Studies on iron deficiency anemia, rickets and zinc deficiency and their prevention among Chinese preschool children.

The incidence of iron deficiency anemia, rickets, and zinc deficiency is very high in Chinese preschool children and a method for prevention is urgently needed. From our studies, it can be seen that a soft drink powder is a convenient vehicle for the supplementation of iron, zinc, calcium, vitamin D, riboflavin, and ascorbic acid. Table salt is also a good, low-cost carrier for iron and zinc, and cow's milk can only be used for the enrichment of vitamins A and D. In our study the therapeutic dose of iron was lower than 3 mg/kg body weight recommended by the WHO Expert Committee. As ascorbic acid can enhance the absorption of iron in the body, so 300 mg vitamin C was added to 100 g of soft drink powder containing 100 mg of elemental iron. Ten g of powder is not only enough for the prevention of iron deficiency anemia but it can also cure iron deficiency anemia within 3 months. One hundred mg of iron in 100 g of table salt is an adequate level, because an adult or a child taking 10 or 5 g of salt will receive 10 and 5 mg of elemental iron respectively. This dosage is adequate for the prevention of anemia. From our results, 10 mg of zinc daily is enough for the prevention and treatment of zinc deficiency in preschool children. Four hundred IU of vitamin D (from fortified soft drink powder or enriched fresh cow's milk) orally-administered daily, is a good way to prevent rickets in infants and young children.     

Design and preparation of market baskets of European Union commercial baby foods for the assessment of infant exposure to food chemicals and to their effects

The assessment of acute and chronic dietary exposure to contaminants in baby foods is needed to ensure healthy infant growth. Monthly European Union market baskets of commercial baby foods were designed for the first 9 months of life by the ‘babyfood’ study group of the CASCADE Network of Excellence for the specific purpose of assessing exposure to potentially toxic substances in infants fed with such foods. The present paper reports the different steps that led to the preparation of monthly pooled samples of commercial baby foods (‘Infant formulae and follow-on formulae’ and ‘Other baby foods’) that may constitute the extreme case of the diet for an infant who would not be breast fed at all. Several market baskets were generated for an ‘average European Union infant’ and for infants of four selected countries (Italy, Sweden, Spain, and the Slovakia), fed with either milk infant formulae, soy infant formulae or hypoallergenic infant formulae and weaned (at the fifth month) with commercial baby foods and beverages available on the European Union market. Market share data for 2007 for baby foods were used to design the baskets. Holding companies and the name of all their products were identified. Monthly diets for European Union infants were elaborated in terms of food categories (e.g. infant cereals) of typologies of products (e.g. infant cereals without gluten) and of a specific product. The number of baskets generated was 30 for ‘Infant formulae and follow-on formulae’ (including 62 products) and 13 for ‘Other baby foods’ (including 35 products). These market baskets were designed to be used for the determination of certain contaminants and nutrients in the diet of European Union infants and for the assessment of their effects on infant health.     

Counteracting the inhibitory effect of tea on the in-vitro availability of iron from cereal meals

Studies were carried out on the in-vitro availability of iron to determine the effect of addition of tea, milk and ascorbic acid to a standard cereal meal in all possible combinations. The availability of iron from the cereal meal was low (3.92%). Tea, when added to the meal, had a significant depressing effect on available iron (2.56%). Addition of 100 mg ascorbic acid or 200 g milk completely counteracted the inhibitory effect of tea, and addition of both ascorbic acid and milk brought about an even greater enhancement in the in-vitro availability of iron than when either was added alone. This investigation reveals that milk is as effective a factor as ascorbic acid in counteracting the depressing effect of tea on in-vitro iron availability.     

Microencapsulated Iron for Food Fortification

Lipid microcapsules of FeSO₄, alone or with ascorbic acid, and FeCl₃, were developed to fortify cheese and other high moisture foods with iron. Varying lipid coat composition and amount of core iron solution optimized their stability. A high melting fraction of milk fat (m.p. 43.5°C) was oxidized by iron and was thus unsuitable as coat material. Microcapsules made with cottonseed stearine (m.p. 62.8°C) had good oxidative stability and retained more iron under rapid stirring at 39°C than those made with hydrogenated milk fat (m.p. 49.0°C). Microcapsules having good oxidative stability and low leakage of iron were coated with stearine and had a ratio of 0.10g Fe solution/g lipid coat. Microencapsulation may allow fortification of cheese and other iron sensitive foods.     

