Maize Porridge Enriched with a Micronutrient Powder Containing Low-Dose Iron as NaFeEDTA but Not Amaranth Grain Flour Reduces Anemia and Iron Deficiency in Kenyan Preschool Children

Macharia-Mutie, Catherine W; Moretti, Diego; Briel, Natalie Van den; Omusundi, Agnes M.; Mwangi, Alice; Kok, F.J.; Zimmermann, Michael; Brouwer, Inge D.

doi:10.3945/jn.112.157578

Cited by 38 publications

(39 citation statements)

References 53 publications

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“…In-home iron fortification, where the caregiver adds vitamins and minerals to weaning foods at home using micronutrient powders (MNPs) containing iron reduces IDA risk in African infants, even in areas with high prevalence of infection and inflammation [12,13,14,15]. The most widely-used MNP is the “Sprinkles” formulation; it provides a high dose of 12.5 mg iron/day in order to deliver adequate absorbed iron even when added to complementary foods rich in inhibitors of iron absorption.…”

Section: Iron-containing Micronutrient Powdersmentioning

confidence: 99%

Iron Fortification of Foods for Infants and Children in Low-Income Countries: Effects on the Gut Microbiome, Gut Inflammation, and Diarrhea

2016

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Iron deficiency anemia (IDA) is common among infants and children in Sub-Saharan Africa and is a leading contributor to the global burden of disease, as well as a hindrance to national development. In-home iron fortification of complementary foods using micronutrient powders (MNPs) effectively reduces the risk for IDA by ensuring that the iron needs of infants and young children are met without changing their traditional diet. However, the iron dose delivered by MNPs is high, and comparable on a mg iron per kg body weight to the supplemental doses (2 mg/kg) typically given to older children, which increases diarrhea risk. In controlled studies, iron-containing MNPs modestly increase risk for diarrhea in infants; in some cases, the diarrhea is severe and may require hospitalization. Recent in vitro and in vivo studies provide insights into the mechanism of this effect. Provision of iron fortificants to school-age children and iron-containing MNPs to weaning infants decreases the number of beneficial ‘barrier’ commensal gut bacteria (e.g., bifidobacteria), increases the enterobacteria to bifidobacteria ratio and abundances of opportunistic pathogens (e.g., pathogenic Escherichia coli), and induces gut inflammation. Thus, although iron-containing MNPs are highly effective in reducing IDA, they may increase gastrointestinal morbidity in infants, and safer formulations are needed.

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Section: Iron-containing Micronutrient Powdersmentioning

confidence: 99%

Iron Fortification of Foods for Infants and Children in Low-Income Countries: Effects on the Gut Microbiome, Gut Inflammation, and Diarrhea

2016

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“…In the MixMe MNP, NaFeEDTA is combined with ascorbic acid and an exogenous phytase, both of which are enhancers of iron absorption, and this combination results in higher iron absorption from maize porridge (16). This MNP has shown to have weak efficacy in preschool children in Kenya (19) and school-age children in South Africa (20); however, in a 1-y controlled trial in Kenyan infants, the MNP did not reduce IDA (21), possibly because the absorbed iron dose was insufficient as a result of the low dose and the high prevalence of infections increasing serum hepcidin (12). Thus, it is uncertain how far the iron dose in MNPs can be lowered while maintaining efficacy against anemia.…”

mentioning

confidence: 99%

The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: a review

Paganini

Zimmermann

2017

The American Journal of Clinical Nutrition

207

160

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In infants and young children in Sub-Saharan Africa, iron-deficiency anemia (IDA) is common, and many complementary foods are low in bioavailable iron. In-home fortification of complementary foods using iron-containing micronutrient powders (MNPs) and oral iron supplementation are both effective strategies to increase iron intakes and reduce IDA at this age. However, these interventions produce large increases in colonic iron because the absorption of their high iron dose ($12.5 mg) is typically ,20%. We reviewed studies in infants and young children on the effects of iron supplements and iron fortification with MNPs on the gut microbiome and diarrhea. Iron-containing MNPs and iron supplements can modestly increase diarrhea risk, and in vitro and in vivo studies have suggested that this occurs because increases in colonic iron adversely affect the gut microbiome in that they decrease abundances of beneficial barrier commensal gut bacteria (e.g., bifidobacteria and lactobacilli) and increase the abundance of enterobacteria including entropathogenic Escherichia coli. These changes are associated with increased gut inflammation. Therefore, safer formulations of iron-containing supplements and MNPs are needed. To improve MNP safety, the iron dose of these formulations should be reduced while maximizing absorption to retain efficacy. Also, the addition of prebiotics to MNPs is a promising approach to mitigate the adverse effects of iron on the infant gut. Am J Clin Nutr 2017;106(Suppl):1688S-93S.

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“…The choice of processed food vehicles varies widely by region and context, depending on the subpopulation targeted, food consumption and acceptability, food availability and sustainability, as well as the financial and technical concerns. The staple food is the most commonly used as vehicle of fortification, in addition, milk powder, beverages, biscuits, the most commonly used sauce, such as soy sauce, drink and water, can also be used as fortified foods [92][93][94][95][96][97][98][99][100][101][102][103][104].…”

Section: Food Fortification With Ironmentioning

confidence: 99%

“…A nutrition intervention trial conducted in India showed that iron-fortified biscuits led to a significant enhancement in haemoglobin status of anaemic school children in rural areas [98]. Another study showed that maize porridge fortified with multi-micronutrient powder contained low dose, highly bioavailable iron can reduce the prevalence of IDA in pre-school children [102]. Home fortification with multi-micronutrient powder with low dosages of bioavailable iron may therefore be a promising strategy to improve iron status among children.…”

Section: Food Fortification With Ironmentioning

confidence: 99%

Iron Deficiency Anaemia

Zeng¹,

Pei²,

Li³

et al. 2018

Current Topics in Anemia

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Iron deficiency anaemia as the most common nutrition disorder has only marginal reduction globally during recent decades, with the highest burden in pregnant women and young children. Insufficient iron storage and/or excessive loss of iron are common causes of iron deficiency anaemia. Therefore, understanding the complexity of the regulatory network required to maintain iron homeostasis and identifying the functional variants associated with iron metabolism should be fundamental and crucial to control and treat the iron deficiency anaemia. Sensitive and inexpensive measures to distinguish iron deficiency anaemia from the other kinds of anaemia should be developed for precise treatment. Original disease treatments combined with oral or intravenous iron therapy are key approaches in clinical practices. The integrated, multifactorial and multi-sectoral approach with food-based strategy and iron supplementation as the leading public health inventions is required to achieve iron deficiency anaemia control target. This chapter will focus on the advanced knowledge associated with iron metabolism, disease burden and health consequences of iron deficiency anaemia in different life course, newly parameters development in the diagnosis of iron deficiency anaemia, therapy choice in clinical practice and public health strategies to reduce iron deficiencies in high-burden areas.

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Maize Porridge Enriched with a Micronutrient Powder Containing Low-Dose Iron as NaFeEDTA but Not Amaranth Grain Flour Reduces Anemia and Iron Deficiency in Kenyan Preschool Children

Cited by 38 publications

References 53 publications

Iron Fortification of Foods for Infants and Children in Low-Income Countries: Effects on the Gut Microbiome, Gut Inflammation, and Diarrhea

Iron Fortification of Foods for Infants and Children in Low-Income Countries: Effects on the Gut Microbiome, Gut Inflammation, and Diarrhea

The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: a review

Iron Deficiency Anaemia

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