Strategies for the prevention of iron deficiency through foods in the household

Carotenoids in Staple Foods: Their Potential to Improve Human Nutrition

As part of the Consultative Group on International Agricultural Research (CGIAR) Micronutrients Project, we have investigated the content of carotenoids in staple foods, particularly wheat. Wheat varies widely in carotenoid content, depending on the variety and type. Durum (pasta) wheat is generally higher in carotenoid content, because the market has continued to demand strong pigment in pasta and noodle products, whereas in bread wheat the market demands flour as white as possible. Consequently, twentieth-century wheat breeders have consciously selected wheat varieties low in carotenoid content, although older, high-carotenoid bread wheats are still available and the trait is not lost. The entire carotenoid biosynthetic pathway exists in wheat grains, so varieties high in β-carotene and/or other carotenoids can be reintroduced if and when education in nutrition creates the demand. Numerous high-yielding maize varieties high in β-carotene already exist and have been used to eliminate vitamin A deficiency in livestock. A β-carotene–rich rice has been genetically engineered recently. Although the carotenoid content of beans has not yet been explored, high–β-carotene lines of cassava exist, and the trait is easily handled in a breeding programme. Yellow types of most staples are known, for example, sorghum, potatoes, and sweet potatoes. The amounts present are such that we can assert that vitamin A deficiency could easily be eliminated globally by delivering the required amounts via food staples. Moreover, there are strong signs that other benefits in eye health, enhanced absorption of iron from non-haem sources, anticarcinogenic effects, enhanced aroma, and better storage life may also result.

Nutritionally enhanced cereals: A sustainable foundation for a balanced diet

Three nutrients, iron, zinc and pro-vitamin A, are widely deficient in humans, especially among low socioeconomic groups in developing countries, but they remain significant concerns in industrialized countries as well. Cereals provide the majority of the intake of these nutrients in low-income families. Moreover, these three nutrients may interact synergistically in absorption and function to such an extent that there are potentially huge advantages in providing all three together in the one staple food. Because of this, they may be more bioavailable to deficient individuals than current thinking allows. To do so would provide a sound basis on which to build a better balanced diet for nutritionally compromised individuals. Genetic variation in nutrient composition exists in cereals and can be exploited in conventional breeding programmes and through gene technology. Cultural techniques, including fertiliser technology and organic farming, have also impacted upon the nutrient composition of cereals. Human iron and zinc intake can be doubled at least, and essential carotenoid intakes can be increased dramatically. Preliminary feeding trials with nutrient-dense grains have been encouraging. Moreover, nutrient-dense seeds also produce more vigorous seedlings and higher grain yield in soils where these nutrients are poorly available, so that to a significant extent agronomic and health objectives coincide. New varieties are rapidly adopted, especially where there are yield advantages, ensuring maximum impact without new inputs. This approach is potentially more sustainable than fortification and supplementation programmes because intake is continuous, which is especially important for zinc because it is needed almost daily.

Nutrition education alone improves dietary practices but not hematologic indices of adolescent girls in Iran

BACKGROUND

Iron-deficiency anemia is the most prevalent nutritional deficiency worldwide. Iron-deficiency anemia has particular negative consequences on women in their childbearing years, and its prevention is a high priority in most health systems.

OBJECTIVE

This interventional study assessed the effect of nutrition education on hematologic indices, iron status, nutritional knowledge, and nutritional practices of high-school girls in Iran.

METHODS

Sixty healthy 16- to 18-year-old girls were randomly selected from two high schools in the city of Ahvaz and divided into two equally matched groups, one that received nutrition education, and one that did not. The education group received instruction in face-to-face sessions, group discussions, and pamphlets for 2 months. The control group did not receive any information during the study. Hematologic tests, corpuscular indices, and serum ferritin levels were measured at baseline and after 2 months. Food-frequency questionnaires were administered and histories taken, clinical signs of nutritional deficiencies observed, anthropometric measurements taken, nutritional knowledge tested, practices determined, and lifestyle questionnaires administered to all subjects.