Effects of Product Formulation, Processing, and Meal Composition on In Vitro Estimated Iron Availability from Cereal-Containing Breakfast Meals

The effects of breakfast cereal composition, breakfast cereal processing, and breakfast meal composition on relative iron availability from breakfast meals were estimated using an in vitro method. Addition of wheat bran and germ to cereals and meals reduced iron availability. Presweetening caused a slight increase in iron availability. Comparisons among meals containing cereals that were similar except for type of processing showed that processing may affect iron availability. Addition of orange juice to breakfast meals caused a dramatic enhancement of iron availability. Ascorbic acid fortified apple and grape juice increased iron availability but the effect was small compared with the orange juice effect. Studies with purified organic acids showed that ascrobic and citric acids present in the juices caused the observed enhancement of iron availability. Citric acid was a more potent enhancer than ascorbic acid.     

In vitro bioavailability of iron from wheat flour fortified with ascorbic acid, EDTA and sodium hexametaphosphate, with or without iron

A laboratory scale technology was developed to fortify wheat flour with absorption promoters of iron, such as ascorbic acid, disodium ethylenediaminetetraacetic acid (NaEDTA) and with a stabilizer, sodium hexametaphosphate (SHMP), with or without iron. The in vitro bioavailability of iron in food (Indian bread, chapathi) prepared with the wheat flour fortified at 60 mg of iron/kg in the presence (1:1 molar ratio) or absence of the three chemical additives was tested. NaEDTA and ascorbic acid enhanced the in vitro bioavailability of native iron from Indian bread while SHMP had no effect. All three additives showed a trend of enhancing the in vitro bioavailabilty of total iron (native and added iron) from iron fortified chapathis. The predicted bioavailability of iron in man from Indian bread containing ascorbic acid or NaEDTA was twice as high than that with wheat flour alone or that with SHMP (8%). Similar enhancing effects of these two compounds were shown with iron-fortified wheat flour. It is concluded that wheat flour fortified with ascorbic acid or NaEDTA, either with or without iron, can enhance the predicted bioavailability of both native and added iron in man.     

Survival and growth of Enterobacter sakazakii in infant cereal as affected by composition, reconstitution liquid, and storage temperature

Invasive infections caused by Enterobacter sakazakii have occurred predominantly in low-birth-weight neonates and infants younger than 2 months of age. However, infections have also occurred in healthy infants up to 8 months of age and in immunocompromised children up to 4 years of age. The ability of E. sakazakii to survive and grow in infant cereals as affected by composition of the cereal, composition of the reconstitution liquid, and temperature is unknown. A study was done to determine the survival and growth characteristics of E. sakazakii initially at populations of 0.005 and 0.52 CFU/ml of infant rice cereal, oatmeal cereal, or rice with mixed fruit cereal reconstituted with water, milk, or apple juice. Reconstituted cereals were stored at 4, 12, 21, and 30 degrees C, and populations were monitored for up to 72 h. Growth did not occur in reconstituted cereals stored at 4 degrees C or in cereals reconstituted with apple juice and stored at 12 degrees C. Populations (> or =1 CFU/ml) were detected in cereals reconstituted with water or milk and stored at 12, 21, and 30 degres C for 24, 8, and 4 h, respectively. The composition of infant cereals did not markedly affect the survival or growth of E. sakazakii in reconstituted cereals. Populations of E. sakazakii in reconstituted cereal decreased with increases in populations of mesophilic aerobic microflora up to 8 to 9 log CFU/ml, which was concurrent with decreases in pH. E. sakazakii, initially at 2.62 log CFU/ml of rice cereal reconstituted with apple juice (pH 4.32), survived at 40C for at least 14 days. The pathogen grew at 21 and 30 degrees C within 2 days and then decreased to undetectable levels (<1 CFU/10 ml) in cereal stored at 21 degrees C for 5 days or 30'C for 4 days. Initially, at 7.32 log CFU/ml, E. sakazakii was detected in rice cereal stored at 4 degrees C for 50 days. It is recommended that reconstituted infant cereals stored at 21 or 30 degrees C be discarded within 4 h after preparation or stored at -40C, temperatures at which E. sakazakii will not grow.     

