Iron in ferrous fumarate
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Iron in Ferrous Fumarate: Bioavailability and Efficacy
Bioavailability of Ferrous Fumarate vs. Ferrous Sulfate
Comparative Absorption in Different Populations
Ferrous fumarate is often compared to ferrous sulfate for its bioavailability in various populations. Studies have shown that in non-anemic Mexican women and children, iron absorption from ferrous fumarate is comparable to that from ferrous sulfate. Specifically, the relative bioavailability (RBV) of ferrous fumarate was found to be 86% in women, 97% in infants, and 106% in young children, indicating no significant differences in iron absorption between the two compounds 1. This suggests that ferrous fumarate can be effectively used in fortifying complementary foods to prevent iron deficiency in these groups.
Iron Absorption in Infants and Young Children
However, other studies have reported that iron absorption from ferrous fumarate in young children is significantly lower than from ferrous sulfate, with an RBV of only 30% 2. This discrepancy may be due to factors such as lower iron status in children, reduced gastric acid secretion, or the influence of added ascorbic acid on iron absorption. Despite these findings, ferrous fumarate-fortified foods have been shown to improve iron status in iron-deficient infants and prevent iron deficiency as effectively as ferrous sulfate in iron-replete infants 2.
Efficacy in Treating Anemia
Ferrous Fumarate in Pregnancy
In pregnant women with iron deficiency anemia, intravenous iron sucrose has been found to be more effective than oral ferrous fumarate in increasing hemoglobin and serum ferritin levels. A study showed that women receiving intravenous iron had a significantly higher increase in hemoglobin (22 g/L) compared to those receiving oral ferrous fumarate (12 g/L) 3. This suggests that while ferrous fumarate is beneficial, intravenous iron may be more effective in severe cases of anemia during pregnancy.
Microencapsulated Ferrous Fumarate
Microencapsulated ferrous fumarate combined with ascorbic acid has been used as a sprinkle to treat anemia in infants. This method has shown similar efficacy to ferrous sulfate drops, with 58% of children in the sprinkles group and 56% in the drops group successfully treated for anemia 4. Additionally, iron absorption from microencapsulated ferrous fumarate sprinkles is up-regulated in infants with iron deficiency anemia, meeting and surpassing their iron requirements 5.
Fortification of Complementary Foods
Iron Fortification in Malaria-Endemic Regions
In malaria-endemic regions, complementary foods fortified with a combination of sodium iron EDTA and ferrous fumarate have been effective in reducing iron deficiency anemia in children. A study in Côte d’Ivoire showed a significant decrease in iron deficiency anemia prevalence from 32.8% to 1.2% in the group receiving ferrous fumarate-fortified foods 7. This indicates that ferrous fumarate can be a valuable component in iron fortification strategies, even in challenging environments.
Enhancing Iron Absorption with Juices
The absorption of iron from ferrous fumarate can be enhanced by consuming it with orange juice, which contains ascorbic acid. A study found that iron absorption increased from 5.5% to 8.2% when ferrous fumarate was consumed with orange juice compared to apple juice 8. This suggests that dietary modifications can improve the efficacy of ferrous fumarate in iron supplementation programs.
Conclusion
Ferrous fumarate is a viable option for iron fortification and supplementation, with comparable bioavailability to ferrous sulfate in many populations. Its efficacy in treating anemia, particularly when used in innovative delivery systems like microencapsulated sprinkles, makes it a valuable tool in combating iron deficiency. However, its absorption can be influenced by various factors, and in some cases, alternative forms of iron or additional dietary modifications may be necessary to achieve optimal results. Further research is needed to fully understand the conditions under which ferrous fumarate is most effective and to refine its use in different demographic and health contexts.
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Most relevant research papers on this topic
A comparison of the bioavailability of ferrous fumarate and ferrous sulfate in non-anemic Mexican women and children consuming a sweetened maize and milk drink
Ferrous fumarate is as well absorbed as ferrous sulfate in non-anemic, iron sufficient infants and young children, making it a useful fortification compound for complementary foods designed to prevent iron deficiency.
RCTUse of ferrous fumarate to fortify foods for infants and young children.
Ferrous fumarate fortification in infants and young children may not provide as effective iron absorption as ferrous sulfate, and more iron in the form of fumarate is needed for equivalent efficacy.
Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial
Intravenous iron sucrose is more effective than oral ferrous fumarate in increasing maternal iron stores during anemia in pregnancy.
RCT
Rigorous JournalTreatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods.
Microencapsulated ferrous fumarate sprinkles plus ascorbic acid effectively treat anemia in infants without side effects, potentially improving adherence to treatment.
RCT
Large Human Trial
Highly CitedDetermination of iron absorption from intrinsically labeled microencapsulated ferrous fumarate (sprinkles) in infants with different iron and hematologic status by using a dual-stable-isotope method.
Microencapsulated ferrous fumarate sprinkles in maize-based porridge meet and surpass iron requirements in infants, with higher absorption in those with iron deficiency anemia.
RCTHighly CitedMulti-micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial.
A low dose of 12.5 mg of iron as ferrous fumarate in multi-micronutrient Sprinkles may be effective in improving haemoglobin concentrations in anaemic children, with better adherence and side effects compared to iron drops.
RCTRigorous JournalHighly CitedIron Fortified Complementary Foods Containing a Mixture of Sodium Iron EDTA with Either Ferrous Fumarate or Ferric Pyrophosphate Reduce Iron Deficiency Anemia in 12- to 36-Month-Old Children in a Malaria Endemic Setting: A Secondary Analysis of a Cluster-Randomized Controlled Trial
Iron fortified complementary foods significantly reduce iron deficiency anemia in preschool-age children in malaria-endemic settings, but have no overall effect on anemia.
RCTLarge Human Trial
Very Rigorous JournalOrange But Not Apple Juice Enhances Ferrous Fumarate Absorption in Small Children
Orange juice enhances iron absorption from ferrous fumarate in small children, while apple juice does not, with a 2-fold increase in absorption in children older than 6.
RCTVery Rigorous JournalDry cereals fortified with electrolytic iron or ferrous fumarate are equally effective in breast-fed infants.
Both electrolytic iron and ferrous fumarate are equally effective in maintaining iron status and preventing iron deficiency in breast-fed infants.
RCTVery Rigorous JournalDaily home fortification with iron as ferrous fumarate versus NaFeEDTA: a randomised, placebo-controlled, non-inferiority trial in Kenyan children
Home fortification with either 3 mg iron as NaFeEDTA or 12.5 mg iron as encapsulated ferrous fumarate was insufficiently efficacious to assess non-inferiority in Kenyan children aged 12–36 months.
Rigorous Journal