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Food-based strategies improve iron status in toddlers: a randomized controlled trial^1,23

¹ From the Departments of Human Nutrition (EAS-G, ELF, A-LMH, and RSG) and Preventive and Social Medicine (ARG), University of Otago, Dunedin, New Zealand.

² Supported by the Health Research Council of New Zealand, Meat and Livestock Australia, Meat and Wool New Zealand, and the University of Otago. EAS-G was supported by a University of Otago Postgraduate Prestigious Scholarship and a University of Otago Postgraduate Publishing Bursary (PhD). Heinz Wattie's New Zealand Ltd provided the iron-fortified milk; Fonterra New Zealand provided the nonfortified milk; Canpac International Ltd donated the cans and spoons; and Fisher and Paykel Appliances Ltd donated a freezer. All study meat dishes were prepared in the Bristol-Myers Squibb Metabolic Kitchen, University of Otago, New Zealand.

³ Address correspondence to A-LM Heath, Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand. E-mail: anne-louise.heath{at}stonebow.otago.ac.nz.

Background: Nonanemic iron deficiency is common in toddlers in developed countries. Food-based strategies are safe methods to control and prevent mild micronutrient deficiencies.

Objective: Our objective was to determine the efficacy of an increased intake of red meat, or the consumption of iron-fortified milk, in improvement of iron status in toddlers at a population level.

Design: In this 20-wk randomized placebo-controlled trial, 225 healthy nonanemic 12–20-mo-old children were assigned to 1 of 3 groups: red meat (toddlers encouraged to consume 2.6 mg iron from red meat dishes daily), fortified milk [toddlers' regular milk replaced with iron-fortified (1.5 mg iron/100 g prepared milk) cow milk], or control [toddlers' regular milk replaced with nonfortified (0.01 mg iron/100 g prepared milk) cow milk]. Blood samples were collected at baseline and at 20 wk for hemoglobin, serum ferritin, serum transferrin receptor, and C-reactive protein. The prevalence of suboptimal iron status (ie, depleted iron stores, iron-deficient erythropoiesis, and iron deficiency anemia) was determined, and body iron was calculated.

Results: No intervention effects were shown on the prevalence of suboptimal iron status. Serum ferritin increased by 44% (95% CI: 14%, 82%; P = 0.002) in the fortified milk group, did not change (+10%) in the red meat group (95% CI: –7%, 30%; P = 0.241), and tended to decrease (–14%) in the control group (95% CI: –27%, 1%; P = 0.063). By 20 wk, in comparison with the control group, serum ferritin and body iron were significantly higher in the fortified milk group (both P < 0.001), and serum ferritin was significantly higher in the red meat group (P = 0.033).

Conclusions: Consumption of iron-fortified milk can increase iron stores in healthy nonanemic toddlers, whereas increased intakes of red meat can prevent their decline. This trial was registered at actr.org.au as ACTRN12605000487617.