Effects of Salt Fortified with Iron and Iodine on the Haemoglobin Levels and Productivity of Tea Pickers

Rajagopalan, S.; Vinodkumar, Malavika

doi:10.1177/156482650002100313

Cited by 20 publications

(42 citation statements)

References 6 publications

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“…The difference in change in hemoglobin ranged from 40 to 72 g/L (17) over 6 and 8 mo, respectively (16). To our knowledge, the present study is the first that describes the impact of DFS on iron-deficiency measures other than hemoglobin in women.…”

Section: Introductionmentioning

confidence: 99%

Double-Fortified Salt Is Efficacious in Improving Indicators of Iron Deficiency in Female Indian Tea Pickers

Haas

Rahn

Venkatramanan

et al. 2014

The Journal of Nutrition

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Poor iron status affects 50% of Indian women and compromises work productivity, cognitive performance, and reproduction. Among the many strategies to reduce iron deficiency is the commercial fortification of iodized table salt with iron to produce a double-fortified salt (DFS). The objective of this study was to test the efficacy of DFS in reducing iron deficiency in rural women of reproductive age from northern West Bengal, India. The participants were 212 women between 18 and 55 y of age who worked as full-time tea pickers on a large tea estate. Participants in the randomized, controlled, double-blind study were assigned to use either DFS or a control iodized salt for 7.5 to 9 mo. The DFS was fortified with 3.3-mg ferrous fumarate (1.1-mg elemental iron) per kg of iodized salt, whereas the control salt contained only iodine (47 mg/kg potassium iodate), and both salt varieties were distributed gratis to the families of participants at 0.5 kg/mo for each 2 household members. At baseline, 53% of participants were anemic (hemoglobin <120 g/L), 25% were iron deficient (serum ferritin <12 μg/L), and 23% were iron-deficient anemic. Also, 22% had a transferrin receptor concentration >8.6 mg/L and 22% had negative (<0.0 mg/kg) body iron stores. After 9 mo the participants receiving DFS showed significant improvements compared with controls in hemoglobin (+2.4 g/L), ferritin (+0.13 log10 μg/L), soluble transferrin receptor (−0.59 mg/L), and body iron (+1.43 mg/kg), with change in status analyzed by general linear models controlling for baseline values. This study demonstrated that DFS is an efficacious approach to improving iron status and should be further evaluated for effectiveness in the general population. This trial was registered at clinicaltrials.gov as NCT01032005.

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Section: Introductionmentioning

confidence: 99%

Double-Fortified Salt Is Efficacious in Improving Indicators of Iron Deficiency in Female Indian Tea Pickers

Haas

Rahn

Venkatramanan

et al. 2014

The Journal of Nutrition

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“…As presented in Table 1, the most tested condiment, as a vehicle for efficacy or effectiveness of iron fortification, was salt. This fortification approach included 13 Double-fortified Salt (DFS) [21][22][23][24][25][26][27][28][29][30][31][32][33] and five Multiple Micronutrient Fortified Salt (MMFS) studies [34][35][36][37][38]. Only one study evaluated a seasoning powder [39], two studies evaluated fish sauce [40,41], and two studies evaluated soy sauce [42,43].…”

Section: Discussionmentioning

confidence: 99%

“…There were no efficacy or effectiveness studies of iron-fortified bouillon cubes. All studies were conducted in Asia or Africa using as subjects children or women of reproductive age during different time lengths using as fortificants a variety of iron forms that included micronized ground ferric pyrophosphate [21,30,33,38], encapsulated ferrous fumarate [21,31], ferrous fumarate [22], ferrous sulfate [23,28], microencapsulated ferrous fumarate [24], unknown iron source [25][26][27], ferrous sulfate monohydrate chelated with malic acid and sodium hexametaphosphate [29], ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil [32], chelated ferrous sulfate [34][35][36][37], H-reduced elemental iron encapsulated with partially hydrogenated vegetable oil [39], ferrous sulfate citrate [40], or NaFeEDTA [40][41][42][43]. Blood hemoglobin was the main hematological indicator in all studies to evaluate the effect of iron fortification.…”

