Box C-1: Successful Food Fortification Programs: Necessary ...siteresources.worldbank.org/NUTRITION/Resources/Tool2-AnnexC.pdf · Box C-1: Successful Food Fortification Programs:

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Annex C: Micronutrients

Box C-1: Successful Food Fortification Programs:Necessary Conditions

• Political support

• Industrial support

• Adequate application of legislation including external qualitycontrol

• Appropriate fortification level

• Good bioavailability of the fortifying compound

• No inhibitory effect of the common diet

• Human resource training at industry and marketing level

• Consumer acceptability

• No cultural or other objection against fortified foods

• Adequate laboratory assessment of micronutrient status

• Well designed and implemented evaluation protocol

• In the case of iron deficiency anemia, absence of parasitism orother nondietary causes of anemia

• No constraints regarding procurement of micronutrients

(adapted from Lotfi et al, 1996)

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Table C-1: Vitamin A Deficiency: Indicators to Definea Public Health ProblemCriterion for a Public Health Problem Minimum Prevalence

Night Blindnessa > 1.0%Bitot’s Spot (X1B)b > 0.5%Corneal xerosis/ulceration (X2. X3A. X3B)2 > 0.01%Xerophthalmia-related corneal scars (XS)2 > 0.05%(A serum retinol level < 0.35 �mol/l in > 5%of the population is corroborative evidence.)

a. Target group for this measure is limited to children 24–71 months of age. It is difficult to assessnight blindness in children who are not proficient at walking.b. Indicators of clinical deficiency(Sommer, 1995)

Table C-1a: Prevalence of Vitamin A Deficiency inChildren ����� 1 Year of Age with Serum Values ����� 0.70 �����mol/lLevel of Public Health Problem Prevalence

Mild � 2 – < 10%Moderate � 10 – < 20%Severe � 20%

(WHO/UNICEF, 1994)

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Table C-2: Treatment of Xeropthalmia and CaseManagement of Other Illness with Vitamin ACondition Dosage

Xerophthalmia Full treatment: one dosea at diagnosisone dose the following dayone dose within 1–4 weeks

Children with measles 2 doses: once at diagnosis and once thenext day

Adults and children with Full treatment schedule and continuesevere malnutrition in prevention program

Children with diarrhea, lower Single dose and continue in preventionrespiratory infection or program; do not give dose if child hasother acute infections received a routine high-dose vitamin A

supplement in last 30 days.

a. Dose = 110 mg retinal palmitate = 200,000 IU for children 12 mo. or more; 100,000 IU for children6 to 11 mo.; 50,000 IU for infants < 6 mo.(Compiled from Sanghvi, 1999)

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Table C-4: Common Food Sources of Vitamin AContain beta-carotene

Contain retinol (highly bioavailable) and other carotenoids

Breastmilk Red palm oila

Egg Mangoa

Liver Papayaa

Kidney Yellow sweet potatoesa

Small fish with liver Amaranth leavesCod liver oil CarrotWhole milk Pumpkin/yellow squashFortified skim milk Collard greensButter SpinachCheese made with whole milk Apricots

a. Among the plant-based sources of vitamin A, these have higher bioavailability.

Table C-3: Estimated Mean Requirement and Safe Levelof Intake for Vitamin A

Mean Recommendedrequirement safe intake

Age �����g RE/day �����g RE/day

Infants and children0–6 months 180 3757–12 months 190 4001–3 years 200 4004–6 years 200 4507 years 250 500

Adolescents, 10–18 years 330–400 600Adults

Females, 19–65 years 270 500Males, 19–65 years 300 600

65+ 300 600Pregnant women 370 800Lactating women 450 850

(FAO/WHO, 1988)

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Table C-5: Dosage and Approximate Cost of Fortificationwith Vitamin A

