Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children

Susilowati Herman, Ian J. Griffin, Susi Suwarti, Fitrah Ernawati, Dewi Permaesih, Djoko Pambudi, Steven A. Abrams

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: Iron deficiency is a major nutritional concern in developing countries, and food fortification is a common strategy to treat it. In Indonesia wheat flour is fortified with 60 mg Fe/kg, but because of increasing concerns about marginal zinc status in at-risk populations, consideration is being given to cofortifying flour with zinc. However, little is known about the effect of zinc fortification of flour on iron bioavailability or about the optimum form of zinc supplementation. Objective: We measured iron and zinc bioavailability from wheat-flour dumplings containing 25 g flour fortified with 60 mg Fe/kg, either alone or with 60 mg Zn/kg as zinc oxide or as zinc sulfate. Design: Ninety children aged 4-8 y were recruited and assigned randomly to the 3 groups; 86 completed the study, Iron and zinc absorption were measured with established stable-isotope methods. Results: Iron absorption from the flour fortified with iron only was good (15.9 ± 6.8%), but when corrections were made for hemoglobin concentrations, it was significantly lower from the flour cofortified with zinc sulfate (11.5 ± 4.9%; P < 0.05) but not from the flour cofortified with zinc oxide (14.0 ± 8.9%). Zinc absorption was not significantly different between the zinc oxide and zinc sulfate cofortified flours (24.1 ± 8.2% compared with 23.7 ± 11.2%; P = 0.87). Conclusions: Iron and zinc appear to be highly bioavailable from foods made from fortified flour, but zinc sulfate cofortification may have a detrimental effect on iron absorption.

Original languageEnglish (US)
Pages (from-to)813-817
Number of pages5
JournalAmerican Journal of Clinical Nutrition
Volume76
Issue number4
StatePublished - Oct 2002
Externally publishedYes

Fingerprint

Zinc Oxide
Zinc Sulfate
zinc oxide
zinc sulfate
iron absorption
Flour
flour
Iron
zinc
iron
Zinc
wheat flour
bioavailability
Biological Availability
Triticum
food fortification
Fortified Food
at-risk population
Indonesia
stable isotopes

Keywords

  • Children
  • Food fortification
  • Indonesia
  • Iron absorption
  • Stable isotopes
  • Zinc absorption

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science

Cite this

Herman, S., Griffin, I. J., Suwarti, S., Ernawati, F., Permaesih, D., Pambudi, D., & Abrams, S. A. (2002). Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children. American Journal of Clinical Nutrition, 76(4), 813-817.

Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children. / Herman, Susilowati; Griffin, Ian J.; Suwarti, Susi; Ernawati, Fitrah; Permaesih, Dewi; Pambudi, Djoko; Abrams, Steven A.

In: American Journal of Clinical Nutrition, Vol. 76, No. 4, 10.2002, p. 813-817.

Research output: Contribution to journalArticle

Herman, S, Griffin, IJ, Suwarti, S, Ernawati, F, Permaesih, D, Pambudi, D & Abrams, SA 2002, 'Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children', American Journal of Clinical Nutrition, vol. 76, no. 4, pp. 813-817.
Herman, Susilowati ; Griffin, Ian J. ; Suwarti, Susi ; Ernawati, Fitrah ; Permaesih, Dewi ; Pambudi, Djoko ; Abrams, Steven A. / Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children. In: American Journal of Clinical Nutrition. 2002 ; Vol. 76, No. 4. pp. 813-817.
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abstract = "Background: Iron deficiency is a major nutritional concern in developing countries, and food fortification is a common strategy to treat it. In Indonesia wheat flour is fortified with 60 mg Fe/kg, but because of increasing concerns about marginal zinc status in at-risk populations, consideration is being given to cofortifying flour with zinc. However, little is known about the effect of zinc fortification of flour on iron bioavailability or about the optimum form of zinc supplementation. Objective: We measured iron and zinc bioavailability from wheat-flour dumplings containing 25 g flour fortified with 60 mg Fe/kg, either alone or with 60 mg Zn/kg as zinc oxide or as zinc sulfate. Design: Ninety children aged 4-8 y were recruited and assigned randomly to the 3 groups; 86 completed the study, Iron and zinc absorption were measured with established stable-isotope methods. Results: Iron absorption from the flour fortified with iron only was good (15.9 ± 6.8{\%}), but when corrections were made for hemoglobin concentrations, it was significantly lower from the flour cofortified with zinc sulfate (11.5 ± 4.9{\%}; P < 0.05) but not from the flour cofortified with zinc oxide (14.0 ± 8.9{\%}). Zinc absorption was not significantly different between the zinc oxide and zinc sulfate cofortified flours (24.1 ± 8.2{\%} compared with 23.7 ± 11.2{\%}; P = 0.87). Conclusions: Iron and zinc appear to be highly bioavailable from foods made from fortified flour, but zinc sulfate cofortification may have a detrimental effect on iron absorption.",
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AU - Griffin, Ian J.