RESULTS

There were no statistically significant differences in any baseline characteristics between the two groups. Scores for nutritional knowledge and practices of the education group were significantly higher after two months compared with the baseline (31.4 +/- 6 vs. 24.3 +/- 5.9 points, p < .001, and 31.2 +/- 5 vs. 28.4 +/- 5.7 points, p < .05, respectively). The scores in the control group showed no significant changes from baseline to 2 months. Mean corpuscular volume values were elevated in the education group (p < .001) but not in the control group. However, in the control group, serum ferritin concentrations showed about a 17% drop at the end of the study (p < .004). There were no changes in other hematologic, lifestyle, clinical, or anthropometric data compared with baseline after completion of the study in both groups.

CONCLUSION

These findings indicate that nutritional education can improve knowledge of healthy nutrition and lifestyle choices. Focused nutritional education using available resources and correcting current dietary habits in a vulnerable group of young women may result in dietary changes that can ultimately improve iron intake.

Iron deficiency is unacceptably high in refugee children from Burma

Iron-deficiency anemia (IDA) in refugees is reported to be among the major medical problems worldwide. Because food rations are typically inadequate in iron, long-term reliance is a key predictor of anemia among displaced people. Comprehensive nutritional assessments of refugee children from Burma have not previously been completed. Refugee children aged 6-59 mo were studied to determine 1) the prevalences of anemia, iron deficiency (ID) and IDA and 2) the factors associated with anemia and ID. Cluster sampling in three camps and convenience sampling in two additional camps were used. Hemoglobin (Hb) levels were measured and micro mol zinc protoporphyrin/mol heme were determined in 975 children. Logistic regression analyses (95% CI) determined predictors of anemia and ID. The prevalences of IDA, anemia and ID in these refugee children were 64.9, 72.0 and 85.4%, respectively. Predictors of anemia included young age (P < 0.001), food ration lasting <1 mo (P = 0.001), daily consumption of dietary iron inhibitors (P < 0.05), weight-for-height Z-score of <-2 (P < 0.05), male gender (P < 0.05) and uneducated father (P < 0.001). Predictors of ID were young age (P < 0.001) and recently reported illness (P < 0.05). Laboratory tests confirmed that anemia and ID are major health problems among these refugee children and that ID is the leading cause of anemia. A comprehensive nutrition and public health-focused approach to combating anemia and ID is essential. Following the presentation of results to policy makers, the improvement of the micronutrient content of rations has been initiated.

Formative Research to Develop a Nutrition Education Intervention to Improve Dietary Iron Intake among Women and Adolescent Girls through Community Kitchens in Lima, Peru

Formative research was conducted with 26 women and 16 adolescent girls to develop an education intervention through community kitchens (CK) in Lima, to increase their dietary iron intake and improve their iron status. A combination of qualitative research methods was used to explore perceptions about foods, nutrition, health, anemia and body image. The women recognized that there was a close association among eating well, "alimentarse bien", their health and prevention and treatment of anemia. They perceived that the nutritive value of a meal is determined primarily by its content of "nutritious" foods and by its being "balanced". Using this information the conceptual model of the education intervention was developed. The vulnerability of women to anemia was presented with the relationship between anemia and diet as the central focus. Feasible ways of achieving a nutritious diet were introduced to the community kitchens through promoting local heme iron sources and the consumption of beans with a vitamin C source. Animal source foods were amongst those considered to be nutritious and were "best buys" for iron content. CK searched for ways of assuring accessibility to these foods. The use of animal source foods in the community kitchen menus increased during the intervention.

