Ensuring the Efficacious Iron Fortification of Foods: A Tale of Two Barriers

Iron Absorption from an Iron-Fortified Follow-Up Formula with and without the Addition of a Synbiotic or a Human-Identical Milk Oligosaccharide: A Randomized Crossover Stable Isotope Study in Young Thai Children

BACKGROUND

Previous studies showed that pre- and probiotics may enhance iron absorption. Probiotics combined with prebiotics (synbiotics), including human-identical milk oligosaccharides (HiMOs), are commonly added to infant and follow-up formula (FUF). Whether these additions enhance iron absorption from iron-fortified commercial milk formula is uncertain.

OBJECTIVES

We determined the effect of adding 1) a synbiotic [galacto-oligosaccharides [GOSs] + Limosilactobacillus reuteri (L. reuteri)] or 2) the HiMO 2'-fucosyllactose (2'FL) to iron-fortified FUF on iron absorption in young Thai children.

METHODS

In a randomized, controlled, single-blinded (participants) crossover study, 82 Thai children aged 8-14 mo were enrolled to consume single servings (235 mL) of FUF with isotopically labeled ferrous sulfate (2.2 mg iron) with 1) the synbiotic (400 mg/100 mL GOS and L. reuteri DSM 17938), 2) the 2'FL (100 mg/100 mL), and 3) without synbiotic and 2'FL (control) in random order and a 3-d washout period between administrations. Fractional iron absorption [FIA (%)] was assessed by measuring erythrocyte incorporation of isotopic labels 14 d (n = 26) and 28 d (n = 76) after consumption of the last test FUF.

RESULTS

Median (IQR) FIA from iron-fortified FUF with the synbiotic [8.2 (5.2, 12.9)%] and with 2'FL [8.4 (5.5, 14.1)%] did not differ from the control FUF [8.1 (4.8,14.7)%] (synbiotic compared with control, P = 0.24; 2'FL compared with control, P = 0.95). FIA from all FUF did not differ when measured after 14 and 28 d of erythrocyte incorporation (Time, P = 0.368; FUF, P = 0.435; Time × FUF, P = 0.937). Fecal pH and hemoglobin were negatively associated with FIA.

CONCLUSIONS

In young Thai children, the addition of a synbiotic (GOS + L. reuteri) or 2'FL to iron-fortified FUF did not impact FIA from a single serving. The study was registered at clinicaltrials.gov as NCT04774016.

Ferrous Pyrophosphate and Mixed Divalent Pyrophosphates as Delivery Systems for Essential Minerals

Poorly water-soluble iron-containing compounds are promising iron fortificants. However, ensuring high bioaccessibility and low reactivity of iron is challenging. We present the potential application of ferrous pyrophosphate (Fe(II)PP) and Fe(II)-containing M2(1-x)Fe2x P2O7 salts (0 < x < 1, M = Ca, Zn, or Mn) for delivery of iron and a second essential mineral (M). After preparation by a facile and environment-friendly coprecipitation method, the salts were investigated for their composition, pH-dependent dissolution, iron-mediated discoloration of a black tea solution, and oxidation of vitamin C. Our results suggest that these salts are possible dual-fortificants with tunable composition that compared to Fe(II)PP (i) show lower (<0.5 mM) and enhanced (to 5 mM) iron dissolution in moderate and gastric pH, respectively, (ii) exhibit less discoloration and dissolved iron in tea when x = 0.470 for M = Ca or Zn and x = 0.086 for M = Mn, and (iii) do not increase the oxidation extent of vitamin C over 48 h when x = 0.06, 0.086, or 0.053 for M = Ca, Zn, or Mn, respectively.

The Effect of Iron-Fortified Lentils on Blood and Cognitive Status among Adolescent Girls in Bangladesh

BACKGROUND

Iron deficiency is highly prevalent in South Asia, especially among women and children in Bangladesh. Declines in cognitive performance are among the many functional consequences of iron deficiency.

OBJECTIVE

We tested the hypothesis that, over the course of a 4-month iron fortification trial, cognitive performance would improve, and that improvement would be related to improvements in iron status.

METHODS

Participants included 359 adolescent girls attending Bangladesh Rural Advancement Committee (BRAC) clubs as a subsample of a larger double-blind, cluster-randomized community trial in which participants were assigned to one of three conditions: a condition in which no lentils were supplied (NL, n = 118, but which had the usual intake of lentils), a control (non-fortified) lentil condition (CL, n = 124), and an iron-fortified lentil condition (FL, n = 117). In the FL and CL conditions, approximately 200 g of cooked lentils were served five days per week for a total of 85 feeding days. In addition to biomarkers of iron status, five cognitive tasks were measured at baseline (BL) and endline (EL): simple reaction time task (SRT), go/no-go task (GNG), attentional network task (ANT), the Sternberg memory search Task (SMS), and a cued recognition task (CRT).