Effect of tea and other dietary factors on iron absorption

Iron deficiency is a major world health problem, that is, to a great extent, caused by poor iron absorption from the diet. Several dietary factors can influence this absorption. Absorption enhancing factors are ascorbic acid and meat, fish and poultry; inhibiting factors are plant components in vegetables, tea and coffee (e.g., polyphenols, phytates), and calcium. After identifying these factors their individual impact on iron absorption is described. Specific attention was paid to the effects of tea on iron absorption. We propose a calculation model that predicts iron absorption from a meal. Using this model we calculated the iron absorption from daily menus with varying amounts of enhancers and inhibitors. From these calculations we conclude that the presence of sufficient amounts of iron absorption enhancers (ascorbic acid, meat, fish, poultry, as present in most industrialized countries) overcomes inhibition of iron absorption from even large amounts of tea. In individuals with low intakes of heme iron, low intakes of enhancing factors and/or high intakes of inhibitors, iron absorption may be an issue. Depletion of iron stores enhances iron absorption, but this effect is not adequate to compensate for the inhibition of iron absorption in such an inadequate dietary situation. For subjects at risk of iron deficiency, the following recommendations are made. Increase heme-iron intake (this form of dietary iron present in meat fish and poultry is hardly influenced by other dietary factors with respect to its absorption); increase meal-time ascorbic acid intake; fortify foods with iron. Recommendations with respect to tea consumption (when in a critical group) include: consume tea between meals instead of during the meal; simultaneously consume ascorbic acid and/or meat, fish and poultry.     

Iron and calcium availability from digestion of infant cereals by Caco-2 cells

An adequate mineral intake during infancy is needed for normal growth and development. This study investigated the effect of dephytinization of four infant cereals and the use of water and follow-on formula as the liquid of reconstitution on the intestinal cell uptake of iron and calcium from infant cereals using a model that combines a simulated gastrointestinal digestion adapted to the gastrointestinal conditions of infants younger than 6 months and the Caco-2 cell line. Iron and calcium uptake by Caco-2 cells from most infant cereals was significantly (p < 0.05) improved when a phytase was added. When infant cereals were reconstituted with water, dephytinization increased iron (3.2–19.5 vs. 3–10%) and calcium (0.66–2.3 vs. 0.35–0.59%) availability compared to the same infant cereals reconstituted with a follow-on formula. We can conclude that dephytinization of infant cereals and water addition improved iron and calcium availability, depending on the infant cereal used.     

Bioavailability of Elemental Iron Powders in Bread Assessed with an In vitro Digestion/Caco-2 Cell Culture Model

ABSTRACT: Iron fortification of staple foods is arguably the most widely used strategy for increasing the iron intake of populations. Although FeSO₄ is a bioavailable form of iron, elemental iron powders are often used to fortify products with a long shelf-life, such as wheat flours, to avoid problems associated with the reactive nature of FeSO₄. Therefore, the objectives of this study were to compare the bioavailabilities of elemental iron powders manufactured with different production methods in wheat flour breads and to determine the effects of added ascorbic acid and baking, using an in vitro digestion/Caco-2 cell culture model. Two types of wheat flour (low-extraction and high-extraction) were fortified with 10 different commercial elemental iron powders and baked into breads. Iron bioavailabilities from the resulting breads, with and without added ascorbic acid, were evaluated using FeSO₄ as the control. Depending on the type of wheat flour, bioavailabilities of several powders were comparable to FeSO₄, but there was no consistent trend as to which production method produced the most bioavailable powder. In general, ascorbic acid enhanced, whereas the baking process reduced iron bioavailability from bread. Our results suggest that some elemental iron powders are potential alternatives to FeSO₄. Human studies are warranted before any of these powders are selected for national fortification programs.     