Cost per person/Vehicle Fortificant Dosage year in US cents Country

Sugar Vitamin A 250 CWS 15,000 IU/Kg 29 (1994) Guatemalaa

Cooking fat Vitamin A 50,000 IU/Kg 30–40 (1988) Severala

Edible oil Vitamin A 20 IU/g n/a Pakistana

Margarine Vitamin A 375 RE/15g 20 (1994)Philippinesa

Monosodium Vitamin A Palmitate 175,000 IU/Kg 6 (1988) Indonesiab

glutamate 250 CWS(MSG)

Cornflour/ Vitamin A 39,000 IU/Kg 7–8 (1994) VenezuelaWheatflour

a. Commercial scale.b. Pilot.(Adapted from Lotfi, et al., 1996)

Table C-6: Vitamin A Prophylaxis ScheduleTarget group Dosage and timing

Infants 9–11 months of age 100,000 IU orally, every 4–6 months

Children > 12 months of age 200,000 IU, orally, every 4–6 months

Postpartum women 200,000 IU, orally within 6 wks of delivery

(WHO—Technical Report Series No. 916, 2003).

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Box C-2: Vitamin A Supplement Preparations/Costsa, b

• Capsules containing 110 mg retinol palmitate

• Oily solution in liquid form for use with a dropper or multi-dosedispenser, dispensing a measured dose of vitamin A (27, 55, or110 mg)

• Sugar-coated tablets, each containing 55 mg retinol palmitate

• Ampules of 2 ml each containing 55 mg retinol palmitate in watermiscible solution

Vitamin A is diluted with oil and vitamin E. Storage life in an un-opened opaque container is approximately 2 years.

Cost: Retinol Capsules: 1 capsule = 2 cents (effective up to 6 months)

a. Preparations of vitamin A supplementation are supplied as retinol palmitateor retinol acetate 60 mg retinol = 110 mg retinol palmitate or 66 mg retinol ac-etate = 200,000 IU.b. UNICEF March 2004.

Box C-3: Proposed Classification of Goiter Size

Grade Description

0 No goiter

1 Thyroid enlarged, palpable but not visible when theneck is in the normal position

2 Thyroid enlarged, visible with neck in normal position

(WHO/UNICEF/ICCIDD, 1994)

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Table C-7: IDD Prevalence Indicators and Criteriafor Public Health ProblemIndicator Mild Moderate Severe

Goiter (Grade > 0 measured in school children) 5–19% 20–39% > 30%Thyroid volume > 97th centile by ultrasound 5–19% 20–29% > 30%

(in school age children)Median urinary iodine (�g/l measured in 50–99 20–49 < 20

school children)TSH (prevalence in newborns of > 5 ml U/l 3.0–19.9% 20–39.9% � 40.0%

whole blood)

(WHO/UNICEF/ICCIDD, 1994)

Table C-8: Dietary Requirements for Iodine (�����g/day)Age Amount (�����g/day)

0 through 5 years 906 through 12 years 120Adults > 12 years 150Pregnant and lactating women 200

(FAO/WHO, 2002)

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Table C-9: Recommendations for Dose of Administrationfor Iodized Oil to Target Groupsa

Dosage

Duration of Effect

Target Group 12 Months (oral) > 1 Year (IM)

Women of childbearing age 400–960 mg 480 mgPregnant womenb 300–480 480Infants 100–300 240Children 1–5 years 300–480 480Children 6–15 years 400–960 480Males 400–960 480

a. Oral administration is recommended, if contacts can be made with recipients at least every year.b. Effective if given during the 1st and 2nd trimester of pregnancy.(WHO/UNICEF/ICCIDD, 1994)

Table C-10: Preparations/Estimated Cost of IodineCapsulesForm Iodine level Cost (US$)

1 capsule Lipiodol (oral oil) 200 mg iodine 0.181 ml Lipiodol (intramuscular oil) 480 mg iodine 0.60Dose (dispenser) Oriodol 300 mg iodine 0.10Lugol’s iodine 0.02

(Cost figures, UNICEF)

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Box C-4: Calculation for Fixing the Level of Iodization in Salt

Assuming that the requirement of iodine is 200�g/day and the saltconsumption is 10g/day

