title: Ferrous gluconate and ferrous sulfate added to a complementary food distributed by the Mexican nutrition program Oportunidades have a comparable efficacy to reduce iron deficiency in toddlers.
abstract: OBJECTIVE
  To assess the efficacy of ferrous sulfate (FS) and ferrous gluconate (FG) as fortificants for a complementary baby food (Nutrisano) to improve the iron status and to reduce the prevalence of anemia in toddlers.
  
  
  METHODS
  Toddlers 12 to 30 months old were randomly assigned to receive either of 3 versions of Nutrisano fortified with FS or FG or not fortified (CG) for 6 months. In final blood samples, the concentrations of hemoglobin, serum ferritin, and soluble transferrin receptors (sTfR) were determined. The effects of treatment on final hemoglobin, ferritin, and sTfR were assessed by multivariate analysis.
  
  
  RESULTS
  No significant changes in hemoglobin were observed within or among treatment groups. The prevalence of high sTfR decreased 7.1 percentage points in FG, increased 13.1 percentage points in FS, and increased 0.7 percentage points in CG (P>0.05). In an interaction between treatment and total intake of Nutrisano on the concentration of ferritin, sTfR, and total iron body stores, adjusted means of serum ferritin in the medium tertiles of intake of Nutrisano for FS (P=0.05) and in the higher and medium tertiles for FG were higher (P=0.001), and adjusted means of sTfR were significantly lower (P<0.001), than the respective lower tertile of intake.
  
  
  CONCLUSIONS
  Fortification of Nutrisano with FG has an acceptable level of beneficial effect on markers of iron status. The satisfactory efficacy and other sensory data has led to the political decision to substitute hydrogen-reduced iron, used formerly as a fortificant, with FG. Studies to assess the effectiveness of the reformulated Nutrisano are in order.
authors.affiliation: National Institute of Public Health, Center for Research in Nutrition and Health, Cuernavaca, Morelos, Mexico.
authors.forename: Teresa
authors.initials: T
authors.lastname: Shamah-Levy
authors.forename: Salvador
authors.initials: S
authors.lastname: Villalpando
authors.forename: Juan A
authors.initials: JA
authors.lastname: Rivera-Dommarco
authors.forename: Verónica
authors.initials: V
authors.lastname: Mundo-Rosas
authors.forename: Lucia
authors.initials: L
authors.lastname: Cuevas-Nasu
authors.forename: Alejandra
authors.initials: A
authors.lastname: Jiménez-Aguilar
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D005296:Ferrous Compounds / Q000627:therapeutic use*; D005503:Food Additives / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007225:Infant Food; D007501:Iron / Q000378:metabolism; D008297:Male; D008800:Mexico / Q000453:epidemiology; D015999:Multivariate Analysis; D015995:Prevalence; D012042:Registries
chemical_list: D005296:Ferrous Compounds; D005503:Food Additives; D006397:Hematinics; D006454:Hemoglobins; C020748:ferrous sulfate; D007501:Iron; C011819:ferrous gluconate