Dual fortification of salt with iodine and microencapsulated iron: a randomized, double-blind, controlled trial in Moroccan schoolchildren.
BACKGROUND
In many developing countries, children are at high risk of both goiter and iron deficiency anemia.


OBJECTIVE
In a series of studies in northern Morocco, we developed and tested a dual-fortified salt (DFS) containing iodine and microencapsulated iron.


METHODS
To establish the DFS fortification concentration, we measured salt intake by 3-d weighed food records and estimated iron bioavailability from the local diet by using published algorithms. We then formulated a DFS containing 25 micro g iodine/g salt (as potassium iodide) and 1 mg iron/g salt (as ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil). After storage and acceptability trials, we compared the efficacy of the DFS to that of iodized salt in a 9-mo, randomized, double-blind trial in iodine-deficient, 6-15-y-old children (n = 377).


RESULTS
Mean salt intake in school-age children was 7-12 g/d, and estimated iron bioavailability from the local diet was 0.4-4.3%. After storage for 20 wk, the DFS and iodized salt were not significantly different in iodine content, and color stability was acceptable when the compounds were added to local meals. During the efficacy trial, urinary iodine concentrations and thyroid volumes improved significantly (P < 0.001 and < 0.05, respectively) from baseline in both groups. At 40 wk, mean hemoglobin concentrations in the DFS group had increased by 14 g/L (P < 0.01), and serum ferritin, transferrin receptor, and zinc protoporphyrin concentrations were significantly better (P < 0.05) in the DFS group than in the iodized salt group. The prevalence of iron deficiency anemia in the DFS group decreased from 35% at baseline to 8% at 40 wk (P < 0.001).


CONCLUSIONS
A DFS containing iodine and encapsulated iron can be an effective fortification strategy.
Zimmermann
Michael B
MB
Human Nutrition Laboratory, Instituts of Food Science and Nutrition, Swiss Federal Institute of Technology, Zürich, Switzerland. michael.zimmermann@ilw.agrl.ethz.ch
Zeder
Christophe
C
Chaouki
Noureddine
N
Saad
Amina
A
Torresani
Toni
T
Hurrell
Richard F
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D001682:Biological Availability; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004339:Drug Compounding; D005260:Female; D005511:Food Handling / Q000379:methods; D005527:Food, Fortified; D006042:Goiter / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007455:Iodine / Q000627:therapeutic use*; D019266:Iron, Dietary / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D015995:Prevalence; D017673:Sodium Chloride, Dietary / Q000627:therapeutic use*; D013961:Thyroid Gland / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome
D019266:Iron, Dietary; D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine