Iron fortification: an update.

Iron fortification is the optimal approach to reducing the high prevalence of iron deficiency in developing countries. Selection of the iron source entails a compromise between the use of inert compounds which are poorly absorbed and chemically reactive forms with high bioavailability. Although the vehicle and fortification compound must be chosen in tandem because most iron compounds cause discoloration or rancidity, the emphasis in this review is on the food vehicle. Technology for fortifying wheat flour and bread is well established and the use of these vehicles has probably had a significant impact on iron status in Western countries. Recent studies in India indicate that the fortification of common salt is technically feasible and field trials have shown a good hematological response. Similar success has been achieved by fortifying refined sugar with NaFeEDTA in Guatemala. Rice has advantages as a vehicle in those areas where it is the staple food but the technology requires further development. Fish-based condiments have been successfully fortified with NaFeEDTA and show promise as a vehicle in East Asian countries. The fortification of infant foods poses no technical problems and should be encouraged. Additional work is needed to identify other fortification options and to develop targeted fortification programs that will direct iron to those segments of a population in greatest need.