An iron fortification efficacy study in children in Cote d’Ivoire supports the suggestion that tissue iron is protected at the expense of erythrocyte iron

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1


  1. 1.

    Hentze MW, Muckenthaler MU, Andrews NC. Balancing acts: molecular control of mammalian iron metabolism. Cell. 2004;117:285–97.

    CAS  Article  Google Scholar 

  2. 2.

    Lynch S. Iron metabolism. In: Kramer K, Zimmermann MB, editors. Nutritional anemia. Basel: Sight and Life; 2007. p. 59–76.

  3. 3.

    World Health Organization. Worldwide Prevalence of Anaemia 1993-2005. Geneva: World Health Organization; 2008.

    Google Scholar 

  4. 4.

    Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123:615–24.

    CAS  Article  Google Scholar 

  5. 5.

    Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet. 2007;370:511–20.

    CAS  Article  Google Scholar 

  6. 6.

    Nemeth E, Tuttle MS, Powelson J, Vaughn MB, Donovan A, Ward DM, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science. 2004;306:2090–3.

    CAS  Article  Google Scholar 

  7. 7.

    Thankachan P, Walczyk T, Muthayya S, Kurpad AV, Hurrell RF. Iron absorption in young Indian women: the interaction of iron status with the influence of tea and ascorbic acid. Am J Clin Nutr. 2008;87:881–6.

    CAS  Article  Google Scholar 

  8. 8.

    Hurrell RF. Fortification: overcoming technical and practical barriers. J Nutr. 2002;132:806s–812s.

    CAS  Article  Google Scholar 

  9. 9.

    Hurrell R, Ranum P, De Pee S, Biebinger R, Hulthen L, Johnson Q, et al. Revised recommendations for iron fortification of wheat flour and an evaluation of the expected impact of current national wheat flour fortification programs. Food Nutr Bull. 2010;31:S7–S21.

    Article  Google Scholar 

  10. 10.

    Prentice AM. Clinical implications of new insights into hepcidin-mediated regulation of iron absorption and metabolism. Ann Nutr Metab. 2017;71 Suppl 3:40–48.

    CAS  Article  Google Scholar 

  11. 11.

    Wallace DF. The regulation of iron absorption and homeostasis. Clin Biochem Rev. 2016;37:51–62.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Collings R, Harvey LJ, Hooper L, Hurst R, Brown TJ, Ansett J, et al. The absorption of iron from whole diets: a systematic review. Am J Clin Nutr. 2013;98:65–81.

    CAS  Article  Google Scholar 

  13. 13.

    Doherty CP, Cox SE, Fulford AJ, Austin S, Hilmers DC, Abrams SA, et al. Iron incorporation and post-malaria anaemia. PLoS ONE.2008;3:e2133.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Cercamondi CI, Egli IM, Ahouandjinou E, Dossa R, Zeder C, Salami L, et al. Afebrile Plasmodium falciparum parasitemia decreases absorption of fortification iron but does not affect systemic iron utilization: a double stable-isotope study in young Beninese women. Am J Clin Nutr. 2010;92:1385–92.

    CAS  Article  Google Scholar 

  15. 15.

    Petry N, Olofin I, Hurrell RF, Boy E, Wirth JP, Moursi M, et al. The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: A systematic analysis of national surveys. Nutrients. 2016;8:693.

    Article  PubMed Central  Google Scholar 

  16. 16.

    Glinz D, Wegmüller R, Ouattara M, Diakité VG, Aaron GJ, Hofer L, et al. Iron fortified complementary foods containing a mixture of sodium iron EDTA with either ferrous fumarate or ferric pyrophosphate reduce iron deficiency anemia in 12- to 36-month-old children in a malaria endemic setting: A secondary analysis of a cluster-randomized controlled trial. Nutrients. 2017;9:759.

    CAS  Article  PubMed Central  Google Scholar 

  17. 17.

    Ganz T. Iron and infection. Int J Hematol. 2018;107:7–15.

    CAS  Article  Google Scholar 

  18. 18.

