Fortification of the Diet as a Strategy for Preventing Iron Deficiency

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Abstract
MacPhail, A. P. and Bothwell, T. H. (Joint University and MRC Iron and Red Cell Metabolism Unit, University of the Witwatersrand Medical School, Parktown, Johannesburg, South Africa). Fortification of the diet as a strategy for preventing iron deficiency. Progress in the fortification of food with iron is reviewed in the light of the different circumstances prevailing in the developed and developing world. Although fortification programmes are well established in developed countries many were not based on sound principles and there is no good evidence that they have proved effective. The important steps in establishing a fortification programme include accurate establishment of the need for iron fortification in a particular group or population, the choice of an appropriate combination of food vehicle and iron compound which is both stable and acceptable, and confirmation that the iron in the chosen blend is bioavailable and in different dietary settings. Only after the successful completion of controlled field trials using the chosen combination is the establishment of a regional or national fortification programme worthwhile. These points are illustrated by the success of field trials in the developing world, at least one of which has led to the implementation of a national programme directed to infants and children. Finally, a case study is described in which these principles were followed in the planning and execution of a successful field trial in an iron deficient Indian population in South Africa. The vehicle was curry powder and the iron compound Fe(111)EDTA.

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