Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized ferric pyrophosphate and encapsulated ferrous fumarate in southern India.
BACKGROUND
Dual fortification of salt with iodine and iron could be a sustainable approach to combating iodine and iron deficiencies.


OBJECTIVE
We compared the efficacy of dual-fortified salt (DFS) made by using 2 proposed contrasting formulas-one fortifying with iron as micronized ground ferric pyrophosphate (MGFePP) and the other with iron as encapsulated ferrous fumarate (EFF)-with the efficacy of iodized salt (IS) in schoolchildren in rural southern India.


METHODS
After stability and acceptability testing, a double-blind, household-based intervention was conducted in 5-15-y-old children (n = 458) randomly assigned into 3 groups to receive IS or DFS with iron as MGFePP or EFF, both at 2 mg/g salt. We measured hemoglobin, iron status, and urinary iodine at baseline, 5 mo, and 10 mo.


RESULTS
Median serum ferritin and calculated median body iron improved significantly in the 2 groups receiving iron. After 10 mo, the prevalence of anemia decreased from 16.8% to 7.7% in the MGFePP group (P < 0.05) and from 15.1% to 5.0% in the EFF group (P < 0.01). The median urinary iodine concentration increased significantly in the IS and EFF groups (P < 0.001) but not in the MGFePP group. Losses of iodine in salt with 1.8% moisture were high for MGFePP, whereas the EFF segregated in salt with 0.5% moisture and caused color changes in some local foods.


CONCLUSIONS
Both DFSs were efficacious in reducing the prevalence of anemia and iron deficiency in school-age children. Local salt characteristics should be taken into consideration when choosing an iron fortificant for DFS to achieve optimal iodine stability and color.
Andersson
Maria
M
Human Nutrition Laboratory, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland. maria.andersson@ilw.agrl.ethz.ch
Thankachan
Prashanth
P
Muthayya
Sumithra
S
Goud
Ramakrishna B
RB
Kurpad
Anura V
AV
Hurrell
Richard F
RF
Zimmermann
Michael B
MB
D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000517:prevention & control*; D001682:Biological Availability; D002648:Child; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology; D002675:Child, Preschool; D011756:Diphosphates; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005296:Ferrous Compounds; D005527:Food, Fortified; D006042:Goiter / Q000453:epidemiology / Q000517:prevention & control*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007194:India / Q000453:epidemiology; D007455:Iodine / Q000008:administration & dosage / Q000032:analysis / Q000172:deficiency / Q000627:therapeutic use* / Q000652:urine; D007501:Iron / Q000097:blood*; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D008297:Male; D015995:Prevalence; D012423:Rural Health; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D016896:Treatment Outcome
D011756:Diphosphates; D005296:Ferrous Compounds; D006454:Hemoglobins; D019266:Iron, Dietary; D017673:Sodium Chloride, Dietary; C034024:iodized salt; D005293:Ferritins; D007455:Iodine; D007501:Iron; C049051:ferric pyrophosphate; C031621:ferrous fumarate