An analysis of the etiology of anemia and iron deficiency in young women of low socioeconomic status in Bangalore, India

BACKGROUND: Anemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic. OBJECTIVES: Few studies have comprehensively assessed etiologic factors contributing to anemia and iron deficiency in India. Hence, this study assessed the relative importance of various factors contributing to these problems in young women of low socioeconomic status in Bangalore, India. METHODS: A random sample of 100 nonpregnant, nonlactating women 18 to 35 years of age, selected from among 511 women living in a poor urban settlement, participated in this study. Data were obtained on demography, socioeconomic status, anthropometry, three-day dietary intake, blood hemoglobin, hemoglobinopathies, serum ferritin, serum C-reactive protein, and stool parasites. RESULTS: The prevalence rates of anemia and iron deficiency were 39% and 62%, respectively; 95% of the anemic women were iron deficient. The mean dietary iron intake was 9.5 mg per day, predominantly from the consumption of cereals, pulses, and vegetables (77%). The estimated bioavailability of nonheme iron in this diet was 2.8%. Dietary intakes were suboptimal for several nutrients. Blood hemoglobin was significantly correlated with dietary intake of fat, riboflavin, milk and yogurt, and coffee. Serum ferritin was significantly correlated with intake of niacin, vitamin B12, and selenium. Parasitic infestation was low. CONCLUSIONS: An inadequate intake of dietary iron, its poor bioavailability, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for the high prevalence of anemia and iron deficiency in this population.     

Availability of iron from milk-based formulas and fruit juices containing milk and cereals estimated by in vitro methods (solubility,dialysability) and uptake and transport by Caco-2 cells

Iron solubility, dialysability and transport and uptake (retention + transport) by Caco-2 cells as indicators of iron availability have been estimated in the in vitro gastrointestinal digests of infant foods (adapted, follow-up and toddler milk-based formulas and fruit juices containing milk and cereals (FMC)). Low correlation coefficients (in all cases R-squared ? 37.1%) were obtained between iron solubility or dialysability versus transport or uptake efficiency – a fact emphasizing the importance of incorporating Caco-2 cell cultures to in vitro systems in order to adapt the conditions to those found in in vivo assays. The highest uptake efficiency corresponded to FMC (25.6–26.1%) and toddler formulas (32.1–41.9%), the samples with the highest ascorbic acid contents and ascorbic acid/iron molar ratios. In addition, the toddler formulas contained caseinphosphopeptides with the cluster sequence SpSpSpEE, representing the binding site for minerals. In adapted formulas, greater iron uptake efficiency was obtained for the formulation containing ferrous lactate (22.7%) versus ferrous sulfate (4.7%).     

Trace elements and their distribution in protein fractions of camel milk in comparison to other commonly consumed milks.

Studies on camels' milk, whether with respect to concentration or bioavailability of trace elements from this milk, are limited and warrant further investigation. The object of this study was to analyse the concentration and distribution of zinc, copper, selenium, manganese and iron in camel milk compared to those in human milk, cows' milk and infant formula under similar experimental conditions. Camels' milk and cows' milk were collected from local farms, human milk samples were obtained from healthy donors in Kuwait and infant formula was purchased locally. Milk fractionation was performed by ultra-centrifugation and gelcolumn chromatography. The concentration of trace elements was analysed by atomic absorption spectrometry and that of protein was determined spectrophotometrically. The concentration of manganese and iron in camels' milk was remarkably higher (7-20-fold and 4-10-fold, respectively) than in human milk, cows' milk and infant formula. The zinc content of camels' milk was higher than that of human milk but slightly lower than in cows' milk and infant formula. The concentration of copper in camels' milk was similar to that of cows' milk but lower than in human milk and infant formula. The selenium content of camels' milk was comparable to those of other types of milk, Approximately 50-80% of zinc, copper and manganese in camels' milk were associated with the casein fraction, similar to that of cows' milk, The majority of selenium and iron in camels' milk was in association with the low molecular weight fraction, It is recommended that camels' milk be considered as a potential source of manganese, selenium and iron, perhaps not only for infants, but also for other groups suspected of mild deficiency of these elements. Further investigations are required to confirm this proposal.     

