Regular consumption of a complementary food fortified with ascorbic acid and ferrous fumarate or ferric pyrophosphate is as useful as ferrous sulfate in maintaining hemoglobin concentrations >105 g/L in young Bangladeshi children.
BACKGROUND
Non-water-soluble iron compounds have been reported to be less well absorbed than ferrous sulfate in young children, and concern has been raised about their usefulness as food fortificants.


OBJECTIVE
The objective was to evaluate the usefulness of ferrous fumarate and ferric pyrophosphate, compared with ferrous sulfate, in maintaining hemoglobin concentrations >105 g/L in Bangladeshi children.


METHODS
Two hundred thirty-five children aged 7-24 mo (hemoglobin >105 g/L) were randomly assigned in a double-blind study to receive an infant cereal fortified with ferrous fumarate, ferric pyrophosphate, or ferrous sulfate. One serving of cereal (9.3 mg Fe; molar ratio of ascorbic acid to iron of 3:1) was consumed per day, 6 d/wk, for 9 mo. Blood samples were drawn at 4.5 and 9 mo.


RESULTS
Raw data were reformatted, and a "time to event" was calculated that corresponded to reaching the following thresholds: hemoglobin <105 g/L, plasma ferritin <12 microg/L, or plasma C-reactive protein >10 mg/L at baseline, 4.5 mo, or 9 mo. Data were censored when children did not reach the threshold or were lost to follow-up. A Kaplan-Meier approach was used to compare the 3 groups. No statistically significant differences were observed for hemoglobin <105 g/L (P = 0.943), plasma ferritin <12 microg/L (P = 0.601), or plasma C-reactive protein >10 mg/L (P = 0.508).


CONCLUSIONS
Contrary to earlier concerns, these results do not indicate differences in usefulness between water-soluble and non-water-soluble iron compounds in maintaining hemoglobin concentrations and preventing iron deficiency. These data will be important in the development of food-fortification strategies to combat anemia and iron deficiency in highly vulnerable population groups.
Davidsson
Lena
L
Laboratory for Human Nutrition, Swiss Federal Institute of Technology, ETH Zentrum, Zurich, Switzerland. davidssonlena@hotmail.com
Sarker
Shafiqual Alam
SA
Jamil
Kazi Asif
KA
Sultana
Shamima
S
Hurrell
Richard
R
D018798:Anemia, Iron-Deficiency / Q000517:prevention & control; D001205:Ascorbic Acid / Q000008:administration & dosage*; D001459:Bangladesh; D002097:C-Reactive Protein / Q000378:metabolism*; D002675:Child, Preschool; D011756:Diphosphates / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005293:Ferritins / Q000097:blood; D005296:Ferrous Compounds / Q000008:administration & dosage / Q000494:pharmacology*; D005527:Food, Fortified; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007501:Iron / Q000008:administration & dosage / Q000494:pharmacology*; D019266:Iron, Dietary / Q000008:administration & dosage; D008297:Male; D014131:Trace Elements / Q000008:administration & dosage / Q000494:pharmacology
D011756:Diphosphates; D005296:Ferrous Compounds; D006454:Hemoglobins; D019266:Iron, Dietary; D014131:Trace Elements; C020748:ferrous sulfate; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron; D001205:Ascorbic Acid; C049051:ferric pyrophosphate; C031621:ferrous fumarate