Gül LÖKER BİRİNGEN, Filiz AÇKURT, GÜLÇİN ŞATIR, Birdem AMOUTZOPOULOS

Consumption of Bread Fortified with Vitamins and Minerals Improves Biochemical Nutrient Levels of Healthy Adults: A Pilot Randomised Clinical Trial

Amaç: Bu randomize klinik pilot çalışmanın ana amacı vitamin ve mineraller ile zenginleştirilmiş ticari bir Türk ekmeğinin sağlıklı yetişkin bireylerin bazı kan parametreleri üzerindeki etkilerinin belirlenmesidir. Bireyler ve Yöntem: Yirmi dokuz sağlıklı yetişkin birey çalışmaya katılmış ve iki gruba ayrılmıştır: Deney (n=16) ve kontrol (n=13). Yetmiş üç gün boyunca, deneme grubu günlük diyetlerine ek olarak zenginleştirilmiş ekmek (176 g/gün) tüketmiş, kontrol grubu diyetinde değişiklik yapmamıştır. Biyokimyasal vitamin ve mineral parametreleri müdahale sürecinin başlangıcında ve sonunda, toplanan kan örneklerinde analiz edilmiştir. Bulgular: Uygulama sonunda, deneme grubunun bazı kan vitamin (B1, B2, B6, B12 ve C vitaminleri) ve mineral (demir, kalsiyum, çinko) düzeylerinde önemli artışlar saptanmıştır (p

Vitamin ve Mineraller ile Zenginleştirilmiş Ekmek Tüketimi Sağlıklı Yetişkinlerin Biyokimyasal Besin Ögesi Düzeylerini İyileştirir: Pilot Randomize Klinik Çalışma

Aim: The main objective of this pilot randomised clinical study was to determine the effects of vitamin and mineral fortified commercial Turkish bread on some blood parameters of healthy adults. Subjects and Methods: Twenty-nine healthy adults were participated into the study and divided into two groups: trial (n=16) and control (n=13). Trial group consumed fortified bread (176 g/day) as part of their usual diet for 73 days while control group did not change their diet. Biochemical parameters were analysed in blood samples at the beginning and end of the intervention period. Results: In the trial group, significant increase was determined in blood levels of vitamins B1, B2, B6, B12 and C and minerals iron, calcium, zinc at the end of the intervention period (p<0.05). Change in serum folic acid levels was not significant. Daily consumption of vitamin and mineral fortified commercial Turkish bread led to remarkable increase in the blood vitamin and mineral concentrations, apart from folic acid. Conclusion: Although this pilot study has several limitations in terms of study design, the study results indicate a need for the long term and large scale randomised studies for a clear definition of the effects of fortified bread in daily nutrition.

