Dual fortification of salt with iodine and micronized ferric pyrophosphate: a randomized, double-blind, controlled trial.

Abstract

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 iodate)/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, randomized, 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.

• Authors: Michael B Zimmermann, Rita Wegmueller, Christophe Zeder, Nourredine Chaouki, Fabian Rohner, Mohammed Saïssi, Toni Torresani, Richard F Hurrell
• Journal: The American journal of clinical nutrition (Am J Clin Nutr) Vol. 80 Issue 4 Pg. 952-9 (Oct 2004) ISSN: 0002-9165 [Print] United States
• PMID: 15447905 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Diphosphates
• Iron, Dietary
• Sodium Chloride, Dietary
• iodized salt
• Iodine
• Iron
• ferric pyrophosphate

Topics

• Adolescent
• Adolescent Nutritional Physiological Phenomena
• Anemia, Iron-Deficiency (epidemiology, prevention & control)
• Biological Availability
• Child
• Child Nutritional Physiological Phenomena
• Diphosphates (pharmacokinetics, therapeutic use)
• Double-Blind Method
• Female
• Food Handling (methods)
• Food, Fortified
• Goiter (epidemiology, prevention & control)
• Humans
• Intestinal Absorption
• Iodine (pharmacokinetics, therapeutic use)
• Iron (pharmacokinetics, therapeutic use)
• Iron, Dietary (pharmacokinetics, therapeutic use)
• Male
• Morocco (epidemiology)
• Prevalence
• Rural Health
• Sodium Chloride, Dietary (pharmacokinetics, therapeutic use)
• Thyroid Gland (drug effects)
• Time Factors
• Treatment Outcome