A Randomized, Double Blind Control Efficacy Trial of Chapattis Prepared from NaFeEDTA Fortified Wheat Flour in Pakistan

Abstract

Objectives: The aim of study was to evaluate efficacy of NaFeEDTA (10 ppm Fe) added to high extraction wheat flour in a randomized, double blind, controlled trial in women of child bearing age. Methods: A 5 month long, school based feeding trial was carried out in an urban and a rural school of low socioeconomic community in Islamabad, Pakistan simultaneously. Apparently healthy, 13-35 years old non- pregnant, non-lactating girls (N=201) with Hb > 7.5 g/dl, CRP negative were randomly assigned to either receive fortified wheat flour (NaFeEDTA ) chapattis (85g flour/chapatti) with meal or identical unfortified chapattis (3 chapattis/day). Hemoglobin, serum ferritin and CRP were measured at baseline and post intervention. Results: At urban site there was decrease in prevalence of iron deficency anemia (IDA) (Hb < 12 g/dl) (21% to 17%) and iron deficiency (ID) (Serum Ferritin < 12 ng/ml) (54% to 45%) in intervention group, and increase in prevalence of IDA (25% to 38%) and ID (18% to 26%) in control group. At rural site, in intervention group, there was no apparent change, IDA: (9% to 11%) and ID (37% to 37%). However, situation deteriorated in control group, IDA increased (17% to 32%) and little change in ID (30% to 32%). Any of the effect was not statistically significant (p> 0.01). Conclusions: NaFeEDTA fortified wheat flour reduced prevalence of ID and IDA in urban area. It is recommended for use in roller mill wheat flour fortification which mainly covering urban and semi urban areas. However, more extensive studies are required to show efficacy in rural areas.