Iron Fortification Trail Using NaFeEDTA in Iron Deficient Lead-exposed Children
Primary Purpose
Iron Deficiency, Lead Poisoning
Status
Completed
Phase
Not Applicable
Locations
Switzerland
Study Type
Interventional
Intervention
iron fortified biscuits
iron fortified biscuits
iron fortified biscuits
iron fortified biscuits
Sponsored by
About this trial
This is an interventional health services research trial for Iron Deficiency focused on measuring iron deficiency, Lead poisoning, cognitive development, motor activity
Eligibility Criteria
Inclusion Criteria:
- school and preschool children living in a lead-exposed environment with a high prevalence of iron deficiency
Exclusion Criteria:
- chronic or severe illnesses
- history of bleeding disorder
Sites / Locations
- Swiss Federal Institute of Technology (ETH)
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm Type
Active Comparator
Active Comparator
Active Comparator
Placebo Comparator
Arm Label
NaFeEDTA treatment, biscuit
EDTA treatment, biscuit
FeSO4 treatment, biscuit
control treatment, biscuit
Arm Description
Group receives 10 mg of Fe in form of NaFeEDTA per day. wheat flour based biscuit
Group receives Na2EDTA enriched biscuit
Group receives 10 mg of iron as FeSo4 per day for 8 months
group receives a biscuit without additional iron
Outcomes
Primary Outcome Measures
body lead burden
changes in blood lead levels over time of the intervention
Secondary Outcome Measures
Iron status
changes in iron status (SF,Hb, TfR) before and after intervention
cognitive development
changes in cognitive development (using the K ABC II) before and after intervention
Full Information
NCT ID
NCT01573013
First Posted
November 8, 2011
Last Updated
May 9, 2014
Sponsor
Swiss Federal Institute of Technology
1. Study Identification
Unique Protocol Identification Number
NCT01573013
Brief Title
Iron Fortification Trail Using NaFeEDTA in Iron Deficient Lead-exposed Children
Official Title
Interactions of Lead Intoxication and Iron Deficiency in Morocco: The Effects of Iron Fortification With and Without NaEDTA on Lead Burden, Iron Status and Cognition in Children
Study Type
Interventional
2. Study Status
Record Verification Date
May 2014
Overall Recruitment Status
Completed
Study Start Date
September 2011 (undefined)
Primary Completion Date
June 2012 (Actual)
Study Completion Date
June 2012 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Swiss Federal Institute of Technology
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
In a cross-sectional study allotted by the ethical committee of the ETH Zurich, we are investigating the extent of anemia, iron deficiency and lead intoxication in young children. For this purpose an assessment of body lead burden and iron status was conducted in a cohort of individuals residing in areas of presumed high lead exposure. Associations between lead burden and iron status will be investigated in the near future (current status of the study).
In a follow-on intervention study, the effect of iron fortification with and without NaEDTA on blood lead levels in lead-exposed children will be evaluated; and the relative impact of these two strategies on child growth, motor and cognitive test performance will be compared.
This study will investigate the potential use of iron fortification to not only combat anemia but also reduce body lead burden in lead-exposed populations; it specifically investigates whether iron fortification with NaFeEDTA could have additional beneficial effects to iron alone.
Detailed Description
Introduction Coexisting chronic lead poisoning and iron deficiency anemia (IDA) are common in urban areas in developing regions, particularly in young children. In urban Morocco, anemia affects more than 1/3rd of schoolchildren and lead exposure is high. Lead poisoning and IDA both impair cognitive development and educability and may therefore have substantial health, social and economic costs on developing countries.
Iron status alters susceptibility to gastrointestinal lead exposure; absorption of lead is sharply increased in children with IDA. IDA upregulates the divalent metal transporter trans-port protein (DMT-1) and increases lead absorption. Thus, iron fortification to reduce IDA may also reduce lead absorption and be an effective strategy to accompany environmental lead abatement. The optimal iron compound for wheat flour is currently debated, and although elemental iron compounds are commonly used, they may be only poorly absorbed in the face of inhibitory compounds found in wheat flour.
A form of chelated iron, NaFeEDTA, is a promising iron fortificant that is recommended for wheat flour fortification. It is also a lead chelator. It may be superior to other iron fortificants in its ability to reduce body lead burden, due to:
its iron is highly bioavailable in the face of dietary inhibitors (such as phytic acid in wheat flour); and
potentially, its ability to chelate lead in the gut and bloodstream. Thus, it may be a good choice for fortification of wheat flour in Morocco, particularly in urban areas, to both reduce IDA and lower body lead.
