Wheat flour fortification with iron for reducing anaemia and improving iron status in populations (Review)

*, Prasanna Mithra P and *, Martha S Field and *, Diana Estevez and *, Juan Pablo Peña-Rosas (2020) Wheat flour fortification with iron for reducing anaemia and improving iron status in populations (Review). Cochrane Database of Systematic Reviews. pp. 1-119. ISSN 1469493X

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Abstract

Background Anaemia is a condition where the number of red blood cells (and consequently their oxygen-carrying capacity) is insuDicient to meet the body's physiologic needs. Fortification of wheat flour is deemed a useful strategy to reduce anaemia in populations. Objectives To determine the benefits and harms of wheat flour fortification with iron alone or with other vitamins and minerals on anaemia, iron status and health-related outcomes in populations over two years of age. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, and other databases up to 4 September 2019. Selection criteria We included cluster- or individually randomised controlled trials (RCT) carried out among the general population from any country aged two years and above. The interventions were fortification of wheatflour with iron alone orin combination with other micronutrients. Trials comparing any type of food item prepared from flour fortified with iron of any variety of wheat were included. Data collection and analysis Two review authors independently screened the search results and assessed the eligibility of studies for inclusion, extracted data from included studies and assessed risk of bias. We followed Cochrane methods in this review. Main results Our search identified 3048 records, aKer removing duplicates. We included nine trials, involving 3166 participants, carried out in Bangladesh, Brazil, India, Kuwait, Phillipines, Sri Lanka and South Africa. The duration of interventions varied from 3 to 24 months. One study was carried out among adult women and one trial among both children and nonpregnant women. Most of the included trials were assessed as low or unclear risk of bias for key elements of selection, performance or reporting bias. Three trials used 41 mg to 60 mg iron/kg flour, two trials used less than 40 mg iron/kg and three trials used more than 60 mg iron/kg flour. One trial employed various iron levels based on type of iron used: 80 mg/kg for electrolytic and reduced iron and 40 mg/kg for ferrous fumarate.All included studies contributed data forthe meta-analyses. Seven studies compared wheatflourfortified with iron alone versus unfortified wheatflour,three studies compared wheatflourfortified with iron in combination with other micronutrients versus unfortified wheatflour and two studies compared wheat flour fortified with iron in combination with other micronutrients versus fortified wheat flour with the same micronutrients (but not iron). No studies included a 'no intervention' comparison arm. None of the included trials reported any other adverse side eDects (including constipation, nausea, vomiting, heartburn or diarrhoea). Wheat flour fortified with iron alone versus unfortified wheat flour (no micronutrients added) Wheatflourfortificationwith iron alone may have little or no eDect on anaemia (risk ratio (RR) 0.81, 95% confidence interval(CI) 0.61 to 1.07; 5 studies; 2200 participants; low-certainty evidence). It probably makes little or no diDerence on iron deficiency (RR 0.43, 95% CI 0.17 to 1.07; 3 studies; 633 participants; moderate-certainty evidence) and we are uncertain about whether wheatflourfortified with iron increases haemoglobin concentrations by an average 3.30 (g/L) (95% CI 0.86 to 5.74; 7 studies; 2355 participants; very low-certainty evidence). No trials reported data on adverse eDects in children, except for risk of infection or inflammation at the individual level. The intervention probably makes little or no diDerence to risk of Infection or inflammation at individual level as measured by C-reactive protein (CRP) (moderate-certainty evidence). Wheatflourfortified with iron in combination with other micronutrients versus unfortified wheatflour(no micronutrients added) Wheat flour fortified with iron, in combination with other micronutrients, may or may not decrease anaemia (RR 0.95, 95% CI 0.69 to 1.31; 2 studies; 322 participants; low-certainty evidence). It makes little or no diDerence to average risk of iron deficiency (RR 0.74, 95% CI 0.54 to 1.00; 3 studies; 387 participants; moderate-certainty evidence) and may or may not increase average haemoglobin concentrations (mean diDerence (MD) 3.29, 95% CI -0.78 to 7.36; 3 studies; 384 participants; low-certainty evidence). No trials reported data on adverse eDects in children. Wheat flour fortified with iron in combination with other micronutrients versus fortified wheat flour with same micronutrients (but not iron) Given the very low certainty of the evidence, the review authors are uncertain about the eDects of wheat flour fortified with iron in combination with other micronutrients versus fortified wheat flour with same micronutrients (but not iron) in reducing anaemia (RR 0.24, 95% CI 0.08 to 0.71; 1 study; 127 participants; very low-certainty evidence) and in reducing iron deficiency (RR 0.42, 95% CI 0.18 to 0.97; 1 study; 127 participants; very low-certainty evidence). The intervention may make little or no diDerence to the average haemoglobin concentration (MD 0.81, 95% CI -1.28 to 2.89; 2 studies; 488 participants; low-certainty evidence). No trials reported data on the adverse eDects in children. Eight out of nine trials reported source of funding with most having multiple sources. Funding source does not appear to have distorted the results in any of the assessed trials. Authors' conclusions Eating food items containing wheat flour fortified with iron alone may have little or no eDect on anaemia and probably makes little or no diDerence in iron deficiency. We are uncertain on whether the intervention with wheat flour fortified with iron increases haemoglobin concentrations improve blood haemoglobin concentrations. Consuming food items prepared from wheat flour fortified with iron, in combination with other micronutrients, has little or no eDect on anaemia, makes little or no diDerence to iron deficiency and may or may not improve haemoglobin concentrations. In comparison to fortified flour with micronutrients but no iron, wheat flour fortified with iron with other micronutrients, the eDects on anaemia and iron deficiency are uncertain as certainty of the evidence has been assessed as very low. The intervention may make little or no diDerence to the average haemoglobin concentrations in the population. None of the included trials reported any other adverse side eDects. The eDects of this intervention on other health outcomes are unclear.

Item Type: Article
Uncontrolled Keywords: wheat, fortification
Subjects: Medicine > KMC Mangalore > Community Medicine
Depositing User: KMCMLR User
Date Deposited: 30 Dec 2020 03:55
Last Modified: 30 Dec 2020 03:55
URI: http://eprints.manipal.edu/id/eprint/156135

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