Level of iodine required: 200/10 = 20�g/day of salt or 20 ppm(parts per million)

Compensation for transit and storage losses: 20 ppm

Fixed level of iodization required: 40 ppm iodine = 40 x 1.685a = 67 ppm

a. The ratio of molecular weight of potassium iodate/iodine (247/127) = 1.685.(Mannar and Dunn, 1995)

Table C-11: Estimate of Total Costs of Salt Iodizationin Developing Countries

Range AverageCost Component (US$/ton) (US$/ton)

Chemical (potassium iodate) 0.50–1.30 0.90Processing 2.35–5.50 4.00Extra packing material (if required) 0.00–4.00 —Administrative overheads 0.60–1.50 1.00Amortization 0.50–2.50 1.50Total cost of iodization 3.95–14.80 7.40Retail price crystalline salt 250–1,000 625Cost of iodization as a percentage

or retail price 1.6–1.5% 1.2%

Iodine: range of 40–100ppm@US$30/kg.(Lotti, et al., 1996)

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Box C-5: Iodine Rapid-Test Kits

Available directly from:MBI Chemicals. 85. III Floor. G.N. Chetty Road. T. Nagar. Madras. 600 017,South IndiaTelephone: 91-44-828-1918Fax: 91-44-828-3961

In many countries it is possible to arrange reimbursable procurement through thelocal UNICEF office.

Pricelist:UNICEF stock# Iodine range Fortificant Cost (US$) Amount

05-860-00a 0–50 ppm Potassium iodate $0.40 (3 ampules05-860-01a 0–100 ppm Potassium iodate $0.40 for 80–10005-860-02 Up to 75 ppm Potassium iodate $0.60 tests)05-860-03 Recheck solution for high alkalinity salt $0.36

a. Highest usage since most countries use potassium iodate as the preferred fortificant. Stock#05-860-00 is recommended for checking salt at the household level. Unopened solutions have ashelf life of approximately 18 months; 6 months after opening.

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Table C-12: ICCIDD/UNICEF/WHO Recommended Levelsof Iodine in SaltExamples of desirable average levels at various points in the salt distribution chain,depending on climate, salt intake, and conditions affecting packaging and distribution.Parts of iodine per million parts of salt, i.e. micrograms per gram, milligrams per kilogramor grams per tonne.

Requirement at Requirement at Requirement atFactory Outside Factory Inside Retail Sale

the Country the Country (shop/market)Climate Require-and Daily Packaging ment atSalt Con- Retail Retail Retail house-sumption Bulk Pack Bulk Pack Bulk Pack hold(g/person) Sack (< 2 kg) Sack (< 2kg) Sack (< 2kg) level

Warm moist5 g 100 80 90 70 80 60 5010 g 50 40 45 35 40 30 25

Warm dry or cool moist5 g 90 70 80 60 70 50 4510 g 45 35 40 30 35 25 22.5

Cool dry5 g 80 60 70 50 60 45 4010 g 40 30 35 25 30 22.5 20

N.B. 168.6 mg of K103 contains 100 mg of iodine.N.B. These are indicative initial levels, which should be adjusted in the light of urinary iodine measurement.(WHO/UNICEF/ICCIDD, 1994)(Adapted from World Summit for Children—mid decade goal: iodine deficiency disorders. Geneva, 1994. UNICEF-WHO Joint Committee on Health Policy, document J CHPSS/94/2.7 and document WHO/NUT/93.1)

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Table C-13: Criteria for Assessing Adequacy of SaltIodization Programs

Criterion ofProcess Indicator Adequacy

Factory or importer level1. Percent of food-grade salt claimed to be iodized 100%2. Percent of food-grade salt effectively iodized � 90%3. Adequacy of internal monitoring processa � 90%4. Adequacy of external monitoring processb 10–12 monthly

checks per producer/importer per year

Consumer and district level1. Percent of monitoring sites with adequately

iodized salta. households (or schools) Adequate in 90% ofb. district headquarters (including major markets) samples