RESULTS

Cognitive performance at EL was significantly better for those in the FL relative to the CL and NL conditions, with this being true for at least one variable in each task, except for the GNG. In addition, there were consistent improvements in cognitive performance for those participants whose iron status improved. Although there were overall declines in iron status from BL to EL, the declines were smallest for those in the FL condition, and iron status was significantly better for those in FL condition at EL, relative to those in the CL and NL conditions.

CONCLUSIONS

the provision of iron-fortified lentils provided a protective effect on iron status in the context of declines in iron status and supported higher levels of cognitive performance for adolescent girls at-risk of developing iron deficiency.

Factors affecting iron absorption and the role of fortification in enhancing iron levels

Iron is an important micronutrient required for a number of biological processes including oxygen transport, cellular respiration, the synthesis of nucleic acids and the activity of key enzymes. The World Health Organization has recognised iron deficiency as the most common nutritional deficiency globally and as a major determinant of anaemia. Iron deficiency anaemia affects 40% of all children between the ages of 6 and 59 months, 37% of mothers who are pregnant and 30% of women between the ages of 15 and 49 years worldwide. Dietary iron exists in two main forms known as haem iron and non-haem iron. Haem iron is obtained from animal sources such as meat and shows higher bioavailability than non-haem iron, which can be obtained from both plant and animal sources. Different components in food can enhance or inhibit iron absorption from the diet. Components such as meat proteins and organic acids increase iron absorption, while phytate, calcium and polyphenols reduce iron absorption. Iron levels in the body are tightly regulated since both iron overload and iron deficiency can exert harmful effects on human health. Iron is stored mainly as haemoglobin and as iron bound to proteins such as ferritin and hemosiderin. Iron deficiency affects individuals at increased risk due to factors such as age, pregnancy, menstruation and various diseases. Different solutions for iron deficiency are applied at individual and community levels. Iron supplements and intravenous iron can be used to treat individuals with iron deficiency, while various types of iron-fortified foods and biofortified crops can be employed for larger communities. Foods such as rice, flour and biscuits have been used to prepare fortified iron products. However, it is important to ensure the fortification process does not exert significant negative effects on organoleptic properties and the shelf life of the food product.

Health Benefits of Bread Fortification: A Systematic Review of Clinical Trials according to the PRISMA Statement

Bread is among the most common foods for the world's population. Therefore, it can be fortified to eliminate deficiencies of nutrients or be a carrier of other substances with a nutritional or physiological effect, bringing health benefits to its consumers, thus impacting sustainable health. This systematic review aimed to analyze clinical studies on the effects of bread fortification on human health. The study followed the PRISMA guidelines for transparency and utilized databases Scopus, Embase, PubMed, and Web of Science to search clinical trials focused on the effects of bread fortification on human health over the entire last decade. The methodological quality of selected studies was assessed using the Jadad scale. As a result, twenty-six studies meet the inclusion criteria. Clinical trials have shown health benefits from consuming bread fortified with vitamins (B9, C, D2, D3), minerals (K, P, Ca, Mg, Fe, Zn, Cr, Se), fiber, proteins, and polyphenolic compounds. Conclusions reveal that mandatory fortification aligns with the sustainable development goals. Thus, collaborative partnerships are essential for successful implementation and accessibility, fostering public health advances and progress developing into sustainable health.

Dietary iron intake over two post-fortification periods in Brazil: data from the National Dietary Surveys 2008-2009 and 2017-2018

We aimed to assess the dietary Fe intake and the prevalence of inadequate Fe intake over two post-fortification periods in Brazil. The intake was analysed according to sex, life stage, geographic region and stratum of family income per capita. Excluding pregnant and lactating women, this population-based study included 32 749 and 44 744 participants aged ≥ 10 years from the National Dietary Survey-Brazilian Household Budget Surveys 2008-2009 and 2017-2018, respectively. The National Cancer Institute method was used to predict usual dietary Fe intakes. The prevalence of Fe intake inadequacy was estimated following a probabilistic approach for women of childbearing age or with the Estimated Average Requirement cut-off point method. Over an interval of 10 years, the mean Fe intake remained almost unchanged for most sex-age groups, except for women of childbearing age. In this specific group, the prevalence of Fe intake inadequacy was > 20 % in 2008-2009 and have increased to > 25 % in 2017-2018, with the highest reductions in mean Fe intake found in the highest income strata and richest Brazilian regions. Meanwhile, the highest prevalence of Fe intake inadequacy (> 40 %) occurred among the poorest women aged 31-50 years from the lowest family income stratum, irrespective of the study period. Beans were the main Fe source, while fortified breads, pastas, pizzas, cakes and cookies contributed approximately 40 % of the Fe intake. The results provide important insights into the long-standing dietary impacts of food fortification, which can guide future (re)formulation of effective public health strategies to combat Fe deficiency.

