title: Comparison of the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced elemental iron: randomized, double-blind, controlled trial in Thai women.
abstract: BACKGROUND
  Although elemental iron powders are widely used to fortify cereal products, little data exist on their efficacy in humans.
  
  
  OBJECTIVE
  We compared the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced iron in Thai women with low iron stores.
  
  
  METHODS
  A double-blind intervention was conducted in 18-50-y-old women (n = 330) randomly assigned into 4 groups to receive either no fortification iron or 12 mg Fe/d for 6 d/wk for 35 wk as ferrous sulfate, electrolytic iron, or hydrogen-reduced iron in a baked, wheat-flour-based snack. Snacks were not consumed with meals, and consumption was monitored. At baseline, 20 wk, and 35 wk, hemoglobin status and iron were measured and the groups were compared.
  
  
  RESULTS
  Between baseline and 35 wk, geometric mean serum ferritin (SF) increased significantly in all 3 groups receiving iron (P < 0.01), and geometric mean serum transferrin receptor (TfR) decreased significantly in the groups receiving ferrous sulfate and electrolytic iron (P < 0.05). Calculated mean (+/-SD) body iron stores increased from 1.5 +/- 2.8 to 5.4 +/- 2.9 mg/kg in the ferrous sulfate group, from 1.5 +/- 3.5 to 4.4 +/- 3.6 mg/kg in the electrolytic iron group, and from 1.3 +/- 3.2 to 3.2 +/- 4.3 mg/kg in the hydrogen-reduced iron group (P < 0.01 for all 3 groups) but did not change significantly in the control group.
  
  
  CONCLUSIONS
  Ferrous sulfate, electrolytic iron, and hydrogen-reduced iron, fortified into wheat-based snacks, significantly improved iron status. On the basis of the change in body iron stores during the 35-wk study, the relative efficacy of the electrolytic and hydrogen-reduced iron compared with ferrous sulfate was 77% and 49%, respectively.
authors.affiliation: Laboratory for Human Nutrition, Swiss Federal Institute of Technology, Zürich, Switzerland. michael.zimmermann@ilw.agrl.ethz.ch
authors.forename: Michael B
authors.initials: MB
authors.lastname: Zimmermann
authors.forename: Pattanee
authors.initials: P
authors.lastname: Winichagoon
authors.forename: Sueppong
authors.initials: S
authors.lastname: Gowachirapant
authors.forename: Sonja Y
authors.initials: SY
authors.lastname: Hess
authors.forename: Mary
authors.initials: M
authors.lastname: Harrington
authors.forename: Visith
authors.initials: V
authors.lastname: Chavasit
authors.forename: Sean R
authors.initials: SR
authors.lastname: Lynch
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hurrell
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000517:prevention & control; D001682:Biological Availability; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005296:Ferrous Compounds / Q000008:administration & dosage / Q000493:pharmacokinetics; D005527:Food, Fortified / Q000592:standards; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007408:Intestinal Absorption; D019266:Iron, Dietary / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000592:standards; D008875:Middle Aged; D011990:Receptors, Transferrin / Q000097:blood; D013785:Thailand; D016896:Treatment Outcome; D014908:Triticum
chemical_list: D005296:Ferrous Compounds; D006454:Hemoglobins; D019266:Iron, Dietary; D011990:Receptors, Transferrin; C020748:ferrous sulfate; D005293:Ferritins