title: In-home fortification with 2.5 mg iron as NaFeEDTA does not reduce anaemia but increases weight gain: a randomised controlled trial in Kenyan infants.
abstract: In-home fortification of infants with micronutrient powders (MNPs) containing 12.5 mg iron may increase morbidity from infections; therefore, an efficacious low-dose iron-containing MNP might be advantageous. Effects of iron-containing MNPs on infant growth are unclear. We assessed the efficacy of a low-iron MNP on iron status and growth and monitored safety in a randomised, controlled, double-blind 1-year trial in 6-month-old infants (n = 287) consuming daily a maize porridge fortified with either a MNP including 2.5 mg iron as NaFeEDTA (MNP + Fe) or the same MNP without iron (MNP - Fe). At baseline, after 6 and 12 months, we determined haemoglobin (Hb), iron status [serum ferritin (SF), soluble transferrin receptor (sTfR) and zinc protoporphyrin (ZPP)], inflammation [C-reactive protein (CRP)] and anthropometrics. We investigated safety using weekly morbidity questionnaires asking for diarrhoea, cough, flu, bloody or mucus-containing stool and dyspnoea, and recorded any other illness. Furthermore, feeding history and compliance were assessed weekly. At baseline, 71% of the infants were anaemic and 22% iron deficient; prevalence of inflammation was high (31% had an elevated CRP). Over the 1 year, Hb increased and SF decreased in both groups, without significant treatment effects of the iron fortification. At end point, the weight of infants consuming MNP + Fe was greater than in the MNP - Fe group (9.9 vs. 9.5 kg, P = 0.038). Mothers of infants in the MNP + Fe group reported more infant days spent with cough (P = 0.003) and dyspnoea (P = 0.0002); there were no significant differences on any other of the weekly morbidity measures. In this study, low-dose iron-containing MNP did not improve infant's iron status or reduce anaemia prevalence, likely because absorption was inadequate due to the high prevalence of infections and the low-iron dose.
authors.affiliation: Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Barth-Jaeggi
authors.affiliation: Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.
authors.forename: Diego
authors.initials: D
authors.lastname: Moretti
authors.affiliation: University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Jane
authors.initials: J
authors.lastname: Kvalsvig
authors.affiliation: International Centre for Behavioural Studies, Mombasa, Kenya.
authors.forename: Penny A
authors.initials: PA
authors.lastname: Holding
authors.affiliation: Department of Food, Technology and Nutrition, University of Nairobi, Nairobi, Kenya.
authors.forename: Jane
authors.initials: J
authors.lastname: Njenga
authors.affiliation: Department of Food, Technology and Nutrition, University of Nairobi, Nairobi, Kenya.
authors.forename: Alice
authors.initials: A
authors.lastname: Mwangi
authors.affiliation: Department of Pediatrics and Child Health, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
authors.forename: Meera K
authors.initials: MK
authors.lastname: Chhagan
authors.affiliation: Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Lacroix
authors.affiliation: Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Zimmermann
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D004311:Double-Blind Method; D004492:Edetic Acid / Q000008:administration & dosage; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage*; D005293:Ferritins / Q000097:blood; D005527:Food, Fortified; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood; D007630:Kenya / Q000453:epidemiology; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage / Q000032:analysis; D009017:Morbidity; D010349:Patient Compliance; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects*; D003313:Zea mays
chemical_list: D005290:Ferric Compounds; D006454:Hemoglobins; D018977:Micronutrients; D002097:C-Reactive Protein; D005293:Ferritins; D004492:Edetic Acid; D007501:Iron; C019179:Fe(III)-EDTA
keywords: anaemia; growth; infant; iron fortification; micronutrient powder; sub-Saharan Africa