A comparative intervention trial on fish sauce fortified with NaFe-EDTA and FeSO4+citrate in iron deficiency anemic school children in Kampot, Cambodia

Abstract

Background: Inhabitants of agrarian villages of rural Cambodia suffer from high prevalences of iron deficiency and anemia in the context of a monotonous diet. Objective: To compare the efficacy and safety of placebo Khmer fish sauce to that of 10 mL of fish sauce containing 10 mg of iron, added to daily school meals either as NaFe-EDTA or as FeSO4+ citrate. Methods: 140 students aged 6-21 years were enrolled in a double-blinded, placebo-controlled intervention trial. They were randomly allocated to one of three treatment groups, and followed for 21 weeks during which 114 school meals seasoned with 10 mL of fish sauce were consumed by each participant. Changes in the concentrations of hemoglobin (hb), serum ferritin (SF), and C-reactive protein (CRP) and in body weight and standing height were determined. Prevalences of vomiting, diarrhea, and acute respiratory infections were monitored weekly. Results: Both iron-fortified fish sauces increased hb and SF concentrations significantly as compared to placebo. No significant differences were observed between FeSO4+citrate and NaFe-EDTA fortification, regarding mitigation of iron-deficiency anemia (IDA) or regarding CRP, growth, infections, or side-effects. Conclusions: Iron-fortified Khmer fish sauce added to Khmer food is a suitable vehicle for iron fortification in children and adolescents. FeSO4+citrate and NaFe-EDTA show equivalent efficacy and safety.