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Nutrients 2017, 9(7), 759; doi:10.3390/nu9070759

Iron Fortified Complementary Foods Containing a Mixture of Sodium Iron EDTA with Either Ferrous Fumarate or Ferric Pyrophosphate Reduce Iron Deficiency Anemia in 12- to 36-Month-Old Children in a Malaria Endemic Setting: A Secondary Analysis of a Cluster-Randomized Controlled Trial

1
Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, CH-8092 Zurich, Switzerland
2
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, CH-4031 Basel, Switzerland
3
University of Basel, CH-4003 Basel, Switzerland
4
Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 01 BP V34 Abidjan, Cote d’Ivoire
5
Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, 01 BP 1303 Abidjan, Côte d’Ivoire
6
Département de Sociologie, Université Alassane Ouattara, 01 BP V18 Bouaké, Côte d’Ivoire
7
Global Alliance for Improved Nutrition, CH-1202 Geneva, Switzerland
8
Swiss Tropical and Public Health Institute, CH-4051 Basel, Switzerland
9
Hôpital Général de Taabo, Taabo Cité, BP 700 Toumodi, Côte d’Ivoire
*
Author to whom correspondence should be addressed.
Received: 30 May 2017 / Revised: 8 July 2017 / Accepted: 11 July 2017 / Published: 14 July 2017
(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)
View Full-Text   |   Download PDF [706 KB, uploaded 17 July 2017]   |  

Abstract

Iron deficiency anemia (IDA) is a major public health problem in sub-Saharan Africa. The efficacy of iron fortification against IDA is uncertain in malaria-endemic settings. The objective of this study was to evaluate the efficacy of a complementary food (CF) fortified with sodium iron EDTA (NaFeEDTA) plus either ferrous fumarate (FeFum) or ferric pyrophosphate (FePP) to combat IDA in preschool-age children in a highly malaria endemic region. This is a secondary analysis of a nine-month cluster-randomized controlled trial conducted in south-central Côte d’Ivoire. 378 children aged 12–36 months were randomly assigned to no food intervention (n = 125; control group), CF fortified with 2 mg NaFeEDTA plus 3.8 mg FeFum for six days/week (n = 126; FeFum group), and CF fortified with 2 mg NaFeEDTA and 3.8 mg FePP for six days/week (n = 127; FePP group). The outcome measures were hemoglobin (Hb), plasma ferritin (PF), iron deficiency (PF < 30 μg/L), and anemia (Hb < 11.0 g/dL). Data were analyzed with random-effect models and PF was adjusted for inflammation. The prevalence of Plasmodium falciparum infection and inflammation during the study were 44–66%, and 57–76%, respectively. There was a significant time by treatment interaction on IDA (p = 0.028) and a borderline significant time by treatment interaction on iron deficiency with or without anemia (p = 0.068). IDA prevalence sharply decreased in the FeFum (32.8% to 1.2%, p < 0.001) and FePP group (23.6% to 3.4%, p < 0.001). However, there was no significant time by treatment interaction on Hb or total anemia. These data indicate that, despite the high endemicity of malaria and elevated inflammation biomarkers (C-reactive protein or α-1-acid-glycoprotein), IDA was markedly reduced by provision of iron fortified CF to preschool-age children for 9 months, with no significant differences between a combination of NaFeEDTA with FeFum or NaFeEDTA with FePP. However, there was no overall effect on anemia, suggesting most of the anemia in this setting is not due to ID. This trial is registered at clinicaltrials.gov (NCT01634945). View Full-Text
Keywords: anemia; cluster-randomized controlled trial; complementary food; Côte d’Ivoire; infant cereal; iron deficiency; iron fortification; Plasmodium falciparum; sodium iron EDTA anemia; cluster-randomized controlled trial; complementary food; Côte d’Ivoire; infant cereal; iron deficiency; iron fortification; Plasmodium falciparum; sodium iron EDTA
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Glinz, D.; Wegmüller, R.; Ouattara, M.; Diakité, V.G.; Aaron, G.J.; Hofer, L.; Zimmermann, M.B.; Adiossan, L.G.; Utzinger, J.; N’Goran, E.K.; Hurrell, R.F. Iron Fortified Complementary Foods Containing a Mixture of Sodium Iron EDTA with Either Ferrous Fumarate or Ferric Pyrophosphate Reduce Iron Deficiency Anemia in 12- to 36-Month-Old Children in a Malaria Endemic Setting: A Secondary Analysis of a Cluster-Randomized Controlled Trial. Nutrients 2017, 9, 759.

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