Impact of Double-Fortified Salt with Iron and Iodine on Hemoglobin, Anemia, and Iron Deficiency Anemia: A Systematic Review and Meta-Analysis.

08:00 EDT 1st May 2018 | BioPortfolio

Summary of "Impact of Double-Fortified Salt with Iron and Iodine on Hemoglobin, Anemia, and Iron Deficiency Anemia: A Systematic Review and Meta-Analysis."

Double-fortified salt (DFS) containing iron and iodine has been proposed as a feasible and cost-effective alternative for iron fortification in low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis from randomized and quasi-randomized controlled trials to 1) assess the effect of DFS on biomarkers of iron status and the risk of anemia and iron deficiency anemia (IDA) and 2) evaluate differential effects of DFS by study type (efficacy or effectiveness), population subgroups, iron formulation (ferrous sulfate, ferrous fumarate, and ferric pyrophosphate), iron concentration, duration of intervention, and study quality. A systematic search with the use of MEDLINE, EMBASE, Cochrane, Web of Science, and other sources identified 221 articles. Twelve efficacy and 2 effectiveness studies met prespecified inclusion criteria. All studies were conducted in LMICs: 10 in India, 2 in Morocco, and 1 each in Côte d'Ivoire and Ghana. In efficacy studies, DFS increased hemoglobin concentrations [standardized mean difference (SMD): 0.28; 95%
0.11, 0.44; P < 0.001] and reduced the risk of anemia (
0.59; 95%
0.46, 0.77; P < 0.001) and IDA (RR 0.37; 95%
0.25, 0.54; P < 0.001). In effectiveness studies, the effect size for hemoglobin was smaller but significant (
0.03; 95%
0.01, 0.05; P < 0.01). Stratified analyses of efficacy studies by population subgroups indicated positive effects of DFS among women and school-age children. For the latter, DFS increased hemoglobin concentrations (
0.32; 95%
0.03, 0.60; P < 0.05) and reduced the risk of anemia (
0.48; 95%
0.34, 0.67; P < 0.001) and IDA (
0.37; 95%
0.25, 0.54; P < 0.001). Hemoglobin concentrations, anemia prevalence and deworming at baseline, sample size, and study duration were not associated with effect sizes. The results indicate that DFS is efficacious in increasing hemoglobin concentrations and reducing the risk of anemia and IDA in LMIC populations. More effectiveness studies are needed.


Journal Details

This article was published in the following journal.

Name: Advances in nutrition (Bethesda, Md.)
ISSN: 2156-5376
Pages: 207-218


DeepDyve research library

PubMed Articles [12613 Associated PubMed Articles listed on BioPortfolio]

Universal Salt Iodization Provides Sufficient Dietary Iodine to Achieve Adequate Iodine Nutrition during the First 1000 Days: A Cross-Sectional Multicenter Study.

Dietary iodine requirements are high during pregnancy, lactation, and infancy, making women and infants vulnerable to iodine deficiency. Universal salt iodization (USI) has been remarkably successful ...

Iodine Intake Estimation from the Consumption of Instant Noodles, Drinking Water and Household Salt in Indonesia.

The objective of this study was to assess the contribution of iodine intake from iodised household salt, iodised salt in instant noodles, and iodine in ground water in five regions of Indonesia. Secon...

Relative Bioavailability of Iron in Bangladeshi Traditional Meals Prepared with Iron-Fortified Lentil Dal.

Due to low Fe bioavailability and low consumption per meal, lentil must be fortified to contribute significant bioavailable Fe in the Bangladeshi diet. Moreover, since red lentil is dehulled prior to ...

Iodine status of pregnant women from a coastal Brazilian state after the reduction in recommended iodine concentration in table salt according to governmental requirements.

To evaluate iodine status among pregnant women from a coastal state after Brazilian governmental resolution reducing iodine concentrations in table salt. Secondarily, we correlated urinary iodine conc...

Impact of food supplements on hemoglobin, iron status, and inflammation in children with moderate acute malnutrition: a 2 × 2 × 3 factorial randomized trial in Burkina Faso.

Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplements (LNSs) or corn-soy blends (CSBs) but little is known about the impact of these supplements on hemoglob...

Clinical Trials [5001 Associated Clinical Trials listed on BioPortfolio]

Efficacy of Double Fortified Salt (DFS) to Improve Work Productivity in Women in India

The main objective of the present study is to assess the impact of double fortified salt containing iron and iodine on work performance (productivity) of women plantation workers in India....

Iron Bioavailability From Fortified Food

Determination of fractional iron absorption from bouillon fortified with 3 labeled iron compounds.

Effect of Rice Fortification With Iron on Anemia Among Children

This was a double-blind community-based trial, placebo controlled. During 16 weeks, children in the intervention group (GI, n=180) received iron fortified rice, and children in the control...

Iron Bioavailability From Dairy Product

Determination of fractional iron absorption from dairy product fortified with 2 labelled iron compounds

Efficacy of Micronutrient Fortified Yoghurt in School Children for Health Benefits

To evaluate the efficacy of consumption of yoghurt fortified with 30% recommended dietary allowance (RDA) of essential micronutrients (iron, zinc, vitamin A and iodine) for a period of one...

Medical and Biotech [MESH] Definitions

Any food that has been supplemented with essential nutrients either in quantities that are greater than those present normally, or which are not present in the fortified food. The supplementation of cereals with iron and vitamins is an example of fortified food. Fortified food includes also enriched food to which various nutrients have been added to compensate for those essential nutrients removed by refinement or processing. (From Segen, Dictionary of Modern Medicine, 1992)

Iron or iron compounds used in foods or as food. Dietary iron is important in oxygen transport and the synthesis of the iron-porphyrin proteins hemoglobin, myoglobin, cytochromes, and cytochrome oxidase. Insufficient amounts of dietary iron can lead to iron-deficiency anemia.

Anemia characterized by a decrease in the ratio of the weight of hemoglobin to the volume of the erythrocyte, i.e., the mean corpuscular hemoglobin concentration is less than normal. The individual cells contain less hemoglobin than they could have under optimal conditions. Hypochromic anemia may be caused by iron deficiency from a low iron intake, diminished iron absorption, or excessive iron loss. It can also be caused by infections or other diseases, therapeutic drugs, lead poisoning, and other conditions. (Stedman, 25th ed; from Miale, Laboratory Medicine: Hematology, 6th ed, p393)

Anemia characterized by decreased or absent iron stores, low serum iron concentration, low transferrin saturation, and low hemoglobin concentration or hematocrit value. The erythrocytes are hypochromic and microcytic and the iron binding capacity is increased.

An adult hemoglobin component normally present in hemolysates from human erythrocytes in concentrations of about 3%. The hemoglobin is composed of two alpha chains and two delta chains. The percentage of HbA2 varies in some hematologic disorders, but is about double in beta-thalassemia.

Quick Search


DeepDyve research library

Relevant Topic

Blood is a specialized bodily fluid that delivers necessary substances to the body's cells (in animals) – such as nutrients and oxygen – and transports waste products away from those same cells.  In vertebrates, it is composed of blo...

Searches Linking to this Article