Does iron-fortified chewing gum influence the biochemical profile of school-going children (6–10 yrs.)?

Main Article Content

Muhammad Azeem
Mian Kamran Sharif
Fais-Ul-Hassan Shah
Maratab Ali
Muhammad Amer Nazir
Muhammad Rizwan
Syed Abdul Wadood
Rebia Ejaz


complete blood count (CBC), daily value (DV), ferrous sulfate (FeSO4), iron deficiency anemia (IDA), sodium iron EDTA (NaFeEDTA)


Iron deficiency has become a common nutritional problem of developing countries, especially in children. This study approached to tackle the issue of iron deficiency by inexpensive fortified food such as chewing gums, which is commonly consumed by children. In this study, iron-fortified chewing gums were prepared by adding ferrous sulfate (FeSO4) and sodium iron EDTA (NaFeEDTA) 30 mg/100 g. An efficacy trial was conducted to determine the impact of iron-fortified chewing gums on the blood profile and iron status of school-going children (n = 300). Results showed maximum increase in blood profile and iron status that is, serum ferritin (10.43%), hemoglobin (3.22%), hematocrit (3.42%), red blood cells (3.05%), mean cell volume (1.55%), mean cell hemoglobin (5.43%), total white blood cells count (9.09%), and platelets count (4.40%) as compared with control whereas decrease in mean cell hemoglobin concentration (1.90%) and neutrophils (3.33%) was also observed. The study concluded that FeSO4 and NaFeEDTA (1:1) fortification of chewing gums is an appropriate approach for mitigating iron deficiency among the target population.

Abstract 84 | PDF Downloads 45 XML Downloads 15 HTML Downloads 16


Akhtar S., Ahmed A., Ahmad A., Ali Z., Riaz M. and Ismail T. 2013. Iron status of the Pakistani population—current issues and strategies. Asia Pacific Journal of Clinical Nutrition 22:340–347.

Akhtar S., Anjum F.M. and Rehman S.U. 2005. Effect of iron and zinc fortification on the stability, acceptability and efficacy of whole wheat flour. Journal of Research 16:95–103.

Andang’o P.E., Osendarp S.J., Ayah R., West C.E., Mwaniki D.L., De Wolf C.A. and Verhoef H. 2007. Efficacy of iron-fortified whole maize flour on iron status of school children in Kenya: a randomised controlled trial. Lancet 369:1799–1806. https://doi. org/10.1016/S0140-6736(07)60817-4

Arcanjo F.P.N., Amancio O.M.S., Braga J.A.P. and de Paula Teixeira Pinto V. 2010. Randomized controlled trial of iron-fortified drinking water in preschool children. Journal of the American College of Nutrition 29:122–129. 724.2010.10719825

Azeem M., Mu T.H. and Zhang M. 2019. Effects of high hydrostatic pressure and soaking solution on proximate composition, polyphenols, anthocyanins, beta-carotene, and antioxidant activity of white, orange, and purple fleshed sweet potato flour. Food Science and Technology International 0:1–15. https://doi. org/10.1177/1082013219892716

Bhattacherjee A.K., Dikshit A., Kumar S. and Tandon D.K. 2013. Quality of aonla candy and segments-in-syrup prepared from steep preserved fruits in water. Indian Journal of Natural Products and Resources 4:119–122.

Blanco-Rojo R., Pérez-Granados A.M., Toxqui L., González-Vizcayno C., Delgado M.A. and Vaquero M.P. 2011. Efficacy of a microencapsulated iron pyrophosphate-fortified fruit juice: a randomised, double-blind, placebo-controlled study in Spanish iron-deficient women. British Journal of Nutrition 105:1652– 1659.

Bouhouch R.R., El-Fadeli S., Andersson M., Aboussad A., Chabaa L., Zeder C. and Zimmermann M.B. 2016. 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 trial1. American Journal  of  Clinical Nutrition  104:1318–1326. https://doi. org/10.3945/ajcn.115.129346

Chadare F.J., Idohou R., Nago E., Affonfere M., Agossadou J., Fassinou T.K and Hounhouigan D.J. 2019. Conventional and food-to-food fortification: an appraisal of past practices and lessons learned. Food Science & Nutrition 7:2781–2795. https://

Davidsson L., Dimitriou T., Boy E., Walczyk T. and Hurrell R.F. 2002. Iron bioavailability from iron-fortified guatemalan meals based on corn tortillas and black bean paste. American Journal of Clinical Nutrition 75:535–539. ajcn/75.3.535

Davidsson L., Ziegler E., Zeder C., Walczyk T. and Hurrell R. 2005. Sodium iron EDTA [NaFe(III)EDTA] as a food fortificant: erythrocyte incorporation of iron and apparent absorption of zinc, copper, calcium, and magnesium from a complementary food based on wheat and soy in healthy infants. American Journal of Clinical Nutrition 81:104–109. ajcn/81.1.104

Durrani A.M., Srivastava P.K. and Verma S. 2011. Development and quality evaluation of honey-based carrot candy. Journal of Food Science and Technology 48:502–505. s13197-010-0212-0

Huang J., Sun J., Li W.X., Wang L.J., Wang A.X., Huo J.S. and Chen C.M. 2009. Efficacy of different iron fortificants in wheat flour in controlling iron deficiency. Biomedical and Environmental Sciences 22:118–121. S0895-3988(09)60033-7

Huo J., Sun J., Miao H., Yu B., Yang T., Liu Z. and Li Y. 2002. Therapeutic effects of NaFe EDTA-fortified soy sauce in anae-mic children in China. Asia Pacific Journal of Clinical Nutrition 11:123–127.

