This clinical report covers diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants (both breastfed and formula fed) and toddlers from birth through 3 years of age. Results of recent basic research support the concerns that iron-deficiency anemia and iron deficiency without anemia during infancy and childhood can have long-lasting detrimental effects on neurodevelopment. Therefore, pediatricians and other health care providers should strive to eliminate iron deficiency and iron-deficiency anemia. Appropriate iron intakes for infants and toddlers as well as methods for screening for iron deficiency and iron-deficiency anemia are presented.

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Clinical Report—Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age)

“Ill being” and “ill health” is a multidimensional term covering not only disease but also other dimensions such as hunger, exclusion, isolation, insecurity and powerlessness. This ill health can consequently prevent individuals from realizing their full potential. Good health, in contrast, is identified as a vital component of a good quality of life. That is why access to good health is recognized as a basic human need and a fundamental human right. The WHO‘s definition of health as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” applies to all human beings regardless of age gender, nationality and culture. Inequalities and deficiencies in health thus affect the well being of an individual and welfare of a society as a whole.

Health and Nutrition

Background: Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies. Methods: A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact of fortification was analyzed on the health outcomes and relevant biochemical indicators of women and children. We performed a meta-analysis of outcomes using Review Manager Software version 5.1. Results: Our systematic review identified 201 studies that we reviewed for outcomes of relevance. Fortification for children showed significant impacts on increasing serum micronutrient concentrations. Hematologic markers also improved, including hemoglobin concentrations, which showed a significant rise when food was fortified with vitamin A, iron and multiple micronutrients. Fortification with zinc had no significant adverse impact on hemoglobin levels. Multiple micronutrient fortification showed non-significant impacts on height for age, weight for age and weight for height Z-scores, although they showed positive trends. The results for fortification in women showed that calcium and vitamin D fortification had significant impacts in the post-menopausal age group. Iron fortification led to a significant increase in serum ferritin and hemoglobin levels in women of reproductive age and pregnant women. Folate fortification significantly reduced the incidence of congenital abnormalities like neural tube defects without increasing the incidence of twinning. The number of studies pooled for zinc and multiple micronutrients for women were few, though the evidence suggested benefit. There was a dearth of evidence for the impact of fortification strategies on morbidity and mortality outcomes in women and children. Conclusion: Fortification is potentially an effective strategy but evidence from the developing world is scarce. Programs need to assess the direct impact of fortification on morbidity and mortality.

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Micronutrient fortification of food and its impact on woman and child health: a systematic review

BackgroundIron fortification of wheat flour is widely used as a strategy to combat iron deficiency.ObjectiveTo review recent efficacy studies and update the guidelines for the iron fortification of...

https://journals.sagepub.com/doi/pdf/10.1177/15648265100311S102

Revised recommendations for iron fortification of wheat flour and an evaluation of the expected impact of current national wheat flour fortification programs

Background Anemia, a morbid condition, is a global concern that affects people of all age groups. This scenario has attracted the attention of several government organizations for implementing strict regulations to provide nutritional security. Iron fortification and supplementation has been in practice from the past decades. However, there is a need for determining an effective strategy to address this rising concern among the vulnerable population. Scope and approach Among the existing approaches, iron fortification of foods remains to be cheaper and effective in targeting large-scale population without the intervention of pharmaceutical drugs. The key challenge is the bioavailability of iron from fortified foods. Thus, this work presents a comprehensive review of morbidities of anemia, causes, the significance of haem and non-haem iron, absorption, and bioavailability, in context with different iron fortification approaches. Key findings Apart from the nutritional deficit, anemia is also associated with a sedentary lifestyle linked with obesity and diabetes. The complex interaction of elemental iron and its physiology have been highlighted in consideration with potential iron enhancers and inhibitors. It was found that the incorporation of haem iron would complement the effectiveness of non-haem iron through fortification. Several iron fortification techniques focused on combating iron deficiency have been described. Conclusions Food fortification is a promising strategy for reducing the prevalence of anemia. Food vehicles must be designed considering its synergistic effects with iron complexes for effective absorption and bioavailability. However, the scalability, cost economics, safety concerns and acceptability of the iron-fortified foods remain as constraints that have to be addressed. Further, the application of novel food processing techniques with food fortification can result in the emergence of novel approaches for addressing iron deficiency and anemia.

Iron deficiency anemia: A comprehensive review on iron absorption, bioavailability and emerging food fortification approaches

The objective of this research was to study the effectiveness of NaFeEDTA-fortified soy sauce for controlling iron deficiency in a high-risk population. This was an 18-month, randomized, placebo-controlled intervention trial in 14,000 residents aged three years or older in Bijie City, Guizhou Province, China, using sodium-iron ethylene diamine tetraacetate (NaFeEDTA)-fortified soy sauce (29.6 mg Fe/100 ml). The study data included measurements of food consumption, hemoglobin, serum ferritin, and serum retinol. The results showed that the diet consisted primarily of cereals, fruits, and vegetables, with very little meat. Food consumption remained unchanged during the study period and was similar in the fortified and control groups. The average daily soy sauce consumption of the group consuming the fortified product was 16.4 ml per person, which provided 4.9 mg of iron from NaFeEDTA. At the end of the trial, all age and sex subgroups receiving NaFeEDTA had significantly higher hemoglobin levels, a lower prevalence of anemia, and higher plasma ferritin levels than the controls. The effects became statistically significant after six months of intervention and were maintained throughout the study period. We conclude that NaFeEDTA-fortified soy sauce was highly effective in controlling iron deficiency and reducing the prevalence of iron-deficiency anemia in men, women, and children. NaFeEDTA-fortified soy sauce is affordable and was well accepted by the study population.

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Junshen Huo

Papers

Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial: