Consequences of removing iron fortification of flour on iron status among Danish adults: Some longitudinal observations between 1987 and 1994

Background Health authorities recommend that populations consume a diet pro viding sufficient iron, and in order to prevent iron deficiency a number of countries have fortified certain foods with iron. In Den mark, flour was f ortified with iron from 1954 until 1987, at which time the mandatory fortif ication was stopped. This study examines the effect of iron fortification o n iron status by comparing the intake of iron with serum ferritin over time and in relation to the removal of flour fortification. Methods. In a cohort of 238 Danish men and women, at baseline ages 35-65 ye ars, dietary intake and serum ferritin were measured, first in 1987/1988 an d again in 1993/1994. Results. In 1987/1988 the fortification may have supplied up to 25% of tota l iron intake, and without this enrichment some 35% of the men and 73% of t he women may have had iron intakes lower than 10 mg/day. Assuming that no f lour was enriched, iron intake was constant during the 6-year study period. Despite this, after flour fortification was stopped in 1987, serum ferriti n increased among both men and postmenopausal women. Conclusions. Considering that mandatory iron fortification of flour affects the entire population, including subjects who are at risk for chronic dise ases because of too-high iron stores, the decision to stop the mandatory fo rtification in Denmark seems to have been well-founded. (C) 1999 American H ealth Foundation and Academic Press.