title: Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children.
abstract: Wheat is the primary staple food for nearly one-third of the world's population. NaFeEDTA is the only iron (Fe) compound suitable for fortifying high extraction flours. We tested the hypothesis that NaFeEDTA-fortified, whole wheat flour reduces Fe deficiency (ID) and improves body Fe stores (BIS) and cognitive performance in Indian children. In a randomized, double-blind, controlled, school feeding trial, 6- to 15-y-old, Fe-depleted children (n = 401) were randomly assigned to either a daily wheat-based lunch meal fortified with 6 mg of Fe as NaFeEDTA or an otherwise identical unfortified control meal. Hemoglobin (Hb) and Fe status were measured at baseline, 3.5 mo, and 7 mo. Cognitive performance was evaluated at baseline and 7 mo in children (n = 170) at one of the study sites. After 7 mo, the prevalence of ID and ID anemia in the treatment group significantly decreased from 62 to 21% and 18 to 9%, respectively. There was a time x treatment interaction for Hb, serum ferritin, transferrin receptor, zinc protoporphyrin, and BIS (all P < 0.0001). Changes in BIS differed between the groups; it increased in the treatment group (0.04 ± 0.04 mmol/kg body weight) and decreased in the control group (-0.02 ± 0.04 mmol/kg body weight) (P < 0.0001). In sensory tests, NaFeEDTA-fortified flour could not be differentiated from unfortified flour. There were no significant differences in cognitive performance tests between the groups. NaFeEDTA-fortified wheat flour markedly improved BIS and reduced ID in Fe-depleted children. It may be recommended for wider use in national school feeding programs.
authors.affiliation: Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India. sumi.muthayya@gmail.com
authors.forename: Sumithra
authors.initials: S
authors.lastname: Muthayya
authors.forename: Prashanth
authors.initials: P
authors.lastname: Thankachan
authors.forename: Siddhivinayak
authors.initials: S
authors.lastname: Hirve
authors.forename: Vani
authors.initials: V
authors.lastname: Amalrajan
authors.forename: Tinku
authors.initials: T
authors.lastname: Thomas
authors.forename: Himangi
authors.initials: H
authors.lastname: Lubree
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Agarwal
authors.forename: Krishnamachari
authors.initials: K
authors.lastname: Srinivasan
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hurrell
authors.forename: Chittaranjan S
authors.initials: CS
authors.lastname: Yajnik
authors.forename: Anura V
authors.initials: AV
authors.lastname: Kurpad
mesh_terms: D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005433:Flour / Q000032:analysis*; D005527:Food, Fortified / Q000032:analysis*; D005786:Gene Expression Regulation / Q000187:drug effects; D006454:Hemoglobins; D006801:Humans; D007194:India / Q000453:epidemiology; D007501:Iron / Q000008:administration & dosage* / Q000378:metabolism / Q000494:pharmacology*; D008297:Male; D015995:Prevalence; D011524:Protoporphyrins / Q000235:genetics / Q000378:metabolism; D011990:Receptors, Transferrin / Q000235:genetics / Q000378:metabolism; D014908:Triticum / Q000737:chemistry*
chemical_list: D006454:Hemoglobins; D011524:Protoporphyrins; D011990:Receptors, Transferrin; C017803:zinc protoporphyrin; D005293:Ferritins; D007501:Iron