Enhancing the Absorption of Fortification Iron

Abstract

Iron deficiency remains a major global health problem affecting an estimated 2 billion people. The World Health Organization ranked it as the seventh most important preventable risk for disease, disability, and death in 2002. Since an important factor in its causation is the poor bioavailability of iron in the cereal-based diets of many developing countries, SUSTAIN set up a Task Force, consisting of nutritional, medical, industry, and government experts to consider strategies for enhancing the absorption of fortification iron. This paper summarizes the findings of this Task Force. Detailed reviews of each strategy follow this overview. Highly soluble compounds of iron like ferrous sulfate are desirable food fortificants but cannot be used in many food vehicles because of sensory issues. Thus, potentially less well-absorbed forms of iron commonly are used in food fortification. The bioavailability of iron fortificants can, however, be enhanced with innovative ingredient technologies. Ascorbic acid, NaFeEDTA, ferrous bisglycinate, and dephytinization all enhance the absorption of fortification iron, but add to the overall costs of fortification. While all strategies cannot be recommended for all food fortification vehicles, individual strategies can be recommended for specific foods. For example, the addition of ascorbic acid is appropriate for dry blended foods such as infant foods and other dry products made for reconstitution that are packaged, stored, and prepared in a way that maximizes retention of this vitamin. NaFeEDTA can be recommended for fortification of fish sauce and soy sauce, whereas amino acid chelates may be more useful in milk products and beverages. With further development, dephytinization may be possible for low-cost, cereal-based complementary foods in developing countries. Encapsulation of iron salts in lipid coatings, while not an iron absorption-enhancing strategy per se, can prevent soluble forms of iron from interacting undesirably with some food vehicles and hence broaden the application of some fortificants. Research relevant to each of these strategies for enhancing the bioavailability or utility of iron food fortificants is reviewed. Individual strategies are evaluated in terms of enhancing effect and stability, organoleptic qualities, cost, and regulatory issues of interest to the nutrition community, industry, and consumers. Recommendations are made on potential usages and further research needs. Effective fortification depends on the selection of technically feasible and efficacious strategies. Once suitable strategies have been identified, cost becomes very important in selecting the best approach to implement. However it is essential to calculate cost in relation to the amount of bioavailable iron delivered. An approach to the calculation of cost using a conservative estimate of the enhancing effects of the innovative technologies discussed in the supplement is given in the final section.

Ascorbyl palmitate/DSPE-PEG nanocarriers for oral iron delivery: Preparation, characterisation and in vitro evaluation

“…Food fortification is generally recognised as a cost-effective and convenient approach to counter iron deficiency, and there is a substantial body of evidence that demonstrates the benefits of this approach [2]. The main requirements for an iron source to be used effectively as a fortificant is to have sufficiently high bioavailability without causing any undesirable sensory changes in the food vehicles such as flours, breakfast cereals, cereal-based complementary foods, salt, milk, and milk based products.…”

A novel approach to oral iron delivery using ferrous sulphate loaded solid lipid nanoparticles

“…The World Health Organisation (WHO) recently ranked iron deficiency as seventh in a list of top ten global preventable risks for death, disease and disability (Hurrell et al 2004). Current strategies to counter iron deficiency include food iron fortification and iron supplementation (Zimmermann and Hurrell, 2007).…”

Redox-active labile iron in fortified flours from the Brazilian market

“…Although this approach has proved successful in decreasing iron deficiency worldwide 4,8 , a number of studies have addressed the potential long-term side effects associated with the regular ingestion of highly bioavailable iron forms in food, at least for some segments of the population 8 . A basic assumption is that food fortificants might induce transient but systematic iron overload episodes which may be, at the onset of several clinical conditions, in part due to the propensity of iron to integrate physiological pools of weakly bound forms with potential pro-oxidant activity.…”

“…Iron fortification of food is a cost-effective approach to providing iron for the population 4 . Fortificants differ markedly in chemical identity, bioavailability, likelihood of causing adverse sensory changes, advantages and usage restrictions.…”