Predicting relative concentrations of bioavailable iron in foods using in vitro digestion: New developments

In vitro methods have been developed for the prediction of iron bioavailability from foods and supplements. The dialyzability method measures dialyzable iron, released during a simulated gastrointestinal digestion, as an index of iron bioavailability. A new setup, that involves six-well plates and a ring insert that holds the dialysis membrane, is proposed for the application of the dialyzability method with the objective to increase efficiency and to allow testing small-volume samples. A series of solutions (water, ascorbic acid, and phytate), liquid foods (fresh milk and condensed milk), and solid foods (bread + meat meal, corn flakes), were tested in the presence or absence of added iron and digested with the new setup and the setup previously described for the dialyzability method. In both cases, percent dialyzable iron in each treatment remained similar (P > 0.05). These results suggest that the new setup can be employed in future applications with similar food matrices of the dialyzability method.     

Iron Bioavailability from Common Raisin-containing Foods Assessed with an In Vitro Digestion/Caco-2 Cell Culture Model: Effects of Raisins

The effects of raisins on iron bioavailability from wheat bran cereal, bread, rice pudding, and granola bars were studied. Iron bioavailability was assessed with an in vitro digestion/Caco‐2 cell culture model. Raisins reduced iron bioavailability from all foods except granola bars. Raisins also reduced iron bioavailability from samples of wheat bran cereal and bread fortified with elemental iron or ferrous sulfate, but this inhibitory effect was less pronounced in samples fortified with sodium iron ethylenediaminetetraacetate (NaFeEDTA). Iron bioavailability was markedly higher for samples fortified with NaFeEDTA, suggesting that iron in the form of NaFeEDTA is more bioavailable than elemental iron or ferrous sulfate in raisin‐containing foods.     

Phytic Acid Degradation in Complementary Foods Using Phytase Naturally Occurring in Whole Grain Cereals

Complementary foods based on cereals and legumes often contain high amounts of phytic acid, a potent inhibitor of mineral and trace element absorption. The possibility to degrade phytic acid during the production of complementary foods by using whole grain cereals as the phytase source was investigated. Whole grain rye, wheat, or buckwheat (10%) were added to cereal‐legume‐based complementary food mixtures, and phytic acid was shown to be completely degraded in a relatively short time (1.5 to 3 h) when incubated at optimal conditions for cereal phytase. The potential usefulness of the method for industrial production was demonstrated with a complementary food based on wheat and soybean.     

BEHAVIOR OF LISTERIA MONOCYTOGENES IN RECONSTITUTED INFANT CEREALS

Listeria monocytogenes may contaminate and grow in reconstituted infant cereals refrigerated or temperature abused before consumption. To assess this risk, a 5-strain composite of the pathogen was inoculated in rice, oatmeal, and wheat-rice-oatmeal infant cereals, hydrated (1/6, w/v) with apple juice, pasteurized milk (2% fat) or water, and stored at 4, 15, or 25C for 0, 8 and 24 h to simulate potential advance home preparation and abuse. L. monocytogenes survived with minimal (<0.6 log cfu per mL) or no growth in all cereal preparations at 4C, but it increased in cereals hydrated with water or milk by 2.4–3.3 and 5.3–6.4 log cfu per mL in 24 h at 15 and 25C, respectively. Reconstitution of cereals with water or milk supported growth (P < 0.05) even at 8 h of abuse. In cereals hydrated with apple juice and stored at 15 or 25C, populations of L. monocytogenes were maintained below 3.0 log cfu per mL at 24 h. These results indicate that refrigeration and/or reconstitution with an acid fruit juice may inhibit growth of L. monocytogenes in infant cereal meal preparations. However, in order to ensure prevention of growth, such meals should preferably be consumed soon after preparation or held at 4C for less than 8 h.     

