Wheat flour fortification with iron for reducing anaemia and improving iron status in populations

摘要: Background Anaemia is a condition where the number of red blood cells (and consequently their oxygen-carrying capacity) insuDicient to meet the body's physiologic needs. Fortification wheat flour deemed useful strategy reduce anaemia in populations. Objectives To determine benefits and harms fortification with iron alone or other vitamins minerals on anaemia, iron status health-related outcomes populations over two years age. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, databases up 4 September 2019. Selection criteria We included cluster- individually randomised controlled trials (RCT) carried out among general population from any country aged two above. The interventions were wheatflour orin combination micronutrients. Trials comparing type food item prepared fortified variety included. Data collection analysis Two review authors independently screened search results assessed eligibility studies for inclusion, extracted data from included risk bias. We followed Cochrane methods this review. Main results Our identified 3048 records, aKer removing duplicates. nine trials, involving 3166 participants, in Bangladesh, Brazil, India, Kuwait, Phillipines, Sri Lanka South Africa. duration varied 3 24 months. One study was adult women one trial both children nonpregnant women. Most were assessed as low unclear bias key elements selection, performance reporting bias. Three used 41 mg 60 iron/kg flour, less than 40 three more flour. One employed various levels based used: 80 mg/kg electrolytic reduced ferrous fumarate.All contributed forthe meta-analyses. Seven compared wheatflourfortified versus unfortified wheatflour,three micronutrients unfortified wheatflour and the same (but not iron). No 'no intervention' comparison arm. None reported adverse side eDects (including constipation, nausea, vomiting, heartburn diarrhoea). Wheat (no added) Wheatflourfortificationwith may have little no eDect (risk ratio (RR) 0.81, 95% confidence interval(CI) 0.61 1.07; 5 studies; 2200 participants; low-certainty evidence). It probably makes diDerence deficiency (RR 0.43, CI 0.17 to 1.07; 633 moderate-certainty evidence) we are uncertain about whether increases haemoglobin concentrations by an average 3.30 (g/L) (95% 0.86 5.74; 7 2355 very evidence). No children, except infection inflammation at individual level. intervention probably Infection level measured C-reactive protein (CRP) (moderate-certainty evidence). Wheatflourfortified wheatflour(no added) Wheat iron, micronutrients, decrease 0.95, 0.69 1.31; 2 322 0.74, 0.54 to 1.00; 387 increase haemoglobin (mean diDerence (MD) 3.29, -0.78 7.36; 384 children. Wheat same micronutrients (but iron) Given certainty evidence, in combination iron) reducing 0.24, 95% 0.08 0.71; 1 study; 127 0.42, 0.18 0.97; 1 intervention make haemoglobin concentration (MD -1.28 2.89; 2 488 children. Eight source funding most having multiple sources. Funding does appear distorted trials. Authors' conclusions Eating items containing or no deficiency. increases haemoglobin concentrations improve concentrations. Consuming has on anaemia, concentrations. In but on anaemia evidence been low. population. None eDects. health unclear.