Enhancing micronutrient absorption through simultaneous fortification and phytic acid degradation

Phytic acid (PA), an endogenous antinutrient in cereals and legumes, hinders mineral absorption by forming less bioavailable, stable PA-mineral complexes. For individual micronutrients, the PA-to-mineral molar ratio below the critical level ensures better bioavailability and is achieved by adding minerals or removing PA from cereals and pulses. Although several PA reduction and fortification strategies are available, the inability to completely eradicate or degrade PA using available techniques always subdues fortification's impact by hindering fortified micronutrient absorption. The bioavailability of micronutrients could be increased through simultaneous PA degradation and fortification. Following primary PA reduction of the raw material, the fortification step should also incorporate additional essential control stages to further PA inactivation, improving micronutrient absorption. In this review, the chemistry of PA interaction with metal ions, associated controlling parameters, and its impact on PA reduction during fortification is also evaluated, and further suggestions were made for the fortification's success.

Metal-binding peptides and their potential to enhance the absorption and bioavailability of minerals

Minerals including calcium, iron, zinc, magnesium, and copper have several human nutritional functions due to their metabolic activities. Body tissues require sufficient levels of a variety of micronutrients to maintain their health. To achieve these micronutrient needs, dietary consumption must be adequate. Dietary proteins may regulate the biological functions of the body in addition to acting as nutrients. Some peptides encoded in the native protein sequences are primarily responsible for the absorption and bioavailability of minerals in physiological functions. Metal-binding peptides (MBPs) were discovered as potential agents for mineral supplements. Nevertheless, sufficient studies on how MBPs affect the biological functions of minerals are lacking. The hypothesis is that the absorption and bioavailability of minerals are significantly influenced by peptides, and these properties are further enhanced by the configuration and attribute of the metal-peptide complex. In this review, the production of MBPs is discussed using various key parameters such as the protein sources and amino acid residues, enzymatic hydrolysis, purification, sequencing and synthesis and in silico analysis of MBPs. The mechanisms of metal-peptide complexes as functional food ingredients are elucidated, including metal-peptide ratio, precursors and ligands, complexation reaction, absorbability and bioavailability. Finally, the characteristics and application of different metal-peptide complexes are also described.

Use of granules and free salts for Fe and Zn fortification of leafy vegetables: Improvements in trace element bioaccessibility and fulfillment of Dietary Reference Intakes

BACKGROUND

Leafy vegetables represent an excellent dietary source of trace elements such as Fe and Zn. Nevertheless, Fe and Zn bioaccessibility can lessen due to a high concentration of anti-nutritional compounds. The encapsulation of Fe and Zn salts as granules could be used to fortify these leafy vegetables.

METHOD

Three leafy vegetables, spinach, Swiss chard and Ethiopian mustard were fortified with iron sulfate and zinc sulfate as granules and free salts in order to test the improvements in the bioaccessibility and fulfillments of DRIs. Fe and Zn granules were prepared in a fluidized bed granulator. A probabilistic analysis was performed, using experimental data, to assess bioaccessible intake and fulfillments of DRIs in European populations.

RESULTS

Fe contents ranged between 4.8 mg/100 g of Ethiopian mustard to 157.4 mg/100 g of spinach. Fe and Zn bioaccessibility percentages were low for Swiss chard and spinach without fortification. Fortification with granules improved Fe bioaccessibility of these latter vegetables (196 and 223 mg/100 g). Zn contents in samples without fortification ranged between 2.3 mg/100 g for Ethiopian mustard and 7.4 mg/100 g for spinach. Zn fortification as granules improved Zn bioaccessibility for the three vegetables studied. Thus, Zn bioccessible concentrations ranged between 17.4 and 108 mg/100 g for the solubility assay and between 5.9 and 31.1 mg/100 g for the dialyzability assay. Besides, the probability analysis showed that fortification had a better performance in meeting DRIs for those populations with higher consumption levels of leafy vegetables.

CONCLUSIONS

The probability analysis demonstrated that fortification can be a suitable strategy to meet DRIs for both trace elements, which was especially remarkable for Fe. Fortification with granule was more effective in most the cases, although for Ethiopian mustard, free salt of Fe showed a better performance.

Sustainability and Gender Perspective in Food Innovation: Foods and Food Processing Coproducts as Source of Macro- and Micro-Nutrients for Woman-Fortified Foods

Micro- and macro-nutrient deficiencies among women are considered a global issue that the food industry has not adequately considered until recently. The industry must provide and guarantee a diversity of food products worldwide that allow women to get a correct and balanced diet according their life stage. The food industry must focus on this challenge within a framework of sustainable production, minimizing the use of natural resources and avoiding the emission of waste and pollutants throughout the life cycle of food. Food coproducts are presented as potential bioactive functional compounds which can be useful for technological purposes, due to the fact that they can serve as non-chemical, natural and health-improving food ingredients. In this review, we focus on the potential use of food processing coproducts which must be part of a strategy to promote and improve women's health and well-being. This knowledge will make it possible to select potential ingredients from coproducts to be used in the fortification of foods intended for consumption by females and to introduce sustainability and gender perspectives into food innovation. The attainment of fortifications for foods for women has to be linked to the use of sustainable sources from food coproducts in order to be economically viable and competitive.