Fortification of drinking water to control iron-deficiency anemia in preschool children

Background. Iron-deficiency anemia is the most common type of micronutrient malnutrition in the world. Its etiology and control are well understood, but the problem persists and is increasing in some developing countries. Iron fortification of mass-consumption foods is considered one of the most viable approaches to deliver bioavailable iron to the population. Objective. To review and analyze the use of drinking water as an iron vehicle to reduce ferropenic anemia in developing countries. Methods. Drinking water with added iron compounds was offered to preschool children at day-care centers in Brazil. Iron solutions were prepared with 10 mg to 20 mg iron/L. Clinical and anthropometric measurements and blood hemoglobin concentrations were obtained at the beginning of each study and 4 to 8 months later. Results. No problems with acceptability or side effects were observed. Daily water intake by children was around 500 mL. Iron-deficiency anemia was found in all studies. Control children not receiving iron supplementation mantained their initial hemoglobin level. Anemia was reduced in the groups receiving iron-fortified drinking water. Conclusions. Based on physical properties, tests in rats, and studies on preschool children at Brazilian daycare centers, we have shown that drinking water locally fortified with iron compounds should be considered and used as a worldwide available vehicle to control iron-deficiency anemia. Drinking water, besides being universally available, is a locally available vehicle, easily fortified, can be a vehicle for hydrosoluble iron, and reduces iron-deficiency anemia in preschool children.