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This Article Full Text (Publish Ahead of Print[PDF]) All Versions of this Article: 90/6/1541    most recent ajcn.2009.27588v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Szymlek-Gay, E. A Articles by Gibson, R. S PubMed PubMed Citation Articles by Szymlek-Gay, E. A Articles by Gibson, R. S Agricola Articles by Szymlek-Gay, E. A Articles by Gibson, R. S

Food-based strategies improve iron status in toddlers: a randomized controlled trial^1,2,3

¹ From the Departments of Human Nutrition (EAS-G, ELF, A-LMH, and RSG) and Preventive and Social Medicine (ARG), University of Otago, Dunedin, New Zealand.

² Supported by the Health Research Council of New Zealand, Meat and Livestock Australia, Meat and Wool New Zealand, and the University of Otago. EAS-G was supported by a University of Otago Postgraduate Prestigious Scholarship and a University of Otago Postgraduate Publishing Bursary (PhD). Heinz Wattie's New Zealand Ltd provided the iron-fortified milk; Fonterra New Zealand provided the nonfortified milk; Canpac International Ltd donated the cans and spoons; and Fisher and Paykel Appliances Ltd donated a freezer. All study meat dishes were prepared in the Bristol-Myers Squibb Metabolic Kitchen, University of Otago, New Zealand.

³ Address correspondence to A-LM Heath, Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand. E-mail: anne-louise.heath{at}stonebow.otago.ac.nz.

ABSTRACT

Background: Nonanemic iron deficiency is common in toddlers in developed countries. Food-based strategies are safe methods to control and prevent mild micronutrient deficiencies.

Objective: Our objective was to determine the efficacy of an increased intake of red meat, or the consumption of iron-fortified milk, in improvement of iron status in toddlers at a population level.

Design: In this 20-wk randomized placebo-controlled trial, 225 healthy nonanemic 12–20-mo-old children were assigned to 1 of 3 groups: red meat (toddlers encouraged to consume 2.6 mg iron from red meat dishes daily), fortified milk [toddlers' regular milk replaced with iron-fortified (1.5 mg iron/100 g prepared milk) cow milk], or control [toddlers' regular milk replaced with nonfortified (0.01 mg iron/100 g prepared milk) cow milk]. Blood samples were collected at baseline and at 20 wk for hemoglobin, serum ferritin, serum transferrin receptor, and C-reactive protein. The prevalence of suboptimal iron status (ie, depleted iron stores, iron-deficient erythropoiesis, and iron deficiency anemia) was determined, and body iron was calculated.

Results: No intervention effects were shown on the prevalence of suboptimal iron status. Serum ferritin increased by 44% (95% CI: 14, 82%; P = 0.002) in the fortified milk group, did not change (+10%) in the red meat group (95% CI: –7, 30%; P = 0.241), and tended to decrease (–14%) in the control group (95% CI: –27, 1%; P = 0.063). By 20 wk, in comparison with the control group, serum ferritin and body iron were significantly higher in the fortified milk group (both P < 0.001) and serum ferritin was significantly higher in the red meat group (P = 0.033).

Conclusions: Consumption of iron-fortified milk can increase iron stores in healthy nonanemic toddlers, whereas increased intakes of red meat can prevent their decline. This trial was registered at actr.org.au as ACTRN12605000487617.

Received for publication February 5, 2009. Accepted for publication September 14, 2009.