    Worwood M. Indicators of iron status of populations: ferritin. World Health Organization/CDC editors. Indicators of iron status of populations. 2nd ed. Geneva: World Health Organization; 2007. p. 35–73.

    Google Scholar 

  19. 19.

    World Health Organization. Iron deficiency anaemia: prevention and control: a guide for program managers. Geneva: World health Organization; 2001.

    Google Scholar 

  20. 20.

    Namaste SM, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106:359S–371S.

    PubMed  PubMed Central  Google Scholar 

  21. 21.

    Pasricha SR, Hayes E, Kalumba K, Biggs BA. Effect of daily iron supplementation on health in 
children aged 4–23 months: A systematic review and meta-analysis of randomised controlled trials. 
Lancet. Glob Health. 2013;1:77–86.

    Google Scholar 

  22. 22.

    De-Regil LM, Suchdev PS, Vist GE, Walleser S, Pena-Rosas JP. Home fortification of foods with 
multiple micronutrient powders for health and nutrition in children under two years of age. Evid Based 
Child Health. 2013;8:112–201.

    Article  Google Scholar 

  23. 23.

    Prentice AM, Ghattas H, Doherty C, Cox SE. Iron metabolism and malaria. Food Nutr Bull. 2007;28:S524–S539.

    Article  Google Scholar 

  24. 24.

    Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A, et al. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet. 2006;367:133–43.

    CAS  Article  Google Scholar 

  25. 25.

    Brittenham GM, Andersson M, Egli I, Foman JT, Zeder C, Westerman ME, et al. Circulating non-transferrin-bound iron after oral administration of supplemental and fortification doses of iron to healthy women: a randomized study. Am J Clin Nutr. 2014;100:813–20.

    CAS  Article  Google Scholar 

  26. 26.

    Zimmermann MB, Chassard C, Rohner F, N’goran EK, Nindjin C, Dostal A, et al. The effects of iron fortification on the gut microbiota in African children: a randomized controlled trial in Cote d’Ivoire. Am J Clin Nutr. 2010;92:1406–15.

    CAS  Article  Google Scholar 

  27. 27.

    Gera T, Sachdev HP. Effect of iron supplementation on incidence of infectious illness in children: systematic review. BMJ. 2002;325:1142.

    CAS  Article  Google Scholar 

  28. 28.

    Hercberg S, Galan P. Biochemical effects of iron deprivation. Acta Paediatr Scand Suppl. 1989;361:63–70.

    CAS  Article  Google Scholar 

  29. 29.

    Georgieff MK. Iron assessment to protect the developing brain. Am J Clin Nutr. 2017;106:1588S–1593S.

    Article  Google Scholar 

  30. 30.

    Georgieff MK. Long-term brain and behavioral consequences of early iron deficiency. Nutr Rev. 2011;69:S43–S48.

    Article  Google Scholar 

  31. 31.

    Lynch S, Brittenham G, Fairweather-Tait S, Pfeiffer C, Georgieff M, Hurrell RF, et al. Biomarkers of nutrition for development (BOND) – iron review. J Nutr. (in press).

  32. 32.

    Glinz D, Hurrell RF, Righetti AA, Zeder C, Adiossan LG, Tjalsma H, et al. In Ivorian school-age children, infection with hookworm does not reduce dietary iron absorption or systemic iron utilization, whereas afebrile Plasmodium falciparum infection reduces iron absorption by half. Am J Clin Nutr. 2015;101:462–70.

    CAS  Article  Google Scholar 

  33. 33.

    Cepeda-Lopez AC, Melse-Boonstra A, Zimmermann MB, Herter-Aeberli I. In overweight and obese women, dietary iron absorption is reduced and the enhancement of iron absorption by ascorbic acid is one-half that in normal-weight women. Am J Clin Nutr. 2015;102:1389–97.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Richard F Hurrell.

Ethics declarations

Conflict of interest

The author declares that he has no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hurrell, R.F. An iron fortification efficacy study in children in Cote d’Ivoire supports the suggestion that tissue iron is protected at the expense of erythrocyte iron. Eur J Clin Nutr 72, 1229–1233 (2018).

Download citation