Skip to main content

Advertisement

Springer Nature Link
Log in

Nutrition Epidemiology Highlights Original Article

Comparison of food habits, iron intake and iron status in adolescents before and after the withdrawal of the general iron fortification in Sweden

  • Original Article
  • Published:
European Journal of Clinical Nutrition Submit manuscript

Abstract

Background/Objectives:

Sifted flour was fortified with carbonyl iron for 50 years in Sweden. This study evaluates changes in food habits, intake of iron, factors affecting iron absorption and iron status after the discontinuation of the general iron fortification in adolescents with the highest requirements.

Subjects/Methods:

A total of 2285 15- to 16-year-old students in 1994 (634 girls and 611 boys) and in 2000 (534 girls and 486 boys) in 13 schools in Gothenburg, Sweden, were included in two cross-sectional surveys assessing food habits with diet history interviews and iron deficiency defined with serum ferritin stores ⩽15 μg/l and no preceding infection.

Results:

In girls, iron deficiency increased from 37 to 45%, while in boys, it was stable at 23%. Total iron intake decreased from 15.7 to 9.5 mg/day and 22.5 to 13.9 mg/day in girls and boys, respectively. Cereals were the main iron source. Among girls, the increase of fish and decrease of calcium intake may not counteract the effect of decreased intake of fortification iron. Among boys, more meat, less calcium and more vitamin C may have favoured the bioavailability of iron.

Conclusions:

The discontinuation of the general iron fortification resulted in a 39% decrease in total iron intake and iron deficiency increased substantially in girls. However, in boys no change in iron deficiency was observed. Whether this was a result of changed bioavailability of dietary iron or simultaneous changes of non-dietary factors remains to be explored.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Westin S . Iron in the Swedish diet and sources - How much is fortified iron? (in Swedish). Näringsforskning 1975; 19: 14–16.

    Google Scholar 

  2. Hallberg L, Brune M, Rossander L . Low bioavailability of carbonyl iron in man: studies on iron fortification of wheat flour. Am J Clin Nutr 1986; 43: 59–67.

    Article  CAS  Google Scholar 

  3. Commission of the European Communities Nutrient and energy intakes for the European Community. Commission of the European Communities: Iron, Luxembourg, 1993.

  4. Svanberg B, Arvidsson B, Björn-Rasmussen E, Hallberg L, Rossander L, Swolin B . Dietary iron absorption in pregnancy - a longitudinal study with repeated measurements of non-haeme iron absorption from whole diet. Acta Obstet Gynecol Scand Suppl 1975; 48: 43–68.

    Article  CAS  Google Scholar 

  5. Hallberg L, Hulten L, Gramatkovski E . Iron absorption from the whole diet in men: how effective is the regulation of iron absorption? Am J Clin Nutr 1997; 66: 347–356.

    Article  CAS  Google Scholar 

  6. Bothwell TH . Overview and mechanisms of iron regulation. Nutr Rev 1995; 53: 237–245.

    Article  CAS  Google Scholar 

  7. Gleerup A, Rossander-Hulthen L, Gramatkovski E, Hallberg L . Iron absorption from the whole diet: comparison of the effect of two different distributions of daily calcium intake. Am J Clin Nutr 1995; 61: 97–104.

    Article  CAS  Google Scholar 

  8. Hallberg L, Hulthen L . Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. Am J Clin Nutr 2000; 71: 1147–1160.

    Article  CAS  Google Scholar 

  9. Cook JD, Monsen ER . Food iron absorption in human subjects. III. Comparison of the effect of animal proteins on nonheme iron absorption. Am J Clin Nutr 1976; 29: 859–867.

    Article  CAS  Google Scholar 

  10. Hallberg L, Brune M, Erlandsson M, Sandberg AS, Rossander-Hulten L . Calcium: effect of different amounts on nonheme- and heme-iron absorption in humans. Am J Clin Nutr 1991; 53: 112–119.

    Article  CAS  Google Scholar 

  11. Hallberg L, Brune M, Rossander L . Effect of ascorbic acid on iron absorption from different types of meals. Studies with ascorbic-acid-rich foods and synthetic ascorbic acid given in different amounts with different meals. Hum Nutr Appl Nutr 1986; 40: 97–113.

    CAS  PubMed  Google Scholar 

  12. Brune M, Rossander L, Hallberg L . Iron absorption and phenolic compounds: importance of different phenolic structures. Eur J Clin Nutr 1989; 43: 547–557.

    CAS  PubMed  Google Scholar 

  13. Sjöberg A, Hallberg L, Höglund D, Hulthén L . Meal pattern, food choice, nutrient intake and lifestyle factors in The Goteborg Adolescence Study. Eur J Clin Nutr 2003; 57: 1569–1578.

    Article  Google Scholar 

  14. Sjöberg A, Hulthén L . Anthropometric changes in Sweden during the obesity epidemic – increased overweight among adolescents of non-Nordic origin. Acta Paediatr 2011; 100: 1119–1126.

    Article  Google Scholar 

  15. Hulthen L, Lindstedt G, Lundberg PA, Hallberg L . Effect of a mild infection on serum ferritin concentration—clinical and epidemiological implications. Eur J Clin Nutr 1998; 52: 376–379.