2. Adequacy of monitoring processc 90% or more

a. Internal salt monitoring refers to the quality control procedures established by the salt manufac-turer. Hourly iodine level checks are recommended (using the rapid-test kits) with at least one dailycheck by ritration. Corrective action is taken within 3 hours in 90% of detected cases of poor quality.b. External monitoring of iodine levels is conducted by the responsible government authority, andshould occur at least once a month by titration. Internal monitoring results can be verified by check-ing against the external monitoring results.c. Monitoring undertaken in 90% of districts in each province at both households and district levels.(Adapted from WHO/UNICEF/ICCIDD, 1994)

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Table C-14: Criteria for Monitoring Progress TowardsEliminating IDD as a Public Health ProblemIndicator Goal

Salt IodizationProportion of households consuming effectively iodized salt > 90%

Urinary iodineProportion below 100 �g/l < 50%Proportion below 50 �g/l < 20%

Thyroid sizeIn school children 6–12 years of age:Proportion with enlarged thyroid, by palpation or ultrasound < 5%

Neonatal THSProportion with levels > 5 mU/l whole blood < 3%

(WHO/UNICEF/ICCIDD, 1994)

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Table C-14a: Countries Ranked by Percentage ofHouseholds Consuming Iodized Salt, by Region,2000–2003

Estimated Estimated% of % of

Region Househould Region Householdand Country Salt Iodized and Country Salt Iodized

South AsiaBhutan 95Bangladesh 70Nepal 63India 50Pakistan 17Afghanistan 15

East Asia and PacificChina 93Viet Nam 77Lao PDR 75Thailand 74Indonesia 65Myanmar 48Mongolia 45Philippines 24Cambodia 14

Latin America and CaribbeanNicaragua 96Peru 93El Salvador 91Venezuela 90Brazil 87Bolivia 85Paraguay 83Honduras 80Guatemala 49Dominican Rep. 18Haiti 12

Eastern and Southern AfricaEritrea 97Burundi 96Uganda 95Zimbabwe 93Kenya 91Rwanda 90Lesotho 69Zambia 68Botswana 67Tanzania 67Namibia 64South Africa 62Mozambique 62Swaziland 59Madagascar 52Malawi 36Angola 35Ethiopia 28

Western and Central AfricaNigeria 98Congo, Dem. Rep. 93Central African Rep. 86Cameroon 84Mali 74Benin 72Togo 67Chad 58Sierra Leone 23Burkina Faso 22

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(UNICEF and The Micronutrient Initiative, 2004)

Senegal 16Niger 15Gabon 15Gambia 8Mauritania 2Guinea-Bissau 1

Middle East and North AfricaIran 94Lebanon 87Egypt 80Syria 80Morocco 41Yemen 39

Central and Eastern Europeand Newly Independent StatesArmenia 83Kazakhstan 76Turkmenistan 75Turkey 64Kyrgyzstan 27Azerbaijan 26Tajikistan 20Uzbekistan 19Georgia 8

Estimated Estimated% of % of

Region Househould Region Householdand Country Salt Iodized and Country Salt Iodized

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Table C-15: Hemoglobin and Hematocrit Cutoffsfor Anemia by Group

Hemoglobin HematrocritGroup below (g/dl) below (%)

Infants (6 months to 5 years) 11.0 33Young children (5–11 years) 11.5 34Children 12–13 years 12.0 36Nonpregnant women 12.0 36Pregnant women 11.0 33

Severe anemia 7.0Very severe anemia (life-threatening) 4.0

Men 13.0 39

(WHO/UNICEF/UNU, 1997)

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0 < 11.0100 < 11.0200 < 11.1300 < 11.1400 < 11.1500 < 11.2600 < 11.2700 < 11.3800 < 11.3900 < 11.31000 < 11.41100 < 11.41200 < 11.51300 < 11.51400 < 11.61500 < 11.71600 < 11.71700 < 11.8

Table C-16: Recommended Hb (g/dL) Cutoffs forAnemia in Children (6–59 months) and Women Livingat Different Altitudes

