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Safety of universal provision of iron through home fortification of complementary foods in malaria-endemic areas.

Dewey KG, Baldiviez LM - Adv Nutr (2012)

Bottom Line: Home fortification of complementary foods with iron and other micronutrients is a low-cost strategy for filling nutrient gaps in the diets of infants and young children, but there has been uncertainty about the safety of universal provision of iron via home fortification in malaria-endemic areas.Based on the current understanding of the potential mechanisms of adverse effects of iron, the risk can probably be minimized by using the lowest possible efficacious dose of iron, preferably delivered in small amounts throughout the day with food, to minimize spikes in plasma nontransferrin-bound iron and large amounts of unabsorbed iron in the gastrointestinal tract.At present, the safest option is to implement home fortification in the context of comprehensive malaria control strategies, as recommended in recent WHO guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, Davis, CA, USA. kgdewey@ucdavis.edu

ABSTRACT
Home fortification of complementary foods with iron and other micronutrients is a low-cost strategy for filling nutrient gaps in the diets of infants and young children, but there has been uncertainty about the safety of universal provision of iron via home fortification in malaria-endemic areas. Based on the current understanding of the potential mechanisms of adverse effects of iron, the risk can probably be minimized by using the lowest possible efficacious dose of iron, preferably delivered in small amounts throughout the day with food, to minimize spikes in plasma nontransferrin-bound iron and large amounts of unabsorbed iron in the gastrointestinal tract. Results from 6 home fortification studies in malaria-endemic areas showed no increased risk of morbidity (including malaria), but these studies were not powered to rule out a modest increase in the risk of severe adverse events. At present, the safest option is to implement home fortification in the context of comprehensive malaria control strategies, as recommended in recent WHO guidelines.

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Postulated effect of NTBI on severity of malaria. ICAM-1, intercellular adhesion molecule; iRBC, infected red blood cell; NTBI, nontransferrin-bound iron; PfEMR-1, Plasmodiumfalciparum erythrocyte membrane protein 1; ROS, reactive oxygen species. Adapted from Reference 5 with permission.
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fig1: Postulated effect of NTBI on severity of malaria. ICAM-1, intercellular adhesion molecule; iRBC, infected red blood cell; NTBI, nontransferrin-bound iron; PfEMR-1, Plasmodiumfalciparum erythrocyte membrane protein 1; ROS, reactive oxygen species. Adapted from Reference 5 with permission.

Mentions: The first of these 2 hypothetical pathways is illustrated in Figure 1. Because the rate of iron influx into plasma exceeds the rate at which iron binds to transferrin, iron can appear as NTBI in the plasma. NTBI is thought to contribute to iron toxicity due to its role in the Haber-Weiss and Fenton reactions that generate reactive oxygen species. Reactive oxygen species induce cell damage through the oxidation of lipids, proteins, and DNA.


Safety of universal provision of iron through home fortification of complementary foods in malaria-endemic areas.

Dewey KG, Baldiviez LM - Adv Nutr (2012)

Postulated effect of NTBI on severity of malaria. ICAM-1, intercellular adhesion molecule; iRBC, infected red blood cell; NTBI, nontransferrin-bound iron; PfEMR-1, Plasmodiumfalciparum erythrocyte membrane protein 1; ROS, reactive oxygen species. Adapted from Reference 5 with permission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3649726&req=5

fig1: Postulated effect of NTBI on severity of malaria. ICAM-1, intercellular adhesion molecule; iRBC, infected red blood cell; NTBI, nontransferrin-bound iron; PfEMR-1, Plasmodiumfalciparum erythrocyte membrane protein 1; ROS, reactive oxygen species. Adapted from Reference 5 with permission.
Mentions: The first of these 2 hypothetical pathways is illustrated in Figure 1. Because the rate of iron influx into plasma exceeds the rate at which iron binds to transferrin, iron can appear as NTBI in the plasma. NTBI is thought to contribute to iron toxicity due to its role in the Haber-Weiss and Fenton reactions that generate reactive oxygen species. Reactive oxygen species induce cell damage through the oxidation of lipids, proteins, and DNA.

Bottom Line: Home fortification of complementary foods with iron and other micronutrients is a low-cost strategy for filling nutrient gaps in the diets of infants and young children, but there has been uncertainty about the safety of universal provision of iron via home fortification in malaria-endemic areas.Based on the current understanding of the potential mechanisms of adverse effects of iron, the risk can probably be minimized by using the lowest possible efficacious dose of iron, preferably delivered in small amounts throughout the day with food, to minimize spikes in plasma nontransferrin-bound iron and large amounts of unabsorbed iron in the gastrointestinal tract.At present, the safest option is to implement home fortification in the context of comprehensive malaria control strategies, as recommended in recent WHO guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, Davis, CA, USA. kgdewey@ucdavis.edu

ABSTRACT
Home fortification of complementary foods with iron and other micronutrients is a low-cost strategy for filling nutrient gaps in the diets of infants and young children, but there has been uncertainty about the safety of universal provision of iron via home fortification in malaria-endemic areas. Based on the current understanding of the potential mechanisms of adverse effects of iron, the risk can probably be minimized by using the lowest possible efficacious dose of iron, preferably delivered in small amounts throughout the day with food, to minimize spikes in plasma nontransferrin-bound iron and large amounts of unabsorbed iron in the gastrointestinal tract. Results from 6 home fortification studies in malaria-endemic areas showed no increased risk of morbidity (including malaria), but these studies were not powered to rule out a modest increase in the risk of severe adverse events. At present, the safest option is to implement home fortification in the context of comprehensive malaria control strategies, as recommended in recent WHO guidelines.

Show MeSH
Related in: MedlinePlus