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Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized ferric pyrophosphate and encapsulated ferrous fumarate in southern India^1,2,3

¹ From the Human Nutrition Laboratory, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland (MA, RFH, and MBZ); the Division of Nutrition, Institute of Population Health and Clinical Research, St John's National Academy of Health Sciences, Bangalore, India (SM, PT, and AVK); and the Department of Community Health, St John's Medical College, St John's National Academy of Health Sciences, Bangalore, India (RBG)

Background:Dual fortification of salt with iodine and iron could be a sustainable approach to combating iodine and iron deficiencies.

Objective:We compared the efficacy of dual-fortified salt (DFS) made by using 2 proposed contrasting formulas—one fortifying with iron as micronized ground ferric pyrophosphate (MGFePP) and the other with iron as encapsulated ferrous fumarate (EFF)—with the efficacy of iodized salt (IS) in schoolchildren in rural southern India.

Design:After stability and acceptability testing, a double-blind, household-based intervention was conducted in 5–15-y-old children (n = 458) randomly assigned into 3 groups to receive IS or DFS with iron as MGFePP or EFF, both at 2 mg/g salt. We measured hemoglobin, iron status, and urinary iodine at baseline, 5 mo, and 10 mo.

Results:Median serum ferritin and calculated median body iron improved significantly in the 2 groups receiving iron. After 10 mo, the prevalence of anemia decreased from 16.8% to 7.7% in the MGFePP group (P < 0.05) and from 15.1% to 5.0% in the EFF group (P < 0.01). The median urinary iodine concentration increased significantly in the IS and EFF groups (P < 0.001) but not in the MGFePP group. Losses of iodine in salt with 1.8% moisture were high for MGFePP, whereas the EFF segregated in salt with 0.5% moisture and caused color changes in some local foods.

Conclusions:Both DFSs were efficacious in reducing the prevalence of anemia and iron deficiency in school-age children. Local salt characteristics should be taken into consideration when choosing an iron fortificant for DFS to achieve optimal iodine stability and color.

This article has been cited by other articles:

				S. R. Shankar, A. C Mathew, M Sivamani, M S. Banu, and A A. Idupuganti Fortification of salt with iodine and iron in India Am. J. Clinical Nutrition, July 1, 2009; 90(1): 246 - 246. [Full Text] [PDF]

				M. Andersson, R. F Hurrell, M. B Zimmermann, P. Thankachan, S. Muthayya, A. V Kurpad, and R. B Goud Reply to SLR Shankar et al Am. J. Clinical Nutrition, July 1, 2009; 90(1): 246 - 247. [Full Text] [PDF]