Double-fortified salt containing iron and iodine decreases risk of anemia in low- and middle-income populations

Objectives:
Double-fortified salt (DFS) containing iron and iodine has been proposed as a feasible and cost-effective alternative for iron fortification in low- and middle-income countries (LMICs). Therefore, this review article has been conducted.

Does double-fortified salt containing iron and iodine increase hemoglobin concentrations and decrease the risk of anemia in low- and middle-income populations?

Study design:
This review article included 12 efficacy and 2 effectiveness studies. All studies were conducted in low- and middle-income countries: 10 in India, 2 in Morocco and 1 each in Côte d'Ivoire and Ghana.

Results and conclusions:
The investigators found in efficacy studies that double-fortified salt containing iron and iodine significantly increased hemoglobin concentrations [SMD = 0.28, 95% CI = 0.11 to 0.44, p 0.001] in low- and middle-income populations.

The investigators found in efficacy studies that double-fortified salt containing iron and iodine significantly reduced both risk of anemia with 41% [RR = 0.59, 95% CI = 0.46 to 0.77, p 0.001] and iron deficiency anemia with 63% [RR = 0.37, 95% CI = 0.25 to 0.54, p 0.001] in low- and middle-income populations.

The investigators found in effectiveness studies that double-fortified salt containing iron and iodine significantly increased hemoglobin concentrations [SMD = 0.03, 95% CI = 0.01 to 0.05, p 0.01] in low- and middle-income populations.

The investigators found in stratified analyses of efficacy studies by population subgroups that double-fortified salt containing iron and iodine significantly increased hemoglobin concentrations of school-aged children [SMD = 0.32, 95% CI = 0.03 to 0.60, p 0.05] in low- and middle-income populations.

The investigators found in stratified analyses of efficacy studies by population subgroups that double-fortified salt containing iron and iodine significantly reduced both risk of anemia [SMD = 0.48, 95% CI = 0.34 to 0.67, p 0.001] and iron deficiency anemia [SMD = 0.37, 95% CI = 0.25 to 0.54, p 0.001] of school-aged children in low- and middle-income populations..

The investigators found that hemoglobin concentrations, anemia prevalence and deworming at baseline (at the beginning of the study), sample size and study duration were not associated with effect sizes.

The investigators concluded that double-fortified salt containing iron and iodine is efficacious in increasing hemoglobin concentrations and decreasing the risk of anemia and iron deficiency anemia in low- and middle-income populations, particularly in school-aged children. However, more effectiveness studies are needed.

Original title:
Impact of Double-Fortified Salt with Iron and Iodine on Hemoglobin, Anemia, and Iron Deficiency Anemia: A Systematic Review and Meta-Analysis by Ramírez-Luzuriaga MJ, Larson LM, […], Martorell R.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29767699

Additional information of El Mondo:
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