Cutoff CutoffAltitude (m) Hb (g/dL) Altitude (m) Hb (g/dL)

1800 < 11.81900 < 11.92000 < 12.02100 < 12.12200 < 12.12300 < 12.22400 < 12.32500 < 12.42600 < 12.52700 < 12.62800 < 12.72900 < 12.83000 < 12.93100 < 13.03200 < 13.23300 < 13.33400 < 13.43500 < 13.6

(Dirren et. al., 1994)

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Table C-17: Summary of Iron Indices and RecommendedCutoffs for Assessing Iron DeficiencyBiochemical Process Laboratory Indices Iron Deficiency

Iron storage Serum ferritin < 12�g/LIron transport Serum iron < 50mg/100�L

Transferrin saturation < 16%Total iron binding capacity

(TIBC) > 400�g/100mLErythropoiesis ER > 70mg/100mL RBC

Mean Cell Volume < 80fl

(Gibson, 1990)

Table C-18: Absorbed Iron Requirements (mg/day)Total Requirement

Age Group (years) Median (mg/day)

Infants 4–11 months 0.77Preschool 12–23 months 0.49Preschool 2–5 years 0.56School age 6–11 years 0.94Adolescent girls 12–16 years 1.62Adolescent boys 12–16 years 1.46Adult men 0.91Menstruating women 1.25Pregnant women

1st trimester 0.772nd trimester 4.403rd trimester 6.30

Lactating women 1.05

(Adopted from Gillespie, 1998)

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Table C-19: Daily Dietary Iron RequirementsIron (mg)

High Iron Medium Iron Low IronBioavailability Bioavailability Bioavailability

Diet—15% Diet—10% Diet—5%Age Group Absorptiona Absorption Absorption

Children both sexes0–6 months — — —6–12 months 7 11 21b

0–1 year 7 11 21b

1–3 years 5 7 133–5 years 5 7 145–7 years 7 10 197–10 years 8 12 23b

Boys10–12 years 8 12 23b

12–14 years 12 18 36b

14–16 years 12 18 36b

16–18 years 8 11 23b

Girls10–12 years 8 11 23b

12–14 years 13 20 40b

14–16 years 13 20 40b

16–18 years 16 24b 48b

If pregnant 26b 38b 76b

Men—active18–60 years 8 11 23b

> 60 years 8 11 23b

Women—activeChildbearing age 16 24b 48b

Pregnant1st trimester 6 9 192nd trimester 29b 44b 88b

3rd trimester 42b 63b 126b

Average 26b 38b 76b

Lactating 9 13 26b

> 60 years 6 9 19

a. See chapter III for discussion of iron bioavailability.b. Supplements are usually needed in order to meet these iron requirements.(Savage-King and Burgess, 1993)

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Table C-20: Recommended Dietary Allowances (RDA)for Iron

Infants,Age Children Males Females Pregnancy Lactation

7 to 12 months 11 mg1 to 3 years 7 mg4 to 8 years 10 mg9 to 13 years 8 mg 8 mg14 to 18 years 11 mg 15 mg 27 mg 10 mg19 to 50 years 8 mg 18 mg 27 mg 9 mg51+ years 8 mg 8 mg

(Institute of Medicine, 2001)

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Table C-21: Iron Content of Different Vegetable Foods(low bioavailability < 5%)

Food Iron Content (mg/100g)

Millet 39.0a

Teff 20.9–75.5a

Chickpea 11.1Cowpea 7.6Lentils 7.0Soybean 6.1Sorghum 5.0–15.6a

Cashews 5.0Parsley 4.3Prunes 3.9Maize 3.6–4.9Whole wheat flour 3.3Beet greens 3.2Turnip greens 2.4Spinach, cooked 2.0Cassava 1.9Rice 1.7–2.0Gari 1.6Yam 0.8

a. High iron content most likely reflects high amounts of contaminant iron (Adapted from Svanberg, 1995 and Krause and Mahan, 1984)

