Iron deficiency anemia remains one of the most prevalent micronutrient deficiencies worldwide, notably in developing and emerging countries in Asia and Africa where women of reproductive age and children are particularly vulnerable due to their increased iron requirements. On an individual and population scale, this condition could have a variance of harmful effects on health, a society and an economy.

Laura Hackl, Ph.D., postdoctoral fellow in International Nutrition with the Division of Nutritional Sciences, has led research aimed at investigating the contribution of iron fortified rice to the absorbed iron requirement in Ghanaian school children in hopes of finding new ways to fight iron deficiency around the globe.

“Rice is a staple food worldwide, particularly in countries where iron deficiency has a high prevalence, but has a low micronutrient content in its usually consumed white form,” Hackl said. “For this research, we hypothesized that using novel formulations to fortify rice in West Africa would likely contribute to preventing iron deficiency anemia in this population groups.”

Within the publication, “Micronutrient-fortified rice can be a significant source of dietary bioavailable iron in schoolchildren from rural Ghana” published March 27 in Science Advances, Hackl and co-authors describe findings from a multiple meal iron absorption study testing new and innovative iron formulations for iron-fortified rice in school-age Ghanaian children and show that certain formulations can provide between 36-51 percent of the daily iron requirement when consuming only 100 grams per day of this fortified rice.

“What makes this study unique is that we evaluated the potential impact of novel fortified rice formulations in a potential target population in a study simulating a realistic, regular consumption pattern,” Hackl and her co-author Diego Moretti of the Swiss Distance University of Applied Sciences added. “We used the gold standard technique of stable isotopic labels to measure iron bioavailability in humans – in this particular study: school-age children between 5-10 years of age.”

To identify fortification formulations that led to enhanced iron absorption by subjects, the researchers screened different iron compounds for their suitability as rice fortificants (enriching the food with micronutrients), measured digestive solubility in vitro in the lab, and assessed dietary iron bioavailability by measuring iron incorporation in red blood cells in participant’s blood both before and after consuming fortified rice meals with different iron-containing formulations.

“We found that adding chelating [the bonding of ions and molecules to metal ions] substances such as citric acid trisodium citrate, a common food ingredient found naturally in many fruits and vegetables, or EDTA, a permitted food additive, strongly enhances the iron bioavailability from rice in vitro as well as in vivo, without hampering the color and the taste of the fortified rice,” Moretti said.

“This enhanced iron bioavailability allows for comparably iron fortification levels that keep the rice acceptable both in terms of sensory properties, but also safe as it reduces the amount of unabsorbed, potentially harmful iron in the body.”

Previous research has found that anemia is estimated to affect almost 2 billion people worldwide, with iron deficiency considered the most prominent cause, estimated to account for more than 60 percent of anemia cases. This is in addition to a large number of individuals suffering from iron deficiency without anemia.

Iron deficiency and anemia are associated with numerous health-risks that vary in severity including fatigue, decrease work capacity and productivity, decreased cognitive performance and development, decreased physical performance as well as impaired immune status. Notably, iron deficiency and anemia in particular are linked to adverse pregnancy outcomes and decreased birth weight.

According to the World Health Organization (WHO), the fortification of staple foods can be an effective approach to enhance micronutrient supply in deficient populations as it does not require a change of regular consumption habits in a population. Further, micronutrients delivered through fortified staple foods are generally tolerated well because quantities used for fortification, in contrast to supplementation, are considerably lower.

The issue for many nutritionists and food scientists is that, in many cases, iron-fortification compounds that are highly bioavailable also cause the problems with the way we experience fortified foods – impacting taste, texture and even smell. Those changes can cause individuals or populations to reject fortified foods.

Because of this, novel approaches are needed to deliver nutritionally relevant bioavailable iron in staple foods, without hampering consumer acceptance, Hackl said, adding that these approaches could substantially contribute to the prevention of iron deficiency in rice-eating populations.