Micronutrient Fortified Condiments and Noodles to Reduce Anemia in Children and Adults—A Literature Review and Meta-Analysis

Abstract

Micronutrient deficiencies impose a considerable burden of disease on many middle and low income countries. Several strategies have been shown to be effective in improving micronutrient deficiencies. However, the impact of fortified condiments as well as fortified noodles is less well documented. We aimed to investigate existing evidence on the impact of micronutrient fortified condiments and noodles on hemoglobin, anemia, and functional outcomes in children and adults (age: 5 to 50 years). We conducted a literature review in electronic databases. In addition, we screened the homepages of relevant organizations and journals. We included randomized controlled trials (RCT). Of 1046 retrieved studies, 14 RCT provided data for the meta-analysis. Micronutrient fortification of condiments and noodles increased hemoglobin concentrations by 0.74 g/dL (95%-confidence intervals (95%-CI): 0.56 to 0.93; 12 studies) and 0.3 g/dL (95%-CI: 0.12 to 0.48; 1 study), respectively. Micronutrient fortification also led to a reduced risk of having anemia (risk ratio 0.59 (95%-CI 0.44 to 0.80)). Ferritin concentrations increased with fortified condiments. Functional outcomes were rarely assessed and showed mixed results. The use of micronutrient fortified condiments can be a strategy to reduce anemia in children and adults due to micronutrient deficiencies. The effect of fortified noodles seems to be smaller.

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

“…Nonetheless, the relative impact of these factors has not been comprehensively evaluated. The efficacy of iron fortification of already assessed condiments on increasing hemoglobin levels and decreasing the risk of anemia is well-established, particularly for double-fortified salt with iodine and iron [12][13][14]. The effectiveness of these interventions is less documented and, although hemoglobin and ferritin levels may slightly increase, in some instances the prevalence of anemia does not change in the population [13,14].…”

“…The efficacy of iron fortification of already assessed condiments on increasing hemoglobin levels and decreasing the risk of anemia is well-established, particularly for double-fortified salt with iodine and iron [12][13][14]. The effectiveness of these interventions is less documented and, although hemoglobin and ferritin levels may slightly increase, in some instances the prevalence of anemia does not change in the population [13,14]. Furthermore, results regarding the role of potentially influencing factors affecting the outcome of the interventions are often mixed, show no effect or are not reported [12,13].…”

“…The effectiveness of these interventions is less documented and, although hemoglobin and ferritin levels may slightly increase, in some instances the prevalence of anemia does not change in the population [13,14]. Furthermore, results regarding the role of potentially influencing factors affecting the outcome of the interventions are often mixed, show no effect or are not reported [12,13]. This limited information justifies a more comprehensive analysis of the interplay and degree of impact of associated conditions influencing the performance of interventions with iron-fortified condiments, hoping it will contribute toward their optimization.…”

Efectividad y seguridad del uso de micronutrientes en polvo para tratamiento de niños con anemia: revisión sistemática

“…Se han propuesto varias estrategias, con el fin de prevenir o reducir el impacto de la anemia y las deficiencias nutricionales, especialmente en población menor de cinco años. Se encuentran ejemplos como suplementos en alimentos, incrementando la densidad de energía y la carga de micronutrientes en los mismos; también existe la fortificación casera con aspersión de micronutrientes en polvo (intervención de interés en el presente estudio), así como suministro de cápsulas de vitamina A, a intervalos definidos (Who/Fao, 2006) (Hess, Tecklenburg, & Eichler, 2016).…”

Iron absorption from a novel iron-enriched fungal fortificant in young women

“…The implementation of iron fortification in condiments and commonly consumed food vehicles has shown to be effective as this strategy focuses on fortifying regularly consumed condiments, eliminating concern of adherence and affordability (153). A recent meta-analysis analyzed the comparison of iron status outcomes from iron fortified condiments compared to noodles (154). The review found a significant increase in hemoglobin of adults and children consuming iron-enriched/fortified condiments in comparison to noodles, 0.74g/dL Hb and 0.3g/dL Hb, respectively (154).…”