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Table C-22: Iron Content of Different Animal Foods(high bioavailability ����� 15%)

Food Iron Content (mg/100g)

Beef liver, kidney 7.9Egg, yolk 7.2Oysters, raw 5.6Turkey 3.8Beef 3.0Egg, whole 2.7

(Adapted from Krause and Mahan, 1984)

Table C-23: Iron and Folate Supplementation Dosages/Schedule for Pregnant WomenPrevalenceof Anemiain Pregnancy(Hb < 11.0 g/dl) Dose Duration

< 40% 60 mg iron + 400 �g folic 6 months in pregnancyacid daily

� 40% 60 mg iron + 400 �g folic 6 months in pregnancy,acid daily and continuing to 3

months post-partum

Note: If 6 months duration cannot be achieved in pregnancy, continue to supplement during thepost-partum period until 6 months is completed or increase the dose to 120 mg iron in pregnancy.Where iron supplements containing 400 �g folic acid are not available, an iron supplement with alower level of folic acid may be used.(Stoltzfus and Dreyfuss, 1998)

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Box C-6: Complementary Parasite ControlMeasures in Pregnancy

Where hookworms are endemic (20–30% prevalence or greater) giveanthelminthic treatment once in the second trimester of pregnancy.If hookworms are highly endemic (> 50% prevalence), repeat anthel-minthic treatment in the third trimester of pregnancy. The followinganthelminthic treatments are effective and safe outside of the firsttrimester of pregnancy:

Albendazole 400 mg single dose

Mebendazole 500 mg single dose or 100 mg twice daily for3 days

Levamisole 2.5 mg/kg single dose, best if second dose isgiven after 7 days

Pyrantel 10 mg/kg single dose, best if dose is repeatedon next 2 consecutive days

If P. falciparum malaria is endemic and transmission of infection ishigh, women in their first or second pregnancies should be givensulfadoxine/pyrimethamine treatment once in the second trimesterand once in the third trimester of pregnancy. Each dose should pro-vide 500 mg sulfadoxine + 25 mg pyrimethamine.

(Adapted from Stoltzfus and Dreyfuss, 1998)

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Table C-24: Guidelines for Iron Supplementationto Other Population Groups

Group Dosage

Children 2–5 years 20–30 mg ironChildren 6–11 years 30–60 mg ironAdolescents and adults 60 mg iron (see notes)

Notes:• For children 2–5 years, iron dosage is based on 2 mg iron/kg body weight/day.• If the population group includes girls or women of reproductive age, 400 �g folic acid should be

included with the iron supplementation for the prevention of birth defects in those who becomepregnant.

• Research is ongoing to determine the most cost-effective dosing regimen for iron supplementa-tion to these age groups in different contexts. The efficacy of once- or twice-weekly supplemen-tation in these groups appears promising, and the operational efficiency of intermittent dosingregimens is being evaluated. While policy recommendations are being formulated, programplanners should adopt the dosing regimen believed to be most feasible and sustainable in theircommunities.

(Stoltzfus and Dreyfuss, 1998)

Table C-25: Guidelines for Parasite Control in ChildrenAbove 5 and AdultsParasite Prevalence Drug Dosage Treatment Schedule

Hookworm < 50% Albendazole 400 mg or Once yearlyMebendazole 500 mg orLevamisole 2.5 mg/kg orPyrantel 10 mg/kg

Hookworm � 50% Albendazole 400 mg or 2–3 times yearlyMebendazole 500 mg orLevamisole 2.5 mg/kg orPyrantel 10 mg/kg

Urinary schistosomiasis Praziquantel 40 mg/kg Single dose, annually(school-age children Metrifonate 10 mg/kg 3 doses at 15-dayreporting blood in urine) intervals, annually

(Adapted from Stoltzfus and Dreyfuss, 1998)

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Table C-26: Iron Supplementation Dosage Schedulefor Children 6–24 MonthsPrevalenceof Anemiain Infants Birth Weight6–24 Months Dosage Category Duration