Aflatoxin levels and exposure assessment of Spanish infant cereals

Aflatoxins (AFB₁, AFB₂, AFG₁ and AFG₂) are immunosuppressant, mutagenic, teratogenic and carcinogenic agents with a widespread presence in foodstuffs. Since human exposure to aflatoxins occurs primarily by contaminated food intake, and given the greater susceptibility of infants to their adverse effects, the quantification of these mycotoxins in infant food based on cereals is of relevance. Aflatoxin levels were determined in 91 Spanish infant cereals classified in terms of non- and organically produced and several types from 10 different manufacturers, using a extraction procedure followed by inmunoaffinity column clean-up step and HPLC with fluorescence detection (FLD) and post-column derivatisation (Kobra Cell system). Daily aflatoxin intake was also assessed. Preliminary analysis showed a valuable incidence of detected infant cereal samples at an upper concentration level than the detection limit for total aflatoxin (66%), corresponding to a 46, 40, 34 and 11% for AFB₁, AFB₂, AFG₁ and AFG₂, respectively. Lower aflatoxin values (median, Q₁, Q₃) in conventional infant cereal (n?=?74, AFB₁: <LOD (n.d.; 0.02), AFB₂: n.d. (n.d.; 0.01), AFG₁: <LOD (n.d.; 0.004), and AFG₂: n.d. (n.d.; <LOD) and total AF (AFtotal): 0.01 (<LOD; 0.04 µg?kg^?1) in comparison with infant cereal ecologically produced (n?=?17, AFB₁: 0.02 (0.02; 0.21), AFB₂: n.d. (n.d.; 0.03), AFG₁: 0.02 (0.01; 0.05), and AFG₂: 0.007 (n.d.; 0.02) and AFtotal: 0.05 (0.03; 0.31 µg?kg^?1) were found. In addition, five organic formulations (3.11, 1.98, 0.94, 0.47 and 0.21 µg?kg^?1) exceeded European AFB₁ legislation (0.10?µg?kg^?1) versus two conventional cereals (0.35 and 0.12 µg?kg^?1). According to the type of infant cereal, those with cocoa had the highest aflatoxin levels. Gluten‐free and cereals with dehydrated fruits had an intermediate level and milk- or honey-based cereals and multi-cereals contained the lowest levels. With the exception of the non-compliant cocoa-based organic formulation, none of the infant cereals analyzed gave a higher intake of 1?ng?kg^?1 body weight per day, suggesting that infants fed on infant cereals are exposed to a low health hazard. Nevertheless, manufacturers are advised for continued efforts in routine monitoring and a more careful selection of raw material to minimize aflatoxin levels in these infant foods.     

Bioavailability of Iron in Iron-Fortified Fluid Milk

The bioavailability of iron in pasteurized and homogenized cow's milk was determined by the hemoglobin depletion-repletion technique using rats. A water soluble citrate phosphate iron complex (iron, 16.67%) was used to fortify milk (iron, 38 ppm). Results showed that iron in milk was as well available as that in ferrous sulfate (99% vs 100%); the same was true when the iron complex was tested as such (not added to milk). Thus, milk or milk components appear not to adversely affect the bioavailability of added iron under the conditions of this experiment.     

Effect of fermentation on ionizable iron in cereal-pulse combinations

The average diet in most developing countries is predominantly cereal based. Wheat, rice and millets are major staple foods. Although these diets are sufficient in iron, their low bioavailability is one of the most significant factors for iron deficiency anaemia. Traditional techniques like fermentation show promise in improving iron bioavailability. In vitro ionizable iron was estimated in 31 different combinations of rice, wheat, sorghum, black gram, bengal gram, green gram and coriander in five replicates with or without, fermentation in steamed products. Results indicate that in general cereal pulse combination and fermentation significantly ( P <0.05) increase the per cent ape of ionizable iron. Combination effects dominated in rice whilst fermentation dominated in sorghum. There was a significant reduction ( P <0.05) in phytate phosphorus on fermentation but no loss of tannin.