Hurrell R. 2002. How to ensure adequate iron absorption from iron-fortified food. Nutrition Review 60:7–15. https://doi. org/10.1301/002966402320285137

Idris M. and Anis-ur-Rehman. 2005. Iron deficiency anaemia in moderate to severely anaemic patients. Journal of Ayub Medical College Abbottabad 17:45–47.

Kamruzzaman M., Islam M. and Anjuman S. 2014. A study on tomato candy prepared by dehydration technique using different sugar solutions. Food and Nutrition Sciences 5(13):1261–1271.

Khor G.L. 2005. Micronutrient status and intervention programs in Malaysia. Food and Nutrition Bulletin 26:281–285. https://doi. org/10.1177/15648265050262S220

Krishna G. and Ranjhan S.K. 1981. Gross energy of the herbage, urine, milk and silage. In: Laboratory manual of nutrition research. Vikas Publishing House (Pvt.) Ltd. New Delhi, India. pp.134.

Kulnigg-Dabsch S., Evstatiev R., Dejaco C. and Gasche C. 2012. Effect of iron therapy on platelet counts in patients with inflammatory bowel disease-associated anemia. PLoS ONE 7:1–6.

Kuong K., Laillou A., Chea C., Chamnan C., Berger J. and Wieringa  F.T. 2016. Stability of vitamin A, iron and zinc in fortified rice during storage and its impact on future national standards and programs—Case study in Cambodia. Nutrients 8:3–11.

Longfils P., Monchy D., Weinheimer H., Chavasit V., Nakanishi Y. and Schumann K. 2008. A comparative intervention trial on fish sauce fortified with NaFe-EDTA and FeSO4+citrate in iron deficiency anemic school children in Kampot, Cambodia. Asia Pacific Journal of Clinical Nutrition 17:250–257.

Ma J., Sun Q., Liu J., Hu Y., Liu S., Zhang J. and Hambidge K.M. 2016. The effect of iron fortification on iron (Fe) status and inflammation: a randomized controlled trial. PLoS ONE 11:1– 12.

Manjula K. and Suneetha C. 2014. Formulation and development of functional confectionery by incorporating pumpkin juice. International Journal of Food, Agriculture & Veterinary Sciences 4:47–52.

McLean E., Cogswell M., Egli I., Wojdyla D. and De Benoist B. 2008. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutrition 12:1–11.

Meilgaard M.C., Civille G.V. and Carr B.T. 2007. Sensory evaluation techniques, 4th ed. CRC Press, New York, NY. https://doi. org/10.1201/b16452

Menon M.P. and Yoon S.S. 2015. Prevalence and factors associated with anemia among children under 5 years of age—Uganda, 2009. American Journal of Tropical Medicine and Hygiene 93:521–526.

Molla A. and Khurshid M. 1992. Prevalence of iron deficiency anaemia in children of the urban slums of Karachi. Journal Of Pakistan Medical Association 42:118–121.

Moretti D., Zimmermann M.B., Muthayya S., Thankachan P., Lee T.C., Kurpad A.V. and Hurrell R.F. 2006. Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian schoolchildren: a double-blind randomized controlled trial1–3. American Journal of Clinical Nutrition 84:822–829.

Patil S., Khanwelkar C., Patil S.K. and Thorat V.M. 2013. Comparison of efficacy, tolerability, and cost of newer with conventional oral iron preparation. Al Ameen Journal of Medical Sciences 6:29–33.

Petry N., Olofin I., Hurrell R.F., Boy E., Wirth J.P., Moursi M. and Rohner F. 2016. The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: a systematic analysis of national surveys. Nutrients 8:1–17.

Prentice A.M., Mendoza Y.A., Pereira D., Cerami C., Wegmuller R., Constable A. and Spieldenner J. 2017. Dietary strategies for improving iron status: balancing safety and efficacy. Nutrition Review 75:49–60.

Sari M., Bloem M.W., De Pee S., Schultink W.J. and Sastroamidjojo S. 2001. Effect of iron-fortified candies on the iron status of children aged 4–6 y in East Jakarta, Indonesia. American Journal of Clinical Nutrition 73:1034–1039. ajcn/73.6.1034

Schoorl M., Van der Gaag D. and Bartels P.C.M. 2012. Effects of iron supplementation on red blood cell hemoglobin content in pregnancy. Hematology Reports 4:91–94. hr.2012.e24

Siddiqui I.A., Siddiqui N.A., Aziz J. and Omair A. 2007. Erythrocyte sedimentation rate in healthy first year medical students. Saudi Medical Journal 28:1819–1821.

World Health Organization (WHO). 2011. The global prevalence of anaemia in 2011. WHO Report, 48, WHO, Geneva, Switzerland.