Efficacy of iron-fortified whole maize flour on iron status of schoolchildren in Kenya: a randomised controlled trial.
BACKGROUND
Sodium iron edetic acid (NaFeEDTA) might be a more bioavailable source of iron than electrolytic iron, when added to maize flour. We aimed to assess the effect, on children's iron status, of consumption of whole maize flour fortified with iron as NaFeEDTA or electrolytic iron.


METHODS
516 children, aged 3-8 years, from four schools in Marafa, Kenya, were randomly assigned to four groups. All were given the same amount of porridge five times a week. The porridge for one group was made from unfortified whole maize flour; for the other three groups it was fortified with either high-dose NaFeEDTA (56 mg/kg), low-dose NaFeEDTA (28 mg/kg), or electrolytic iron (56 mg/kg). Concentrations of haemoglobin, plasma ferritin, and transferrin receptor were analysed in samples taken at baseline and at the end of the 5-month intervention. The primary outcome was iron-deficiency anaemia. We analysed data on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00386074.


RESULTS
The prevalence of iron-deficiency anaemia in children given unfortified flour was 10%. Compared with placebo, the prevalence of iron-deficiency anaemia in children given flour fortified with high-dose NaFeEDTA, low-dose NaFeEDTA, and electrolytic iron changed by -89% (95% CI -97% to -49%), -48% (-77% to 20%), and 59% (-18% to 209%), respectively. Consumption of high-dose NaFeEDTA improved all measured iron-status indicators. Low-dose NaFeEDTA decreased the prevalence of iron deficiency but did not noticeably change the prevalence of anaemia. Electrolytic iron did not improve any of these iron-status indicators. Children who were iron-deficient at baseline benefited more from high-dose and low-dose NaFeEDTA than those with sufficient iron at baseline.


CONCLUSIONS
Consumption of whole maize flour fortified with NaFeEDTA caused modest, dose-dependent improvements in children's iron status. Fortification with electrolytic iron did not improve their iron status. Therefore, in high-phytate flours, NaFeEDTA is more suitable than electrolytic iron for supplementation of iron in the diet.
Andang'o
Pauline Ea
PE
Kenya Medical Research Institute, Centre for Public Health Research, Nairobi, Kenya; Division of Human Nutrition, Wageningen University, Netherlands. Electronic address: pauline.andango@wur.nl.
Osendarp
Saskia Jm
SJ
Unilever Food and Health Research Institute, Vlaardingen, Netherlands.
Ayah
Rosemary
R
Kenya Medical Research Institute, Centre for Public Health Research, Nairobi, Kenya.
West
Clive E
CE
Division of Human Nutrition, Wageningen University, Netherlands.
Mwaniki
David L
DL
Kenya Medical Research Institute, Centre for Public Health Research, Nairobi, Kenya.
De Wolf
Corine A
CA
Akzo Nobel Chemicals, Arnhem, Netherlands.
Kraaijenhagen
Rob
R
Meander Medical Centre, Amersfoort, Netherlands.
Kok
Frans J
FJ
Division of Human Nutrition, Wageningen University, Netherlands.
Verhoef
Hans
H
Cell Biology and Immunology Group, Wageningen University, Netherlands.
D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004492:Edetic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D002523:Edible Grain; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D005527:Food, Fortified; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D009752:Nutritional Status / Q000187:drug effects*; D015995:Prevalence
D005290:Ferric Compounds; D007502:Iron Chelating Agents; D004492:Edetic Acid; D007501:Iron; C019179:Fe(III)-EDTA