < 0·05) and became 80 % higher than in the P group after week 16 (P < 0·001), and transferrin decreased in the F group compared with the P group after week 4 (P < 0·001). RDW was higher at weeks 4 and 8 in the F group compared with the P group (P < 0·05). Transferrin saturation increased after week 8, and haematocrit, MCV and Hb increased after week 12, in the F group compared with the P group. Serum Fe did not change. sTfR and ZnPP decreased in the F group at week 16 (P < 0·05). Iron pyrophosphate-fortified fruit juice improves Fe status and may be used to prevent Fe-deficiency anaemia.

Gold kiwifruit consumed with an iron-fortified breakfast cereal meal improves iron status in women with low iron stores: a 16-week randomised controlled trial

Ascorbic acid, and more recently, the carotenoids lutein and zeaxanthin have been shown to enhance Fe absorption. However, it is not clear whether Fe status improves when foods high in ascorbic acid and carotenoids are consumed with Fe-fortified meals. The present study aimed to investigate whether consuming highv.low ascorbic acid-, lutein- and zeaxanthin-rich fruit (gold kiwifruitv.banana) with Fe-fortified breakfast cereal and milk improved Fe status in women with low Fe stores. Healthy women aged 18–44 years (n89) with low Fe stores (serum ferritin ≤ 25 μg/l and Hb ≥ 115 g/l) were randomly stratified to receive Fe-fortified breakfast cereal (16 mg Fe as ferrous sulfate), milk and either two gold kiwifruit or one banana (164 mgv.not detectable ascorbic acid; 526v.22·90 μg lutein and zeaxanthin, respectively) at breakfast every day for 16 weeks. Biomarkers of Fe status and dietary intake were assessed at baseline and end in the final sample (n69). Median serum ferritin increased significantly in the kiwifruit group (n33) compared with the banana group (n36), with 10·0 (25th, 75th percentiles 3·0, 17·5)v.1·0 (25th, 75th percentiles − 2·8, 6·5) μg/l (P < 0·001). Median soluble transferrin receptor concentrations decreased significantly in the kiwifruit group compared with the banana group, with − 0·5 (25th, 75th percentiles − 0·7, − 0·1)v.0·0 (25th, 75th percentiles − 0·3, 0·4) mg/l (P = 0·001). Consumption of an Fe-fortified breakfast cereal with kiwifruit compared with banana improved Fe status. Addition of an ascorbic acid-, lutein- and zeaxanthin-rich fruit to a breakfast cereal fortified with ferrous sulfate is a feasible approach to improve Fe status in women with low Fe stores.

Ability of selected lactic acid bacteria to ferment a pearl millet-soybean slurry to produce gruels for complementary foods for young children

To assess the ability of lactic acid bacteria to improve some nutritional characteristics of the pearl millet-soybean slurry to prepare complementary foods for young children in African countries, inoculation was performed using strains previously selected for their ability to hydrolyse starch, phytate, or alpha-galactooligosaccharides (alpha-GOS). For the sake of comparison with the action of a natural microflora, fermentation was also performed by back slopping inoculation, that is, with a sample obtained from spontaneously fermented traditional pearl millet slurry obtained from a small scale processing unit in Burkina Faso (Ouagadougou). Starter cultures thrived on the slurry as shown by counts on MRS agar, TTGE fingerprints, and fermentation patterns. The fermentation of precooked slurries inoculated by back slopping or with mixed cultures containing the amylolytic strain Lb. plantarum A6 enabled partial starch hydrolysis. Corresponding gruels had a suitable consistency for young child feeding at high dry matter content, and a high energy density: 88.7 +/- 4.2 and 75.8 +/- 5.1 kcal/100 g of sweetened gruel, for the gruels inoculated by back slopping or with Lb. plantarum A6, respectively. Unexpectedly, no decrease in phytates was observed in any of the experiments, suggesting the presence of one or more inhibitory compounds in soybean. Furthermore, preprocessing conditions before fermentation affect the carbohydrate composition of slurry and have a more profound effect than fermentation on the reduction of the alpha-GOS content.