Dual fortification of salt with iodine and microencapsulated iron: a randomized, double-blind, controlled trial in moroccan schoolchildren

• Published in: The American journal of clinical nutrition Vol. 77; no. 2; pp. 425 - 432
• Main Authors: ZIMMERMANN, Michael B, ZEDER, Christophe, CHAOUKI, Noureddine, SAAD, Amina, TORRESANI, Toni, HURRELL, Richard F
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Clinical Nutrition 01-02-2003; American Society for Clinical Nutrition, Inc
• Subjects: Adolescent; Adult; Aged; Anemia, Iron-Deficiency - complications; Anemia, Iron-Deficiency - epidemiology; Anemia, Iron-Deficiency - prevention & control; Anemias. Hemoglobinopathies; Biological and medical sciences; Biological Availability; Child; Child, Preschool; Children & youth; Clinical trials; Diseases of red blood cells; Double-Blind Method; Drug Compounding; Endocrinopathies; Female; Food Handling - methods; Food, Fortified; Goiter - complications; Goiter - epidemiology; Goiter - prevention & control; Hematologic and hematopoietic diseases; Humans; Iodine - therapeutic use; Iron; Iron, Dietary - pharmacokinetics; Iron, Dietary - therapeutic use; Male; Medical sciences; Middle Aged; Morocco - epidemiology; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Prevalence; Salt; Sodium Chloride, Dietary - therapeutic use; Thyroid Gland - drug effects; Thyroid. Thyroid axis (diseases); Time Factors; Treatment Outcome; Tropical medicine; Morocco; Africa; Endocrinopathy; Iron deficiency anemia; Hemopathy; Iron; Supplemented diet; Inorganic element; Prevention; Salt; dual; Morocco; Goiter; children; Microencapsulation; Sideropenia; Child; Iodine; Human; Thyroid diseases; Bioavailability; Hypothyroidism; anemia; Feeding; Micronutrient; School age; Randomized design; deficiency; Double blind study; fortification
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/77.2.425

In many developing countries, children are at high risk of both goiter and iron deficiency anemia.
In a series of studies in northern Morocco, we developed and tested a dual-fortified salt (DFS) containing iodine and microencapsulated iron.
To establish the DFS fortification concentration, we measured salt intake by 3-d weighed food records and estimated iron bioavailability from the local diet by using published algorithms. We then formulated a DFS containing 25 micro g iodine/g salt (as potassium iodide) and 1 mg iron/g salt (as ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil). After storage and acceptability trials, we compared the efficacy of the DFS to that of iodized salt in a 9-mo, randomized, double-blind trial in iodine-deficient, 6-15-y-old children (n = 377).
Mean salt intake in school-age children was 7-12 g/d, and estimated iron bioavailability from the local diet was 0.4-4.3%. After storage for 20 wk, the DFS and iodized salt were not significantly different in iodine content, and color stability was acceptable when the compounds were added to local meals. During the efficacy trial, urinary iodine concentrations and thyroid volumes improved significantly (P < 0.001 and < 0.05, respectively) from baseline in both groups. At 40 wk, mean hemoglobin concentrations in the DFS group had increased by 14 g/L (P < 0.01), and serum ferritin, transferrin receptor, and zinc protoporphyrin concentrations were significantly better (P < 0.05) in the DFS group than in the iodized salt group. The prevalence of iron deficiency anemia in the DFS group decreased from 35% at baseline to 8% at 40 wk (P < 0.001).
A DFS containing iodine and encapsulated iron can be an effective fortification strategy.