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Title: Ferrous sulfate is more bioavailable among preschoolers than other forms of iron in a milk-based weaning food distributed by PROGRESA, a national program in Mexico

Author
item PEREZ-EXPOSITO, ANA - INST NATL DE SALUD PUBLIC
item VILLALPANDO, SALVADOR - INST NATL DE SALUD PUBLIC
item RIVERA, JUAN - INST NATL DE SALUD PUBLIC
item Griffin, Ian
item Abrams, Steven

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/1/2004
Publication Date: 1/1/2005
Citation: Perez-Exposito, A.B., Villalpando, S., Rivera, J.A., Griffin, I.J., Abrams, S.A. 2005. Ferrous sulfate is more bioavailable among preschoolers than other forms of iron in a milk-based weaning food distributed by PROGRESA, a national program in Mexico. Journal of Nutrition. 135(1):64-69.

Interpretive Summary: In Mexico, a program called PROGRESA exists to provide fortified foods for small children. However, the program did not seem effective in improving the iron level in the children. We thought this might be because the iron was not being absorbed well from the food given. In this study we looked at different forms of iron that were being used or could be used in the PROGRESA supplement. We studied 54 small children aged 2 to 4 years. We found that the best absorption of iron came from ferrous sulfate. The type of iron currently in use, reduced iron, had very poor iron absorption. Ferrous fumarate, another type of iron was in between those two. This study was used to change the way in which PROGRESA was fortified with iron in Mexico.

Technical Abstract: After 1 y of distributing a milk-based fortified weaning food provided by the Mexican social program PROGRESA, positive effects on physical growth, prevalence of anemia, and several vitamin deficiencies were observed. There was no effect on iron status, which we hypothesized was related to the poor bioavailability of the reduced iron used as a fortificant in PROGRESA. The objective of this study was to compare the iron bioavailability from different iron sources added as fortificants to the weaning food. Children (n = 54) aged 2-4 y were randomly assigned to receive 44 g of the weaning food fortified with ferrous sulfate, ferrous fumarate, or reduced iron + Na(2)EDTA. Iron absorption was measured using an established double-tracer isotopic methodology. Iron absorption from ferrous sulfate (7.9 +/- 9.8%) was greater than from either ferrous fumarate (2.43 +/- 2.3%) or reduced iron + Na(2)EDTA (1.4 +/- 1.3%) (P < 0.01). The absorption of log-(58)Fe sulfate given with the iron source correlated with serum ferritin (s-ferritin) concentration (n = 13, r = 0.63, P = 0.01) and log-(57)Fe absorption (reference dose) (n = 14, r = -0.52, P = 0.02). Absorption from ferrous fumarate and reduced iron + Na2EDTA did not correlate with s-ferritin or absorption of (57)Fe. The recommended daily portion of the fortified complementary food provides an average of 0.256, 0.096, 0.046 mmol (1.44, 0.54, and 0.26 mg) of absorbed iron, if fortified with sulfate, fumarate, and reduced iron + Na(2)EDTA, respectively. Ferrous sulfate was more bioavailable than either ferrous fumarate or reduced iron + Na(2)EDTA when added to the milk-based fortified food and more readily met the average daily iron requirements for children 2-3 y of age.