QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mehansho, H. Search for Related Content PubMed PubMed Citation Articles by Mehansho, H.

---

Supplement: Forging Effective Strategies to Combat Iron Deficiency

Eradication of Iron Deficiency Anemia through Food Fortification: The Role of the Private Sector^{1 ,2}

Nutrition Science Institute, The Procter & Gamble Co., Cincinnati, OH 45252

	ABSTRACT

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
Delivering iron fortified foods that provide meaningful levels of bioavailable iron without altering the accepted appearance and taste of the product presents multiple challenges. Issues relating to food technology, product formulation, acceptance and efficacy evaluation, marketing and quality control must all be addressed. Procter & Gamble Company has developed a unique technology that stabilizes iron in an aqueous system. Utilizing this technology, a fortified powder drink has been developed that is easy to distribute, store and use and that delivers 20–30% of the U. S. RDA for iron, as well as significant amounts of vitamin A, iodine, zinc and vitamin C in a single serving. Acceptance, bioavailability and effectiveness trials have all produced positive results. This type of fortified product can contribute to alleviating iron deficiency but requires scaling up, packaging, quality control and distribution through normal trade channels and public institutions to have a sustainable impact. To be effective, a well-planned communications campaign should also accompany any major iron fortification program. Eradication of iron deficiency anemia can be done but requires a holistic approach that addresses multiple barriers and leverages the untapped expertise and strength of the alliance between public and private sectors.

KEY WORDS: • bioavailibility • food technology • fortified drink • iron deficiency anemia

	INTRODUCTION

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
Iron deficiency anemia (IDA)⁴ is the most widespread nutritional problem globally (1 ,2 ). The groups at risk are infants, preschool and school children and women of childbearing age. In general, IDA affects all countries and all ages; however, compared with the industrialized countries, the severity and magnitude is much greater in developing countries (1 ). If remained uncorrected, IDA does cause serious health and economic problems. These include impaired mental development, fatigue, poor school performance and reduced work output.

Indeed, there is a consensus within the scientific community that IDA is a widespread nutritional problem and causes serious health and economic liabilities. We, in the private sector, have recognized delivering iron fortified foods as an unmet consumer need. Producing and marketing iron fortified products will play a role in improving people’s health, self-esteem and, ultimately, productivity. However, there are multiple challenges in manufacturing and marketing products with a meaningful level of bioavailable iron without altering the accepted appearance and taste of the finally consumed product (3 ). How do we produce and market iron fortified products that will make a difference on the iron status of the target population? How do we develop and implement an affordable and sustainable iron fortification program?

	Iron fortification of foods

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
During the last 15 years, Procter & Gamble has been working on developing iron fortification technology and products. We have learned that iron fortification of foods is more than adding iron compounds, providing package labeling and marketing the product. Based on our experiences as well as those learned from others, we have proposed a model called "Sustainable Food Fortification Program," whose success is dependent on integration of multiple key elements. As presented in Figure 1 , the model’s key elements for success include: identification of deficiency among the target groups, development of fortification technology and products to meet the need, evaluating the product’s effect in improving iron status, manufacturing and distributing the product and educating consumers about the benefits of fortified products. Omission of these elements is a barrier to the success of an iron fortification program. They should not only be identified but should also be addressed during the different stages of the iron fortification program.

View larger version (113K): [in this window] [in a new window]   Figure 1. Model for sustainable fortification program.

	Establishing strategic alliances with the public sector

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

View larger version (161K): [in this window] [in a new window]   Figure 2. Public-private partnership model.

	Iron fortification technology

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

To find solutions to these challenges, we have evaluated the chemical properties of iron compounds commonly used for fortification. Iron, as a member of the transition elements, is known to undergo oxidation-reduction reactions, which results in changes in color, flavor and vitamin/flavor degradation. Based on the chemical and physical properties of iron, we have developed a technology that delivers highly bioavailable iron without altering the appearance and taste of the product. The technology uses chelation to tie up the iron as well as a unique environment that stabilizes iron in an aqueous system. The iron source used is a chelated ferrous iron (ferrous bis-glycinate; Albion Laboratories, Clearfield, UT). The iron is made stable during formulation, storage and consumption of the product and bioavailable after ingestion by using a unique proprietary technology called GrowthPlus (patent pending).

