title: Iron fortification reduces blood lead levels in children in Bangalore, India.
abstract: OBJECTIVE
  Chronic lead poisoning and iron deficiency are concentrated in urban children from lower socioeconomic strata, and both impair neurocognitive development. Our study objective was to determine if iron fortification reduces blood lead levels in urban, lead-exposed, iron-deficient children in Bangalore, India.
  
  
  METHODS
  A randomized, double-blind, controlled school-based feeding trial was done in 5- to 13-year-old iron-deficient children (n = 186). At baseline, a high prevalence of lead poisoning was found in the younger children. Subsequently, all 5- to 9-year-old children participating in the trial (n = 134) were followed to determine if iron fortification would affect their blood lead levels.
  
  
  METHODS
  Children were dewormed and fed 6 days/week for 16 weeks either an iron-fortified rice meal (approximately 15 mg of iron per day as ferric pyrophosphate) or an identical control meal without added iron. Feeding was directly supervised and compliance monitored.
  
  
  METHODS
  Hemoglobin, serum ferritin, C-reactive protein, transferrin receptor, zinc protoporphyrin, and blood lead concentrations were measured.
  
  
  RESULTS
  The prevalence of iron deficiency was significantly reduced in the iron group (from 70% to 28%) compared with the control group (76% to 55%). There was a significant decrease in median blood lead concentration in the iron group compared with the control group. The prevalence of blood lead levels > or =10 microg/dL was significantly reduced in the iron group (from 65% to 29%) compared with the control group (68% to 55%).
  
  
  CONCLUSIONS
  Our findings suggest providing iron in a fortified food to lead-exposed children may reduce chronic lead intoxication. Iron fortification may be an effective and sustainable strategy to accompany environmental lead abatement.
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: Sumithra
authors.initials: S
authors.lastname: Muthayya
authors.forename: Diego
authors.initials: D
authors.lastname: Moretti
authors.forename: Anura
authors.initials: A
authors.lastname: Kurpad
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hurrell
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D011756:Diphosphates / Q000627:therapeutic use*; D004311:Double-Blind Method; D005527:Food, Fortified; D006801:Humans; D007194:India; D007501:Iron / Q000627:therapeutic use; D000090463:Iron Deficiencies; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000097:blood* / Q000188:drug therapy*; D014505:Urban Population
chemical_list: D011756:Diphosphates; D007854:Lead; D007501:Iron; C049051:ferric pyrophosphate