Sources of dietary iron in urban and provincial 4-year-old children in Iran

Iron-deficiency anaemia is prevalent in childhood, especially in developing countries. Nutritional deficiency is one of the main causes of iron-deficiency anaemia, although absorption varies considerably between different dietary items. Information on the sources of iron in young children is limited. A study was therefore undertaken to investigate the different dietary sources of iron in 151 healthy children aged 4 years who were selected from two districts of Fars province, Iran. Two 3-day dietary diaries with pre- and post-interview were used to record the dietary intake of the children. Food and drinks were categorised into four groups (animal, plant, drinks and other) to measure the relative importance of different sources of iron. Sixty-eight percent of the children completed the 3-day dietary diaries in both summer and winter. The results showed no statistically significant differences in total daily iron intake between the two seasons or between genders. However, the difference in the total daily iron intake between children in the city and the provincial district was significant: 7.73+/-1.75 mg/day and 10.33+/-2.9 mg/day, respectively (P < 0.001). About 75 and 60% of iron intake came from plant sources in the provincial district and city, respectively. The three most important sources of iron for children of the provincial district were bread (51%), fruit and vegetables (12%) and meat (7%). This pattern was also observed for children living in the city, but with different percentages: 27%, 16% and 16%, respectively. In conclusion, total iron intakes were similar to those recorded in European countries, but little of the intake came from animal sources and substantial differences between city and provincial children were recorded.

Iron bioavailability and utilization in rats are lower from lime-treated corn flour than from wheat flour when they are fortified with different sources of iron

Although iron bioavailability from wheat flour fortified with iron has been widely studied, the bioavailability of lime-treated corn flour has not been evaluated sufficiently. We compared iron bioavailability and utilization of lime-treated corn flour and wheat flour supplemented with various iron sources. Bioavailability and utilization were determined in Sprague-Dawley rats using the iron balance and hemoglobin depletion-repletion methods. Rats were iron depleted by feeding them a low iron, casein diet for 10 d. During the repletion period, the rats were fed diets based on lime-treated corn flour or wheat flour, both supplemented with ferrous fumarate, ferrous sulfate, ferric citrate and reduced iron for 14 d. Hemoglobin was determined at the end of depletion and repletion periods. The phytate concentration was lower in wheat flour (114 mg/100g) than in lime-treated corn flour (501 mg/100g). Iron bioavailability and utilization by rats were higher from fortified and unfortified wheat flour than from the lime-treated corn flour counterparts. Iron utilization was greater in rats fed wheat flour supplemented with ferrous sulfate, followed by fumarate and citrate than in rats fed reduced iron. In lime-treated corn flour, iron utilization by rats fed unfortified flour and flour fortified with reduced iron did not differ, but utilization was higher in rats fed corn flour fortified with iron sulfate, fumarate and citrate than with reduced iron. We conclude that fortification of lime-treated corn flour with reduced iron has no effect on iron bioavailability or utilization, probably due to the high phytate content. Other iron compounds must be selected to fortify lime-treated corn flour when intended for public nutrition programs.

Improving dietary intake to prevent anemia in adolescent girls through community kitchens in a periurban population of Lima, Peru

Peru has high rates of iron deficiency anemia. The prevalence is 35% in nonpregnant women of fertile age and 24.7% in adolescent girls in slums of periurban Lima. The major cause of anemia is low intake of dietary iron. A community-based, randomized behavioral and dietary intervention trial was conducted to improve dietary iron intake and iron bioavailability of adolescent girls living in periurban areas of Lima, Peru. Results show that there was a change in knowledge about anemia and improved dietary iron intake in the 71 girls who completed the study compared with the 66 girls in the control group. Although the 9-mo. intervention was not sufficient to improve hemoglobin levels significantly, there appeared to be a protective effect in maintaining the iron status of girls in comparison with the control group.

Iron and folate fortification in the Americas to prevent and control micronutrient malnutrition: an analysis

Although there has been a remarkable decline in the proportion of malnourished children in Latin America, micronutrient deficiencies, especially iron deficiency anemia, remain significant public health problems. A substantial reduction in the prevalence of iron deficiency anemia is an important goal for the end of the decade. Interest in fortifying wheat flour and dry-milled maize flour is thus growing, and significant experience in the fortification of flours with iron and the B vitamins, including folate, is emerging. It is necessary to ensure that fortification levels and standards, legislation, and quality assurance and control measures are in place nationally and harmonized regionally.