	Product formulation

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
By combining the GrowthPlus fortification technology and a fruit juice flavor system, Procter & Gamble has developed a fortified powder drink that is actually easy to distribute, store and use. A single serving of the product delivers (U. S. RDA) 20–30% iron, 15–35% vitamin A, 25–30% iodine, 25% zinc, 100% vitamin C and 15–25% B-vitamins (folic acid, vitamins B-12, B-6, B-2 and niacin). However, the addition of iron should not change the organoleptic properties of the vehicle. For the last 6 years, product attributes meaningful to the consumer (taste, appearance, vitamin stability and bioavailability) have been evaluated before the product’s introduction to the market place.

	Product acceptance evaluation

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
The acceptance of the fortified powder formulated with the GrowthPlus fortification technology was evaluated by conducting a 5-days home-use test among Filipino households. The study compared the fortified product against a placebo (product with the same appearance taste but without GrowthPlus). The subjects were questioned on overall product acceptance, flavor and color during consumption. The findings showed that the new technology had no significant effect on the flavor, color and overall acceptance of the fruit drink.

	Bioavailability and efficacy evaluation

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
The bioavailability of the iron from the fortified powder fruit drink was determined by using a double-isotope labeling technique (5 ). The study was done in collaboration with Dr. Tomas Walter’s group at the University of Chile. The treatments included: fortified powder beverage alone and fortified powder beverage with rice. The results were normalized to that of a standard ferrous ascorbate (40% absorption). When consumed alone, 23% of the iron from the fortified powder was absorbed, which is comparable to that absorbed from meat and approximately five times that of iron fortified milk (6 ,7 ). However, when consumed with rice, the percentage of absorbed iron reduced 50% (23% vs. 10%). However, although there was a significant reduction in iron absorption after consumption of the beverage with rice, the bioavailability is still comparable to that from fish, which is a good source of bioavailable iron.

Efficacy trials, as part of an alliance among Cornell University (Dr. Michael Latham), United Nations Children’s Fund, Tanzania Food & Nutrition Center, Micronutrient Initiative and Procter & Gamble, was conducted as a randomized, double-blind, placebo-controlled study among Tanzanian school children (8 ). Those in the treatment group received 5.4 mg of iron per day, 5 d a week for 6 mo. Among the group with mild/severe anemia (<11 g/dL hemoglobin) at baseline, there was a significant increase in hemoglobin (0.92 g/dL) only in the children receiving the fortified powder drink compared with the placebo group (0.02 mg/dL). This is further confirmed by a significant increase in ferritin (16 µg/L vs. 2 µg/L) among the group receiving the fortified product but not in the group receiving the placebo (8 ).

	Production and distribution of fortified products

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
Currently, many fortification programs mainly focus on the development and evaluation of iron fortified products. However, their affect on alleviating IDA can only be assessed after availability and consumption of the fortified product by the target groups. Therefore, manufacturing, packaging, quality control and distribution through normal trade channels and public institutions are needed steps. Unfortunately, production and distribution of the fortified product are the least recognized barriers to the success and sustainability of an iron fortification program.

Industry has a significant role to play in the production and distribution of fortified products. Successful manufacturing of iron fortified products is dependent on the availability of an effective and verifiable quality assurance program (Table 1 ). The producer (generally the private sector) should be responsible for delivering a fortified product that is safe, has the level of iron claimed in the package, and remains stable during the product’s shelf life.

View this table: [in this window] [in a new window]   TABLE 1 Key elements in quality assurance program (9 )

	Advocacy and communications strategies

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

	CONCLUSION AND RECOMMENDATION

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 
Eradication of IDA, despite seemingly formidable obstacles, is possible. Based on experiences to date, an effective and sustainable iron fortification program will require: new holistic approaches/programs that address multiple barriers and leveraging the untapped expertise and strength of alliances between the public and private sectors.

	FOOTNOTES

 
¹ Presented at the Atlanta conference on Forging Effective Strategies to Combat Iron Deficiency held May 7–9, 2001 in Atlanta, GA. The proceedings of this conference are published as a supplement to The Journal of Nutrition. Supplement guest editors were Frederick Trowbridge, Trowbridge & Associates, Inc., Decatur, GA and Reynaldo Martorell, Rollins School of Public Health, Emory University, Atlanta, GA.