Section: Discussionmentioning

confidence: 99%

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Performance Factors Influencing Efficacy and Effectiveness of Iron Fortification Programs of Condiments for Improving Anemia Prevalence and Iron Status in Populations: A Systematic Review

2020

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Iron fortification of staple foods is a common practice around the world to reduce the prevalence of iron-deficiency anemia. More recently, fortified condiments, including salts, sauces, and powders, have been tested in various efficacy trials. However, there is limited information on how nutritional, environmental, and experimental factors affect their efficacy and effectiveness. The purpose of the present work was to systematically review performance factors affecting the efficacy of condiment fortification trials. Three databases were searched using a standardized keyword search and included based on four-point inclusion criteria. Studies were evaluated against a quality assessment tool and effect sizes were calculated. Studies were ranked as low or high performing, based on whether or not they significantly improved iron-deficiency outcomes (hemoglobin, anemia prevalence, and ferritin levels). Of the 955 retrieved studies, 23 were included—of which, nine performed poorly, eight performed highly, and six were classified as neither because they did not meet the criteria of assessing the three iron outcomes. Results showed that unsuccessful trials did not consider environmental factors such as parasitic infections, nutritional factors such as micronutrient deficiencies other than iron, consumer acceptability of the product or experimental factors such as monitoring and adherence to the trials. Two common performing factors identified among those studies performing highly vs. those that did not were the control of sensory changes and monitoring of consumption compliance (i.e., dose delivery). The present work can be used as decision-making support for nutrition policy makers when determining the appropriate implementation of condiment fortification programs.

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“…20 With respect to bioavailability measured by hemoglobin and other biochemical measures, encapsulation of iron resulted in adequate iron bioavailability, but also unacceptable organoleptic changes. [42][43][44][45] One of the few candidate fortificants of DFS was ferric pyrophosphate, but its use has been limited by inferior bioavailability. However, parallel work demonstrated that particle-size reduction of ferric pyrophosphate could enhance bioavailability.…”

Section: Bioavailability Of Iron In Dual-fortified Salt With Iodinementioning

confidence: 99%

Bioavailability of iron, vitamin A, zinc, and folic acid when added to condiments and seasonings

Degerud

Manger²,

Strand

et al. 2015

Annals of the New York Academy of Sciences

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Seasonings and condiments can be candidate vehicles for micronutrient fortification if consumed consistently and if dietary practices ensure bioavailability of the nutrient. In this review, we identify factors that may affect the bioavailability of iron, vitamin A, zinc, and folic acid when added to seasonings and condiments and evaluate their effects on micronutrient status. We take into consideration the chemical and physical properties of different forms of the micronutrients, the influence of the physical and chemical properties of foods and meals to which fortified seasonings and condiments are typically added, and interactions between micronutrients and the physiological and nutritional status of the target population. Bioavailable fortificants of iron have been developed for use in dry or fluid vehicles. For example, sodium iron ethylenediaminetetraacetic acid (NaFeEDTA) and ferrous sulfate with citric acid are options for iron fortification of fish and soy sauce. Furthermore, NaFeEDTA, microencapsulated ferrous fumarate, and micronized elemental iron are potential fortificants in curry powder and salt. Dry forms of retinyl acetate or palmitate are bioavailable fortificants of vitamin A in dry candidate vehicles, but there are no published studies of these fortificants in fluid vehicles. Studies of zinc and folic acid bioavailability in seasonings and condiments are also lacking.

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Effects of Salt Fortified with Iron and Iodine on the Haemoglobin Levels and Productivity of Tea Pickers

Abstract: To determine if double-fortified salt improved the haemoglobin levels and productivity of tea pickers, a double-blind, randomized, placebo-controlled

Cited by 20 publications

References 6 publications

Double-Fortified Salt Is Efficacious in Improving Indicators of Iron Deficiency in Female Indian Tea Pickers

Double-Fortified Salt Is Efficacious in Improving Indicators of Iron Deficiency in Female Indian Tea Pickers

Performance Factors Influencing Efficacy and Effectiveness of Iron Fortification Programs of Condiments for Improving Anemia Prevalence and Iron Status in Populations: A Systematic Review

Bioavailability of iron, vitamin A, zinc, and folic acid when added to condiments and seasonings

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