Criticality of iron to maintain sound health cannot be overstated and population suffering from anemia or iron deficiency is widely spread over the continents of Asia, Africa and South America. Iron deficiency is caused by poverty as well as eating habits of people which vary from place to place. For wealthy western countries meat is the major source of iron as most of the population are non-vegetarians. In contrast population not having access to meat can be due to food habits or economic compulsions.It is not that plant foods are devoid of iron but the concentration is generally low requiring larger quantities to be consumed to meet the recommended daily intake. Even in Western countries iron fortification is common and mostly cereal products manufactured by the industry do contain added iron.
Iron deficiency can produce anemia as manifested by reduced hemoglobin content in the blood and is often precipitated by poverty conditions among people in may developing countries. Even in developed countries where meat eating is predominant anemia affects about 20% of women though it is only about 3% in men. Such a situation could have led to universal fortification of cereal products in these countries and with more than 80% of the foods consumed in these countries coming from the organized food industry, such a policy is deemed to be effective in countering iron-deficient anemia incidences. In contrast population in India with predominant vegetarian diets suffer from anemia to a greater extent. Normal hemoglobin content varies from 11-13 g/dl in humans, depending on the age as per WHO norms.
Fortification is a procedure that involves addition of one or more nutrient to foods either to restore the losses incurred during processing or to deliver a particular nutrient of critical importance to masses suffering from deficiency. Universal fortification of salt with iodine is a standing example of a successful strategy to prevent development of goiter, a common deficiency disorder occurring widespread in the world and many countries have made it mandatory for the salt manufacturers to sell this commodity only after iodine fortification. Cooking fats and milk are also fortified with Vitamins A and D though how far this is effective is not known.
Considering the success achieved in using salt as a carrier for delivering iodine, the possibility of using the same for incorporating iron has been explored and this approach seems to be feasible as borne out by limited studies in this area. Double fortification of salt can be most effective in tackling two dreaded diseases, goiter and anemia through a single medium. As in the West cereal flours cannot be an effective carrier because in countries like India the share of organized roller flour industry in the flour market is not substantial, with small plate grinders being the prominent players and scientific blending of iron sources with such products is not logistically feasible. Here is where salt come into picture and offers an easy solution.
Earlier efforts to use fluid milk and tea as carriers, explored during nineteen seventies in India did not bear fruit because of insurmountable technical difficulties. Both milk and tea are consumed country wide and could have provided route for the delivery of iron if efforts had succeeded to fortify them. Ferrous sulfate, ferrous gluconate, ferrous fumerate, are good sources of iron but the absorption efficiency is rather low and this problem is further compounded by the composition of foods as many ingredients can inhibit absorption. Iron amino acid chelate ferrous bisglycinate and Sodium Ferredelate EDTA are sources of iron with high bioutilization rate. With the availability of these modern iron sources it may be worth making attempts again to use milk and tea as iron carriers.
Use of salt has some ramifications which need to be kept in view. There is a sustained campaign in many countries to persuade the consumers to cut down drastically on salt because of its connection to blood pressure and cardiac disease and there may be resistance to use salt as a medium to deliver iron. While small quantities like 15 mg/day may not pose much problem, if higher doses in the vicinity of 100 mg/day for treating serious anemia cases may be some what difficult. Still salt presents the best option to day, considering its daily use by 100% of the targeted population and cost wise relatively cheap, as a vehicle for delivery of iron to masses and deserves consideration in many developing countries.