Study aims and objectives:
Assessment of body lead burden and iron status in a cohort of individuals residing in areas of presumed high lead exposure. Investigation of associations between lead burden and iron status.
Comparison of effect of iron fortification with and without NaEDTA on body lead and iron status in lead-exposed children; and the relative impact on cognition.
Study hypotheses:
The prevalence of iron deficiency and elevated blood lead will be high in children in this region.
2) Body lead burden, as assessed by blood lead levels and urinary lead and delta-aminolevulinic acid (ALA), will be higher in individuals with poorer iron status.
3) Poor iron status will be associated with low intakes of bioavailable iron. 4) Greater severity of iron deficiency and/or higher body lead in children will predict poorer performance on cognitive and motor tests, and these conditions will interact to predict poorer performance.
Study design:
Our studies will be carried out in one of the four sub-economic areas, that were previously used in the baseline assessment in and near Marrakesh, Morocco (exact site still needs to be determined according to extend of lead contamination on the level of human population). Body lead burden and iron status will be determined, and associations between these examined using a cross-sectional design. For this purpose, blood and urine samples will be collected from two groups (preschool and school-aged children), residing in an area of high lead exposure.
Study design:
An 8-month intervention study in iron deficient, lead-exposed school children (n=500) will be designed to investigate whether iron fortification to reduce IDA may also reduce lead absorption and be an effective strategy to accompany environmental lead abatement.
For this purpose these children will be divided into four groups to receive a daily fortified baked snack containing either: 1) 66.4 mg NaFeEDTA ; 2) 52.2 mg Na2EDTA dehydrate; 3) 27.1 mg FeSO4 ; or 4) no fortificants.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Iron Deficiency, Lead Poisoning
Keywords
iron deficiency, Lead poisoning, cognitive development, motor activity
7. Study Design
Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
457 (Actual)
8. Arms, Groups, and Interventions
Arm Title
NaFeEDTA treatment, biscuit
Arm Type
Active Comparator
Arm Description
Group receives 10 mg of Fe in form of NaFeEDTA per day. wheat flour based biscuit
Arm Title
EDTA treatment, biscuit
Arm Type
Active Comparator
Arm Description
Group receives Na2EDTA enriched biscuit
Arm Title
FeSO4 treatment, biscuit
Arm Type
Active Comparator
Arm Description
Group receives 10 mg of iron as FeSo4 per day for 8 months
Arm Title
control treatment, biscuit
Arm Type
Placebo Comparator
Arm Description
group receives a biscuit without additional iron
Intervention Type
Dietary Supplement
Intervention Name(s)
iron fortified biscuits
Intervention Description
10 mg of iron per day for 8 months, either in the form of NaFeEDTA
Intervention Type
Dietary Supplement
Intervention Name(s)
iron fortified biscuits
Intervention Description
10 mg of iron per day for 8 months, in the form of FeSo4
Intervention Type
Dietary Supplement
Intervention Name(s)
iron fortified biscuits
Intervention Description
EDTA fortified biscuit on a daily basis for 8 months
Intervention Type
Dietary Supplement
Intervention Name(s)
iron fortified biscuits
Intervention Description
control biscuit on a daily basis for 8 months
Primary Outcome Measure Information:
Title
body lead burden
Description
changes in blood lead levels over time of the intervention
Time Frame
8 months
Secondary Outcome Measure Information:
Title
Iron status
Description
changes in iron status (SF,Hb, TfR) before and after intervention
Time Frame
8 months
Title
cognitive development
Description
changes in cognitive development (using the K ABC II) before and after intervention
Time Frame
8 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
13 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
school and preschool children living in a lead-exposed environment with a high prevalence of iron deficiency
Exclusion Criteria:
chronic or severe illnesses
history of bleeding disorder
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael B Zimmermann, Prof. Dr. med
Organizational Affiliation
Swiss Federal Institute of Technology (ETH)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Swiss Federal Institute of Technology (ETH)
City
Zurich
ZIP/Postal Code
8092
Country
Switzerland
12. IPD Sharing Statement
Citations:
PubMed Identifier
27733396
Citation
Bouhouch RR, El-Fadeli S, Andersson M, Aboussad A, Chabaa L, Zeder C, Kippler M, Baumgartner J, Sedki A, Zimmermann MB. Effects of wheat-flour biscuits fortified with iron and EDTA, alone and in combination, on blood lead concentration, iron status, and cognition in children: a double-blind randomized controlled trial. Am J Clin Nutr. 2016 Nov;104(5):1318-1326. doi: 10.3945/ajcn.115.129346. Epub 2016 Oct 12.
Results Reference
derived
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Iron Fortification Trail Using NaFeEDTA in Iron Deficient Lead-exposed Children
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