    Article  CAS  Google Scholar 

  16. Sjöberg A . Food habits in Swedish adolescents. Meal pattern, food choice and bioavailability of iron 1994 and 2000. Thesis Sahlgrenska Academy at Göteborg University: Göteborg, Sweden, 2004.

    Google Scholar 

  17. Sjöberg A, Slinde F, Arvidsson D, Ellegård L, Gramatkovski E, Hallberg L et al. Energy intake in Swedish adolescents: validation of diet history with doubly labelled water. Eur J Clin Nutr 2003; 57: 1643–1652.

    Article  Google Scholar 

  18. Sjöberg A, Hulthén L . Assessment of habitual meal pattern and intake of foods, energy and nutrients in Swedish adolescent girls: comparison of diet history with 7-day record. Eur J Clin Nutr 2004; 58: 1181–1189.

    Article  Google Scholar 

  19. Swedish National Food Administration The Food Composition Table - Energy and Nutrients. Swedish National Food Administration: Uppsala, Sweden, 1994.

  20. Swedish National Food Administration The Food Composition Table - Energy and Nutrients. Swedish National Food Administration. Uppsala, Sweden, 1996.

  21. Hoppe M, Sjöberg A, Hallberg L, Hulthen L . Iron status in Swedish teenage girls: impact of low dietary iron bioavailability. Nutrition 2008; 24: 638–645.

    Article  CAS  Google Scholar 

  22. World Health Organization Iron deficiency anaemia: assessment, prevention and control. A guide programme for managers: WHO, UNICEF, UNU, 2001 Report No.: WHO/NHD/01.3.

  23. Nordic Council of Ministers Nordic Nutrition Recommendations 2012—Integrating Nurition and Physical Activity. Copenhagen, Denmark, 2014.

  24. Swedish National Food Administration Swedish Nutrition Recommendations 1989 (Svenska Näringsrekommendationer 1989) [in Swedish]. Uppsala, Sweden, 1989.

  25. Tseng M, Chakraborty H, Robinson DT, Mendez M, Kohlmeier L . Adjustment of iron intake for dietary enhancers and inhibitors in population studies: bioavailable iron in rural and urban residing Russian women and children. J Nutr 1997; 127: 1456–1468.

    Article  CAS  Google Scholar 

  26. Viglietti GC, Skinner JD . Estimation of iron bioavailability in adolescents' meals and snacks. J Am Diet Assoc 1987; 87: 903–908.

    CAS  PubMed  Google Scholar 

  27. Hallberg L, Brune M, Rossander L . Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate. Am J Clin Nutr 1989; 49: 140–144.

    Article  CAS  Google Scholar 

  28. Siegenberg D, Baynes RD, Bothwell TH, Macfarlane BJ, Lamparelli RD, Car NG et al. Ascorbic acid prevents the dose-dependent inhibitory effects of polyphenols and phytates on nonheme-iron absorption. Am J Clin Nutr 1991; 53: 537–541.

    Article  CAS  Google Scholar 

  29. Tuntawiroon M, Sritongkul N, Brune M, Rossander-Hulten L, Pleehachinda R, Suwanik R et al. Dose-dependent inhibitory effect of phenolic compounds in foods on nonheme-iron absorption in men. Am J Clin Nutr 1991; 53: 554–557.

    Article  CAS  Google Scholar 

  30. Samuelson G, Bratteby LE, Enghardt H, Hedgren M . Food habits and energy and nutrient intake in Swedish adolescents approaching the year 2000. Acta Paediatr Suppl 1996; 415: 1–19.

    Article  CAS  Google Scholar 

  31. Hallberg L, Björn-Rasmussen E, Howard L, Rossander L . Dietary heme iron absorption. A discussion of possible mechanisms for the absorption-promoting effect of meat and for the regulation of iron absorption. Scand J Gastroenterol 1979; 14: 769–779.

    Article  CAS  Google Scholar 

  32. Hagman U, Bruce Å, Persson L-Å, Samuelson G . Food habits and nutrient intake in childhood in relation to health and socio-economic conditions. A Swedish multi-center study. Acta Paediatr Scand Suppl 1986; 328: 1–56.

    Article  CAS  Google Scholar 

  33. Hunt JR . Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 2003; 78: 633S–639SS.

    Article  CAS  Google Scholar 

  34. Hunt JR, Roughead ZK . Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lactoovovegetarian diets for 8 wk. Am J Clin Nutr 1999; 69: 944–952.

    CAS  PubMed  Google Scholar 

  35. Hunt JR, Roughead ZK . Adaptation of iron absorption in men consuming diets with high or low iron bioavailability. Am J Clin Nutr 2000; 71: 94–102.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The study was funded by The Swedish Medical Research Council, The Swedish Mill Industry and WM Lundgren Foundations.

Author Contributions

Both authors designed the study, collected data, interpreted the results and wrote the paper.

Author information

Authors and Affiliations

  1. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden

    A Sjöberg

  2. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    L Hulthén

Authors
  1. A Sjöberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L Hulthén
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Sjöberg.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sjöberg, A., Hulthén, L. Comparison of food habits, iron intake and iron status in adolescents before and after the withdrawal of the general iron fortification in Sweden. Eur J Clin Nutr 69, 494–500 (2015). https://doi.org/10.1038/ejcn.2014.291

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2014.291

  • Springer Nature Limited

Search

Navigation