Iron Fortification Practices and Implications for Iron Addition to Salt

Abstract

This introductory article provides an in-depth technical background for iron fortification, and thus introduces a series of articles in this supplement designed to present the current evidence on the fortification of salt with both iodine and iron, that is, double-fortified salt (DFS). This article reviews our current knowledge of the causes and consequences of iron deficiency and anemia and then, with the aim of assisting the comparison between DFS and other common iron-fortified staple foods, discusses the factors influencing the efficacy of iron-fortified foods. This includes the dietary and physiological factors influencing iron absorption; the choice of an iron compound and the fortification technology that will ensure the necessary iron absorption with no sensory changes; encapsulation of iron fortification compounds to prevent unacceptable sensory changes; the addition of iron absorption enhancers; the estimation of the iron fortification level for each vehicle based on iron requirements and consumption patterns; and the iron status biomarkers that are needed to demonstrate improved iron status in populations regularly consuming the iron-fortified food. The supplement is designed to provide a summary of evidence to date that can help advise policy makers considering DFS as an intervention to address the difficult public health issue of iron deficiency anemia, while at the same time using DFS to target iodine deficiency.

Influence of Iron Addition (Alone or with Calcium) to Elements Biofortification and Antioxidants in Pholiota nameko

“…The critical issue is the bioavailability of Fe, and it has been estimated to be in the range of 14-18% for mixed diets and 5-12% for vegetarian diets. Dietary factors that influence Fe absorption, such as ascorbic acid, Ca intake, phytate, polyphenols, and muscle tissue, have been identified repeatedly [31]. Hence, there is need to search for new sources of the element, including fortification products.…”

Effectiveness of Dietary Interventions in Prevention and Treatment of Iron-Deficiency Anemia in Pregnant Women: A Systematic Review of Randomized Controlled Trials

“…Iron fortification according to the dietary habits of the affected population group is regarded as the most cost-effective long-term approach to reduce the prevalence of anemia [ 49 ], while food vehicles which are used should be affordable and consumed regularly among the targeted population [ 50 ]. Such strategy seems to be especially promising for low income countries with a serious problem of inadequate intake and food supply [ 51 ]. The last possible strategy of anemia management is nutritional counselling.…”

Making programmes worth their salt: Assessing the context, fidelity and outcomes of implementation of the double fortified salt programme in Uttar Pradesh, India

“…It is important to acknowledge here that while DFS promotion efforts are important to normalise food discolouration experienced in UP, they can only be a short‐term solution in improving implementation outcomes. The sustainable solution would be to improve product quality, and the DFS production technology is continuously evolving (Baxter & Zlotkin, 2015 ; Diosady et al, 2019 ; Hurrell, 2021 ) to attain this, perhaps future programmes will not face the discolouration challenges observed in UP.…”