title: Suitability of instant noodles for iron fortification to combat iron-deficiency anemia among primary schoolchildren in rural Vietnam.
abstract: BACKGROUND
  Anemia is a significant public health problem among schoolchildren in Vietnam. Food fortification is considered one of the most sustainable long-term strategies to control iron-deficiency anemia in Vietnam. The success of a food-fortification program depends on the choice of the food vehicle.
  
  
  OBJECTIVE
  The aim of the present study was to identify an appropriate vehicle for iron fortification to be used in a school-feeding program aimed at improving the iron and anemia status of schoolchildren in rural Vietnam.
  
  
  METHODS
  Children 6 to 8 years of age in two primary schools in Tam Nong District, Phu Tho Province, and their parents were included in this study. The study consisted of three substudies: a food-consumption study with 24-hour recalls of two nonconsecutive days; a food-beliefs study, with focus group discussions, a pile-sorting test, and a food attributes and differences exercise; and a food-acceptance study using noodles and biscuits fortified with sodium iron ethylenediaminetetraacetic acid (NaFeEDTA).
  
  
  RESULTS
  The average number of meals consumed daily was 3.2 +/- 0.4, and the average intakes of energy and iron were 1,218 +/- 406 kcal and 7.5 +/- 4.0 mg, respectively. Compared with biscuits and instant rice soup, instant noodles were consumed more frequently and in larger portion sizes and are more acceptable as children's food in the culture of the local people. The iron level of the fortified product did not affect the mean consumption of noodles, but a higher level of iron was associated with a lower mean consumption of biscuits (p < .05). The production process did not affect the NaFeEDTA level in noodles; however, during preparation at least 70% of the iron is leaked into the soup.
  
  
  CONCLUSIONS
  Instant noodles are a suitable vehicle for iron fortification for use in school-based intervention to improve iron-deficiency anemia among primary schoolchildren in rural Vietnam.
authors.affiliation: Nutrition Department, Hanoi Medical University, Vietnam. huong.lethi@wur.nl
authors.forename: Huong Thi
authors.initials: HT
authors.lastname: Le
authors.forename: Inge D
authors.initials: ID
authors.lastname: Brouwer
authors.forename: Corine A
authors.initials: CA
authors.lastname: de Wolf
authors.forename: Lidwien
authors.initials: L
authors.lastname: van der Heijden
authors.forename: Khan Cong
authors.initials: KC
authors.lastname: Nguyen
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Kok
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D001682:Biological Availability; D002648:Child; D004492:Edetic Acid / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D005527:Food, Fortified; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D012423:Rural Health; D012574:Schools; D014744:Vietnam / Q000453:epidemiology
chemical_list: D019266:Iron, Dietary; D004492:Edetic Acid