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The Potential of Iodine and Iron Double-Fortified Salt Compared with Iron-Fortified Staple Foods to Increase Population Iron Status.
J Nutr. 2021 02 15; 151(Suppl 1):47S-63S.JN

Abstract

The potential of double-fortified salt (DFS) to improve population iron status is compared with the potential of iron-fortified wheat flour, maize flour, rice grains, and milk products. The potential for a positive impact on iron status is based on reported efficacy studies, consumption patterns, the extent of industrialization, and whether there are remaining technical issues with the fortification technologies. Efficacy studies with DFS, and with iron-fortified wheat flour, maize flour, and rice, have all reported good potential to improve population iron status. Iron-fortified milk powder has shown good impact in young children. When these foods are industrially fortified in modern, automated facilities, with high-level quality control and assurance practices, high-quality raw materials, and a wide population coverage, all vehicles have good potential to improve iron status. Relative to other fortification vehicles, fortification practices with wheat flour are the most advanced and iron-fortified wheat flour has the highest potential for impact in the short- to medium-term in countries where wheat flour is consumed as a staple. Liquid milk has the least potential, mainly because an acceptable iron fortification technology has not yet been developed. Maize is still predominantly milled in small-scale local mills and, although the extruded rice premix technology holds great promise, it is still under development. Salt has a proven record as an excellent vehicle for iodine fortification and has demonstrated good potential for iron fortification. However, technical issues remain with DFS and further studies are needed to better understand and avoid color formation and iron-catalyzed iodine losses in both high- and low-quality salts under different storage conditions. There is currently a risk that the introduction of DFS may jeopardize the success of existing salt iodization programs because the addition of iron may increase iodine losses and cause unacceptable color formation.

Authors+Show Affiliations

Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

33582784

Citation

Hurrell, Richard F.. "The Potential of Iodine and Iron Double-Fortified Salt Compared With Iron-Fortified Staple Foods to Increase Population Iron Status." The Journal of Nutrition, vol. 151, no. Suppl 1, 2021, 47S-63S.
Hurrell RF. The Potential of Iodine and Iron Double-Fortified Salt Compared with Iron-Fortified Staple Foods to Increase Population Iron Status. J Nutr. 2021;151(Suppl 1):47S-63S.
Hurrell, R. F. (2021). The Potential of Iodine and Iron Double-Fortified Salt Compared with Iron-Fortified Staple Foods to Increase Population Iron Status. The Journal of Nutrition, 151(Suppl 1), 47S-63S. https://doi.org/10.1093/jn/nxaa204
Hurrell RF. The Potential of Iodine and Iron Double-Fortified Salt Compared With Iron-Fortified Staple Foods to Increase Population Iron Status. J Nutr. 2021 02 15;151(Suppl 1):47S-63S. PubMed PMID: 33582784.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Potential of Iodine and Iron Double-Fortified Salt Compared with Iron-Fortified Staple Foods to Increase Population Iron Status. A1 - Hurrell,Richard F, PY - 2020/02/26/received PY - 2020/04/10/revised PY - 2020/06/22/accepted PY - 2021/2/14/entrez PY - 2021/2/15/pubmed PY - 2021/8/26/medline KW - cereals KW - consumption patterns KW - industry landscape KW - iron fortification efficacy KW - salt KW - sensory changes SP - 47S EP - 63S JF - The Journal of nutrition JO - J Nutr VL - 151 IS - Suppl 1 N2 - The potential of double-fortified salt (DFS) to improve population iron status is compared with the potential of iron-fortified wheat flour, maize flour, rice grains, and milk products. The potential for a positive impact on iron status is based on reported efficacy studies, consumption patterns, the extent of industrialization, and whether there are remaining technical issues with the fortification technologies. Efficacy studies with DFS, and with iron-fortified wheat flour, maize flour, and rice, have all reported good potential to improve population iron status. Iron-fortified milk powder has shown good impact in young children. When these foods are industrially fortified in modern, automated facilities, with high-level quality control and assurance practices, high-quality raw materials, and a wide population coverage, all vehicles have good potential to improve iron status. Relative to other fortification vehicles, fortification practices with wheat flour are the most advanced and iron-fortified wheat flour has the highest potential for impact in the short- to medium-term in countries where wheat flour is consumed as a staple. Liquid milk has the least potential, mainly because an acceptable iron fortification technology has not yet been developed. Maize is still predominantly milled in small-scale local mills and, although the extruded rice premix technology holds great promise, it is still under development. Salt has a proven record as an excellent vehicle for iodine fortification and has demonstrated good potential for iron fortification. However, technical issues remain with DFS and further studies are needed to better understand and avoid color formation and iron-catalyzed iodine losses in both high- and low-quality salts under different storage conditions. There is currently a risk that the introduction of DFS may jeopardize the success of existing salt iodization programs because the addition of iron may increase iodine losses and cause unacceptable color formation. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/33582784/The_Potential_of_Iodine_and_Iron_Double_Fortified_Salt_Compared_with_Iron_Fortified_Staple_Foods_to_Increase_Population_Iron_Status_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.1093/jn/nxaa204 DB - PRIME DP - Unbound Medicine ER -