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AU - Ernawati, Fitrah

AU - Permaesih, Dewi

AU - Pambudi, Djoko

AU - Abrams, Steven A.

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N2 - Background: Iron deficiency is a major nutritional concern in developing countries, and food fortification is a common strategy to treat it. In Indonesia wheat flour is fortified with 60 mg Fe/kg, but because of increasing concerns about marginal zinc status in at-risk populations, consideration is being given to cofortifying flour with zinc. However, little is known about the effect of zinc fortification of flour on iron bioavailability or about the optimum form of zinc supplementation. Objective: We measured iron and zinc bioavailability from wheat-flour dumplings containing 25 g flour fortified with 60 mg Fe/kg, either alone or with 60 mg Zn/kg as zinc oxide or as zinc sulfate. Design: Ninety children aged 4-8 y were recruited and assigned randomly to the 3 groups; 86 completed the study, Iron and zinc absorption were measured with established stable-isotope methods. Results: Iron absorption from the flour fortified with iron only was good (15.9 ± 6.8%), but when corrections were made for hemoglobin concentrations, it was significantly lower from the flour cofortified with zinc sulfate (11.5 ± 4.9%; P < 0.05) but not from the flour cofortified with zinc oxide (14.0 ± 8.9%). Zinc absorption was not significantly different between the zinc oxide and zinc sulfate cofortified flours (24.1 ± 8.2% compared with 23.7 ± 11.2%; P = 0.87). Conclusions: Iron and zinc appear to be highly bioavailable from foods made from fortified flour, but zinc sulfate cofortification may have a detrimental effect on iron absorption.

AB - Background: Iron deficiency is a major nutritional concern in developing countries, and food fortification is a common strategy to treat it. In Indonesia wheat flour is fortified with 60 mg Fe/kg, but because of increasing concerns about marginal zinc status in at-risk populations, consideration is being given to cofortifying flour with zinc. However, little is known about the effect of zinc fortification of flour on iron bioavailability or about the optimum form of zinc supplementation. Objective: We measured iron and zinc bioavailability from wheat-flour dumplings containing 25 g flour fortified with 60 mg Fe/kg, either alone or with 60 mg Zn/kg as zinc oxide or as zinc sulfate. Design: Ninety children aged 4-8 y were recruited and assigned randomly to the 3 groups; 86 completed the study, Iron and zinc absorption were measured with established stable-isotope methods. Results: Iron absorption from the flour fortified with iron only was good (15.9 ± 6.8%), but when corrections were made for hemoglobin concentrations, it was significantly lower from the flour cofortified with zinc sulfate (11.5 ± 4.9%; P < 0.05) but not from the flour cofortified with zinc oxide (14.0 ± 8.9%). Zinc absorption was not significantly different between the zinc oxide and zinc sulfate cofortified flours (24.1 ± 8.2% compared with 23.7 ± 11.2%; P = 0.87). Conclusions: Iron and zinc appear to be highly bioavailable from foods made from fortified flour, but zinc sulfate cofortification may have a detrimental effect on iron absorption.

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