Efficacy of Pandesal Baked from Wheat Flour Fortified with Iron and Vitamin A in Improving the Iron and Anthropometric Status of Anemic Schoolchildren in the Philippines

Abstract

Objective: To determine the efficacy of pandesal baked from wheat flour fortified with iron, with or without vitamin A (VA), in improving anemic schoolchildren's iron and anthropometric status.

Methods: Anemic 6- to 12-year-old Filipino children (n  =  250) received two 60 g pandesal daily for 8 months. They were randomized into 1 of 4 groups: (1) iron-fortified (with hydrogen-reduced iron at 80 mg/kg, electrolytic iron at 80 mg/kg, or ferrous fumarate at 40 mg/kg), (2) iron and VA-fortified, (3) VA-fortified (at 490 RE/100 g), and (4) nonfortified flour. Hemoglobin (Hb) and zinc protoporphyrin (ZnPP) concentrations and weight and height were determined before and after intervention. Analyses of variance and chi-square and multiple regression analyses were performed.

Results: Mean Hb increased by 1.3 g/dL (p < 0.001) and mean ZnPP decreased by 24.4 µmol/mol (p < 0.001) after 8 months. Anemia decreased to 26% and iron deficiency decreased from 58% to 12%. After controls were applied for baseline concentration, age, and gender, Hb concentration at post intervention was significantly higher in the Iron + VA group than in the nonfortified group (coefficient  =  0.37; p  =  0.034). The odds of being iron deficient at post intervention were significantly lower in the Iron group than in the nonfortified group after controls were applied for age, gender, and baseline prevalence (coefficient  =  0.12; p  =  0.006). None of the 3 fortified groups had significantly different weight-for-age z-score, body mass index-for-age z-score, or height-for-age z-score compared with the nonfortified group after controls were applied for baseline z-scores, age, and gender.

Conclusions: Our study shows that in a non–malaria-endemic area, iron fortification of flour significantly reduced the prevalence of iron deficiency among anemic schoolchildren, and double fortification with iron and VA significantly improved Hb status.

• hydrogen-reduced iron
• electrolytic iron
• ferrous fumarate
• iron
• vitamin A

We thank the participating children and their parents for their cooperation. We acknowledge the contributions of the study team, including the field staff, supervisor, doctor, data collectors, data manager, and other support staff. We thank the Local Government Unit and the Department of Education officials of the Municipality of Compostela, Cebu, and the teaching staff of Estaca and Magay Elementary Schools for their support. We thank Dr Paul Lohmann GmbH KG, Vitachem Industries, and Roche Philippines for the iron and VA fortificants used in the study. The study was conducted by the Nutrition Center of the Philippines with fund support from the Early Childhood Development Project of the Philippine government. The authors have no conflict of interest in relation to this study.