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1. WHO. Fortification of flour to control iron deficiencies in the Middle East and North Africa. Report of a Joint WHO/UNICEF/MI/ILSI Workshop Beirut, 13-16 June 1998. Alexandri, WHO Regional Office for the Eastern Mediterranean; 1999. 2. Açkurt F, Wetherilt H, Löker M, Hacıbekiroğlu M. Biochemical assessment of nutritional status in pre-and post-natal Turkish women and outcome of pregnancy. Eur J Clin Nutr 1995;49:613-622. 3. Pekcan G. Food and nutrition policies: whats being done in Turkey. Public Health Nutr 2006;9(1A):158 162. 4. FAO. Food Fortification: Technology and Quality Control. Rome, FAO Food and Nutrition Paper; 1996. 5. Liberato SC, Pinheriro-Santana HM. Fortification of industrialized foods with vitamins, Rev Nutr, 2006; 19 (2), 215-231. 6. Hertrampf E, Cortes FF, Erickson JD, Cayazzo M, Freire W, Bailey LB, Howson C, Kauwell GA, Pfeiffer C. Consumption of folic acidfortified bread improves folate status in women of reproductive age in Chile, J Nutr 2003;133: 31663169. 7. Czeizel AE. Bread is fortified with folic acid in Hungary, BMJ 2002;325(7360):391. 8. Köksal O. Nutrition in Turkey-national nutrition-health and food consumption survey of Turkey 1974. Ankara, UNICEF; 1977. 9. TMO. Türkiyede ekmek israfı araştırması. Ankara, Toprak Mahsulleri Ofisi Genel Müdürlüğü, Ocak, 2013. 10. DPT. Ulusal gıda ve beslenme stratejisi çalışma grubu raporu. Ankara, DPT; 2003. 11. UNICEF. UNICEF and the Flour Fortification Initiative Support Improving Iron Status through Flour Fortification. Press Centre; 6/2012. Available online at http://www.unicef.org.tr/basinmerkezidetay. aspx?id=2244&dil=en&d=1 12. TBSA. Turkey Nutrition and Health Survey 2010. Ankara, Republic of Turkey Ministry of Health, General Directorate of Health Surveys, Hacettepe University Faculty of Health Sciences Department of Nutrition and Dietetics;2014. Available online at http://www.sagem. gov.tr/TBSA_Beslenme_Yayini.pdf 13. Löker GB, Açkurt F, Toklu G. Project report-5034149. Gebze, TÜBİTAK Marmara Research Center; 2003. 14. Johansson M, Witthoft CM, Bruce A, Jagerstad M., Study of wheat breakfast rolls fortified with folic acid- The effect on folate status in women during a 3-month intervention, Eur J Nutr 2002; 41(6): 279-286. 15. Donald S, Young MB. Implementation of SI units for clinical laboratory data. Ann Intern Med 1987;106:114- 129. 16. Hansen M, Samman S, Madsen LT, Jensen M, Soresen SS, Sandström B. Folic acid enrichment of bread does not appear to affect zinc absorption in young women. Am J Clin Nutr 2001;74:125-129. 17. Oshiro I, Takenaka T, Maeda J. New method for haemoglobin determination by using sodium lauryl sulfate (SLS). Clin Biochem 1982;15:83-88. 18. Flegg HM., An investigation of the determination of serum cholesterol by an enzymatic method, Ann Clin Biochem 1973; 10:70-84. 19. Roschlou P. Enzymatic bestimung des gesamtcholesterins in serums. J Clin Chem Biochem 1974;12:403-407. 20. Kunst A. UV methods with hexokinase and glucose- 6-phosphate dehydrogenase, Meth Enzym Anal 1983;6:163-172. 21. Talke H, Schubert GE. Enzymaticsche. Blood and serum in optischen test nach Warburg, Klin Wschr 1965;41:174. 22. Bowers GN, McComb RB. A continuous spectrophotometric method for measuring the activity of serum alkaline phosphatase, Clin Chem 1966;12:70. 23. Clin Rep. Instruction manuel for the determination of Vitamin B1 in whole blood by HPLC, Version, 1.3.05/04. Munich, Recipe chemicals+instruments GmbH; 2004. 24. Clin Rep. Instruction manuel for the determination of Vitamin B2 in whole blood by HPLC, Version, 1.0, 08/02. Munich, Recipe chemicals+instruments GmbH; 2002. 25. Clin Rep, Instruction manuel for the determination of Vitamin B6 in plasma/whole blood by HPLC, Version, 1.3. 02/03. Munich. Recipe chemicals+instruments GmbH; 2003. 26. Hofmann P, Brodhag C, Schüep W. Determination of B vitamins in tablets-version 1.2, Roche Vitamins Ltd, pp. 1/5-5/5; 1988. 27. Immundiagnostik AG, Kit-Vitamin C for colorimetric determination of Vitamin C in Li-heparine plasma, serum and urine, Bensheim; Immundiagnostik AG, 2005. 28. AOAC. Official Methods of Analysis of the Association of Official Chemists, 15th ed. Gaithersburg, AOAC; 1995. 29. AOAC. Official Methods of Analysis of AOAC International, 7th ed. Gaithersburg, AOAC; 2000. 30. Roche. Elecsys 2010 System Menu. Germany, Roche Diagnostics; 2005. 31. National Research Council. Subcommittee on the 10th ed. of the RDAs. Washington, National Academy Press; 1989. 32. Baysal A. Beslenme. Ankara, Hatipoğlu Yayınevi; 1996. 33. Winkels R. Dietary folate intake: is there a need for folic acid fortification in the Netherlands? Ph.D. Thesis. Wageningen, Wageningen University; 2008. 34. Rader JI, Weaver CM, Angyal G. Total folate in enriched cereal-grain products in the United States following fortification. Food Chem 2000;70:275-289. 35. Finglas PM, Witthöft CM, Vahteristo L, Wright AJA, Southon S, Mellon FA. et al. Use of an oral/intravenous dual-label stable-isotope protocol to determine folic acid bioavailability from fortified cereal grain foods in women. J Nutr 2002;132:936-939. 36. Cho S, Johnson G, Song WO. Folate content of foods: comparison between databases compiled before and after new FDA fortification requirements. J Food Compost Anal 2002;15(3):293-307. 37. Mills JL, Von Kohorn I, Conley MR, Zeller JA, Cox C, Williamson RE et al. Low vitamin B12 concentrations in patients without anemia: the effect of folic acid fortification of grain. Am J Clin Nutr 2003;77:1474- 1477. 38. Tulchinsky TH, Varavikova EA. The new public health. 2th ed. London, Elsevier Academic Press; 2009. 39. Zimmermann MB, Chaouki N, Hurrell RF. Iron deficiency due to consumption of a habitual diet low in bioavailable iron: a longitudinal cohort study in Moroccan children. Am J Clin Nutr 2005;81:115-121. 40. Ballot DE, Macphail AP, Bothwell TH, Gillooly M, Mayet FG. Fortification of curry powder with NaFe (111) EDTA in an iron-deficient population: report of a controlled iron-fortification trial. Am J Clin Nutr 1989;49:162-169. 41. Nayak B, Nair KM. In vitro bioavailability of iron from wheat flour fortified with ascorbic acid, EDTA and sodium hexametaphosphate, with or without iron. Food Chem 2002;80:545-550. 42. Hallberg L. Does calcium interfere with iron absorption? Am J Clin Nutr 1998;68:34. 43. Mendoza C, Pearson JM, Brown KH, Lönnerdal B. Effect of a micronutrient fortificant mixture and 2 amounts of calcium on iron and zinc absorption from a processed food supplement. Am J Clin Nutr 2004;79:244-250. 44. De Ramana DL, Lönnerdal B, Brown KH. Absorption of zinc from wheat products fortified with iron and either zinc sulphate or zinc oxide. Am J Clin Nutr 2003;78:279-283. 45. Alp A, Ergün C. Evaluation of nutritional policies of some developed countries. Journal of Nutrition and Dietetics 2013;41(1):83-90.