title: Double-fortified salt is efficacious in improving indicators of iron deficiency in female Indian tea pickers.
abstract: Poor iron status affects 50% of Indian women and compromises work productivity, cognitive performance, and reproduction. Among the many strategies to reduce iron deficiency is the commercial fortification of iodized table salt with iron to produce a double-fortified salt (DFS). The objective of this study was to test the efficacy of DFS in reducing iron deficiency in rural women of reproductive age from northern West Bengal, India. The participants were 212 women between 18 and 55 y of age who worked as full-time tea pickers on a large tea estate. Participants in the randomized, controlled, double-blind study were assigned to use either DFS or a control iodized salt for 7.5 to 9 mo. The DFS was fortified with 3.3-mg ferrous fumarate (1.1-mg elemental iron) per kg of iodized salt, whereas the control salt contained only iodine (47 mg/kg potassium iodate), and both salt varieties were distributed gratis to the families of participants at 0.5 kg/mo for each 2 household members. At baseline, 53% of participants were anemic (hemoglobin <120 g/L), 25% were iron deficient (serum ferritin <12 μg/L), and 23% were iron-deficient anemic. Also, 22% had a transferrin receptor concentration >8.6 mg/L and 22% had negative (<0.0 mg/kg) body iron stores. After 9 mo the participants receiving DFS showed significant improvements compared with controls in hemoglobin (+2.4 g/L), ferritin (+0.13 log10 μg/L), soluble transferrin receptor (-0.59 mg/L), and body iron (+1.43 mg/kg), with change in status analyzed by general linear models controlling for baseline values. This study demonstrated that DFS is an efficacious approach to improving iron status and should be further evaluated for effectiveness in the general population. This trial was registered at clinicaltrials.gov as NCT01032005.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY jdh12@cornell.edu.
authors.forename: Jere D
authors.initials: JD
authors.lastname: Haas
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY.
authors.forename: Maike
authors.initials: M
authors.lastname: Rahn
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada.
authors.forename: Sudha
authors.initials: S
authors.lastname: Venkatramanan
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada.
authors.forename: Grace S
authors.initials: GS
authors.lastname: Marquis
authors.affiliation: Departments of Psychology and Cellular and Behavioral Neurobiology, University of Oklahoma, Norman, OK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wenger
authors.affiliation: Department of Nutritional Science, Pennsylvania State University, University Park, PA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Murray-Kolb
authors.affiliation: Micronutrient Initiative and International Development Research Centre, Ottawa, ON, Canada; and.
authors.forename: Annie S
authors.initials: AS
authors.lastname: Wesley
authors.affiliation: Mathile Institute for the Advancement of Human Nutrition, Dayton, OH.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Reinhart
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology* / Q000517:prevention & control; D000886:Anthropometry; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005296:Ferrous Compounds / Q000008:administration & dosage; D005500:Follow-Up Studies; D005527:Food, Fortified; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007194:India / Q000453:epidemiology; D007452:Iodates / Q000008:administration & dosage; D007455:Iodine / Q000008:administration & dosage* / Q000737:chemistry; D019266:Iron, Dietary / Q000097:blood; D016014:Linear Models; D008875:Middle Aged; D017680:Potassium Compounds / Q000008:administration & dosage; D011990:Receptors, Transferrin / Q000097:blood; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*; D044465:White People; D055815:Young Adult
chemical_list: D005296:Ferrous Compounds; D006454:Hemoglobins; D007452:Iodates; D019266:Iron, Dietary; D017680:Potassium Compounds; D011990:Receptors, Transferrin; D017673:Sodium Chloride, Dietary; C034024:iodized salt; D005293:Ferritins; D007455:Iodine; C039693:potassium iodate; C031621:ferrous fumarate
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