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This Article Full Text (Publish Ahead of Print[PDF]) All Versions of this Article: 89/6/1815    most recent ajcn.2008.27353v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Davidsson, L. Articles by Hurrell, R. Search for Related Content PubMed PubMed Citation Articles by Davidsson, L. Articles by Hurrell, R. Agricola Articles by Davidsson, L. Articles by Hurrell, R.

Regular consumption of a complementary food fortified with ascorbic acid and ferrous fumarate or ferric pyrophosphate is as useful as ferrous sulfate in maintaining hemoglobin concentrations >105 g/L in young Bangladeshi children^1,2,3

¹ From the Laboratory for Human Nutrition, Swiss Federal Institute of Technology, ETH Zentrum, Zurich, Switzerland (LD and RH), and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh (SAS, KAJ, and SS).

² Supported by the Nestlé Foundation (Lausanne, Switzerland), Third World Nutrition (Brussels, Belgium), and the Swiss Federal Institute of Technology (Zurich, Switzerland). Financial support to conduct the statistical analysis was provided by Nestec, Vevey, Switzerland.

³ Address correspondence to L Davidsson, the Laboratory for Human Nutrition, Swiss Federal Institute of Technology, ETH Zentrum, CH-8807 Zurich, Switzerland. E-mail: davidssonlena{at}hotmail.com.

ABSTRACT

Background: Non-water-soluble iron compounds have been reported to be less well absorbed than ferrous sulfate in young children, and concern has been raised about their usefulness as food fortificants.

Objective: The objective was to evaluate the usefulness of ferrous fumarate and ferric pyrophosphate, compared with ferrous sulfate, in maintaining hemoglobin concentrations >105 g/L in Bangladeshi children.

Design: Two hundred thirty-five children aged 7–24 mo (hemoglobin >105 g/L) were randomly assigned in a double-blind study to receive an infant cereal fortified with ferrous fumarate, ferric pyrophosphate, or ferrous sulfate. One serving of cereal (9.3 mg Fe; molar ratio of ascorbic acid to iron of 3:1) was consumed per day, 6 d/wk, for 9 mo. Blood samples were drawn at 4.5 and 9 mo.

Results: Raw data were reformatted and a "time to event" was calculated corresponding to reaching the following thresholds: hemoglobin <105 g/L, plasma ferritin <12 µg/L, or plasma C-reactive protein >10 mg/L at baseline, 4.5 mo, or 9 mo. Data were censored when children did not reach the threshold or were lost to follow-up. A Kaplan-Meier approach was used to compare the 3 groups. No statistically significant differences were observed for hemoglobin <105 g/L (P = 0.943), plasma ferritin <12 µg/L (P = 0.601), or plasma C-reactive protein >10 mg/L (P = 0.508).

Conclusions: Contrary to earlier concerns, these results do not indicate differences in the usefulness between water-soluble and non-water-soluble iron compounds in maintaining hemoglobin concentrations and preventing iron deficiency. These data will be important in the development of food-fortification strategies to combat anemia and iron deficiency in highly vulnerable population groups.

Received for publication December 12, 2008. Accepted for publication April 1, 2009.