< 40% 12.5 mg iron + 50 �g Normal From 6–12 months of agefolic acid daily Low birth weight From 2–24 months of age

(< 2500g)

� 40% 12.5 mg iron + 50 �g Normal From 6–24 months of agefolic acid daily Low birth weight From 2–24 months of age

(< 2500g)

If the prevalence of anemia in infants 6–24 months is not known, substitute the prevalence of anemia in pregnantwomen in the same population. (Adapted from Stotzfus and Dreyfuss, 1998)

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Table C-27: Food Vehicles with Potential for Single Fortificationwith IronVehicle Fortificant Stability Biovailability Status

Wheat flour Elemental iron good good +Ferrous sulphate fair good +

Infant cereals Elemental iron good fair +Infant formulas Ferrous fumarate good good +CSM/CSB/WS, other Ferrous sulphate fair good +

Maize meal Elemental iron good good +

Potato starch Ferric chloride fair fair labFerric citrate fair poor dis

Processed cereals Ferrous fumarate n/a good n/aFerric orthophosphate good poor dis

Rice flour Bovine hemoglobin concentrate fair good exp

Bread Ferrous sulphate fair good exp

Salt Premix: ferrous sulphate/ n/a good +sodium-acid-pyrophosphate/sodium-acid-sulphateFerric orthophosphate n/a good lab

Sugar Ferrous sulphate good good expFerric orthophosphate n/a n/a n/aFerrous-sodium-EDTA good fair exp

Milk powder Ferrous sulphate fair fair exp

Cheese Ferrous sulphate + ascorbic acid good good lab

Coffee Ferrous fumerate good fair exp

Curry powder Ferric-sodium-EDTA good good exp

Eggs Ferric citrate fair poor lab

Fish sauce Ferric-sodium-EDTA good good exp

“Kool-aid” Ferrous sulphate fair good exp

Note: + = ongoing; dis = discontinued; exp = experimental/field trials; lab = laboratory stage; n/a= not available. (Lotfi, et al., 1996)

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Table C-28: Iron Fortification of Flours and Common Cereals/GrainsEstimated Relative

Consumption Bioavail-Cereal Country Fortificant Level (mg/day) ability Costa

Wheat USA Reduced iron sulfate 44ppm 6 40 6.70Wheat Canada Reduced iron 29–43ppm 4–6 40 6.70Wheat Sweden A-131 electrolytic

iron powder 60ppm 8 60 14.03Wheat Venezuela Iron fumarate 20ppm 110 15.75Wheat Chile Ferrous sulfate 30ppm 100 7.12Maize USA Reduced iron 29-57 100 7.12Maize Venezuela Iron fumarate 20ppm 40

Reduced iron 30ppm 6.70Pasta USA Iron sulfate 30–35

a. $US/Kg of available iron(Lotfi, et al., 1996)

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Table C-29: Major Iron Compounds Used in FoodFortification and Approximate Relative Costs

Relative BioavailabilityIron Compound in Humansa Relative Costa

Water-solubleFerrous sulphate 100 1Ferrous gluconate 89 5Ferric ammonium citrate n/a 5Ferrous ammonium sulphate n/a 2

Poorly water-solubleFerrous succinate 92 4Ferrous fumarate 100 1Ferric saccharate 75 4

Water-solubleFerric orthophosphate 31 4Ferric pyrophosphate 39 4Elemental iron 13–90

ExperimentalSodium iron EDTA Depends on food vehicle 10Bovine hemoglobin n/a n/a

a. Both bioavailability and cost are expressed as a percentage relative to that of ferrous sulphate.(Lotfi, et al., 1996)

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Table C-30: U.S. Recommended Daily Allowancefor Zinc (assumes bioavailability)

Age (years) Zinc mg/day

Infants0–6 mo 27–12 mo 3

Children1–3 34–8 5

Males9–13 814+ 11

Females9–13 814–18 919+ 8

Pregnancy� 18 2019+ 11

Lactation� 18 1319+ 12

(National Institute of Medicine, 2001)

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