² This article was commissioned by the International Life Sciences Institute Center for Health Promotion (ILSI CHP). The use of trade names and commercial sources in this document is for purposes of identification only and does not imply endorsement. In addition, the views expressed herein are those of the individual authors and/or their organizations and do not necessarily reflect those of ILSI CHP.

³ Address correspondence to The Procter & Gamble Co., Miami Valley Laboratories, 11810 East Miami River Road, Cincinnati OH 45252. E-mail: mehansho.h{at}pg.com.

⁴ Abbreviation used: IDA, iron deficiency anemia.

	LITERATURE CITED

TOP ABSTRACT INTRODUCTION Iron fortification of foods Establishing strategic alliances... Iron fortification technology Product formulation Product acceptance evaluation Bioavailability and efficacy... Production and distribution of... Advocacy and communications... CONCLUSION AND RECOMMENDATION LITERATURE CITED

 

1. DeMaeyer, E. M. & Adiels-Tegman, M. (1985) The prevalence of anemia in the world. World Health Stat. Q. 38:302-316.[Medline]

2. Administrative Committee on Coordination/Sub-Committee on Nutrition (1997) The Third Report on the World Nutrition Situation 1997 ACC/SCN Geneva, Switzerland. .

3. Hurrell, R. F. & Cook, J. D. (1990) Strategies for iron fortification of foods. Trends Food Sci. Technol. 1:56-61.

4. Hurrell, R. F. (1990) Preventing iron deficiency anemia through food fortification. Nutr. Rev. 55:210-222.

5. Olivares, M., Pizarro, F., Penida, O., Name, J. J., Hertrampf, E. & Walter, T. (1997) Milk inhibits and ascorbic acid favors ferrous bis-glycine chelate bioavailability in humans. J. Nutr. 127:1407-1411.[Abstract/Free Full Text]

6. Stekel, A., Amar, M., Calvo, E., Chadud, P., Hertrampf, E., Llaguno, S., Olivares, M. & Pizarro, F. (1983) Nutritional significance of interactions between iron and food components. Archivos Latino Americanos de Nutricion 33:34-41.

7. Clydesdale, F. M. (1982) The effect of physicochemical properties of food on the chemical status of iron. Kies, C. eds. Nutritional Bioavailability of Iron 1982:55-84 American Chemical Society Washington, DC. .

8. Latham, M. C., Ash, D., Ndossi, C., Mehansho, H. & Tatala, S. (2001) Micronutrient dietary supplements—a new fourth approach. Archivos Latino Americanos de Nutricion 51:37-41.

9. Mehansho, H. & Mannar, M.G.V. (1999) Mineral fortification in developing countries. Hurrell, R. eds. The Mineral Fortification of Foods 1999:210-228 Leatherhead International Ltd. Leatherhead, England. .

This article has been cited by other articles:

				S. M. Ziauddin Hyder, F. Haseen, M. Khan, T. Schaetzel, C. S. B. Jalal, M. Rahman, B. Lonnerdal, V. Mannar, and H. Mehansho A Multiple-Micronutrient-Fortified Beverage Affects Hemoglobin, Iron, and Vitamin A Status and Growth in Adolescent Girls in Rural Bangladesh J. Nutr., September 1, 2007; 137(9): 2147 - 2153. [Abstract] [Full Text] [PDF]

				H. Mehansho Iron Fortification Technology Development: New Approaches J. Nutr., April 1, 2006; 136(4): 1059 - 1063. [Abstract] [Full Text] [PDF]

				D. Makola, D. M. Ash, S. R. Tatala, M. C. Latham, G. Ndossi, and H. Mehansho A Micronutrient-Fortified Beverage Prevents Iron Deficiency, Reduces Anemia and Improves the Hemoglobin Concentration of Pregnant Tanzanian Women J. Nutr., May 1, 2003; 133(5): 1339 - 1346. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mehansho, H. Search for Related Content PubMed PubMed Citation Articles by Mehansho, H.