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Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women^1,2,3

¹ From the National Institute of Nutrition, Hanoi, Vietnam (PVT, NCK, NTL, and HHK); RU 106 (Nutrition, Food, Societies), Institute of Research for Development, Montpellier, France (JB); the Laboratory for Human Nutrition, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology, Zurich, Switzerland (LD and RFH); and the Division of Hematology, Kansas University Medical Center, Kansas City (JDC).

Background: Fish sauce is consumed daily by a large proportion of the Vietnamese population and could therefore be a potentially useful food vehicle for iron-fortification programs.

Objective: We evaluated the efficacy of iron-fortified fish sauce in improving the iron status of anemic women.

Design: In a randomized, double-masked study of 152 anemic (hemoglobin concentration of 81–119 g/L) women, a meal based on noodles or rice was served 6 d/wk with 10 mL fish sauce containing either 10 mg Fe as NaFeEDTA (iron-fortified group) or no added iron (control group). Concentrations of hemoglobin, serum ferritin (SF), and serum transferrin receptor (TfR) were measured at baseline and after 3 and 6 mo.

Results: After 6 mo, hemoglobin and SF concentrations were higher and TfR concentrations were lower in the iron-fortified group than in the control group [hemoglobin: 116.3 ± 8.7 ( ± SD) compared with 107.6 ± 11.0 g/L (P < 0.0001); SF: 30.9 (95% CI: 23.4, 40.6) compared with 14.6 (11.3, 19.0) µg/L (P = 0.0002); TfR: 7.2 (6.4, 7.9) compared with 9.0 (8.1, 9.9) mg/L (P = 0.002)]. The prevalence of iron deficiency (SF < 12 µg/L or TfR > 8.5 mg/L) and iron deficiency anemia (iron deficiency with hemoglobin < 120 g/L) was lower in the iron-fortified group than in the control group [32.8% compared with 62.5% (P = 0.0005) and 20.3% compared with 58.3% (P < 0.0001), respectively].

Conclusions: Regular consumption of iron-fortified fish sauce significantly reduced the prevalence of iron deficiency anemia in Vietnamese women during the 6-mo intervention. Fortifying fish sauce with iron by using a water-soluble, highly bioavailable compound (NaFeEDTA) is a promising strategy for combating iron deficiency anemia in Vietnam.

Key Words: Iron • food fortification • anemia • iron deficiency • transferrin receptor • ferritin

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