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Iron Pots for the Treatment of Iron Deficiency
Anemia: Is there Sufficient Favorable Evidence?
Francisco Plácido Nogueira Arcanjo*, Cecília Costa Arcanjo and Paulo Roberto Santos
PhD, Universidade Federal do Ceará, Brazil
Submission: December 21, 2018; Published: March 13, 2019
*Corresponding author: Francisco Plácido Nogueira Arcanjo, Universidade Federal do Ceará, Campus Sobral, Av. Comandante Maurocélio Rocha Ponte, 100, Derby, 62.042-280, Sobral-CE, Brazil
How to cite this article: Francisco P N A, Cecília C A, Paulo R S. Iron Pots for the Treatment of Iron Deficiency Anemia: Is there Sufficient Favorable Evidence?. Nutri Food Sci Int J. 2019. 8(3): 555738. DOI:10.19080/NFSIJ.2019.08.555738.
In the last years, there has been increasing interest in the development of affordable, easy-to-implement interventions to control the prevalence of iron deficiency anemia, due to the magnitude of this nutritional deficiency and knowledge of its effects on quality of life, morbidity and mortality. Previous studies have demonstrated that cooking food in cast iron pots could be efficacious in reducing the incidence of iron deficiency and iron deficiency anemia. This review highlights the results from the main published clinical trials on the effect of preparing food in cast-iron pots on hemoglobin concentrations and anemia prevalence rates, and their acceptability for cooking.
Keywords: Anemia; Iron Deficiency; Iron Pots; Nutrition; Review
Iron deficiency anemia (IDA) results from lack of sufficient iron within the body leading to a decrease in mean hemoglobin (Hb) concentration, volume and size. IDA is typically caused by inadequate intake of iron, chronic blood loss, or a combination of both . In the world, anemia affects almost 2 billion people and the majority of these live-in developing countries. Infants, children and women of reproductive age are especially at risk due to their increased nutrition needs [2,3]. In terms of public health, the negative repercussions of IDA are particularly serious as it is associated to inhibited growth, low birth weight, poor psychomotor and cognitive development, compromised immunity and increased infant morbidity and mortality [4-6].
Over the years, researchers have sought strategies to prevent and control IDA; however high IDA prevalence rates still persist in populations around the world, justifying the search for new strategies. One such strategy is the use of iron pots for cooking food. Up to date, different researchers have sought to assess the effect of cooking food in iron pots and its influence on hemoglobin concentrations in the blood with varying results, and a recently published paper has once again called into discussion this known but less popular method of iron supplementation . The aim of this study is to conduct a review on the effect of preparing food in cast-iron pots on Hb concentrations and anemia prevalence rates, and the acceptability of these for cooking.
As far as this review could determine, there is a relatively
small number of published clinical trials on this theme. The
main findings of which are summarized in this review and
presented in Table 1 in order to simplify comparisons. In one
randomized controlled clinical trial, Borigato et al.  assessed
the efficacy of cooking food in iron pots for the prevention of
anemia in premature infants aged 4 to 12 months (postnatal
age). After intervention, the infants fed with food cooked in
iron pots had significantly better hematologic values compared
to the aluminum pots group, and lower IDA prevalence rates
(36.4 vs. 73.9%). Adish et al.  conducted a community-based
randomized trial to assess the effect of cooking in iron cooking
pots compared to aluminum pots in Ethiopian children aged
2-5 years. At the end of the 12-month intervention, hemoglobin
concentrations of participants in the iron-pot group was 1.7g/
dL higher than at baseline (p=0.008), which represented an
adjusted difference of 1.3g/dL (p<0.001) between the groups.
Furthermore, in the iron-pot group, anemia prevalence rates
(hemoglobin <11g/dL) decreased from 57% to 13%, while the
rate in the aluminum-pot group fell much less, from 55% to
All numbers are absolute, unless otherwise stated.
p-value baseline - end-line
n.a. not available
Geerlings et al.  performed a community-based
randomized trial to compare the effects of cooking food in
iron pots with aluminum pots in an area with high malaria
prevalence. Results from the study showed that adults (age
≥ 12 years) in the iron pots group presented a significant
increase in Hb levels after 6 weeks, this difference remained
significant after 20 weeks (iron + 5.3g/l vs. aluminum -2.2g/l,
mean difference 7.5g/l, p=0.01); children (age < 12 years)
showed an improvement in iron deficiency with no significant
increase in Hb levels, possibly due to high malaria and parasite
A cluster-randomized clinical trial was conducted in
Benin with young children (aged 6-24 months), adolescent
girls (aged 11-15 years) and women of reproductive age (15-
44 years). Individuals were randomly assigned to one of three
intervention groups: cast iron cooking pot, blue steel cooking pot or control. Participants in the control group received
either SprinklesTM or iron tablets. However, the results
from this study were inconclusive regarding the efficacy of
cooking food in iron pots to reduce IDA . Another cluster
randomized clinical trial, performed by Arcanjo et al.  with
preschoolers aged 4 to 5 years, examined the effect of preparing
food in iron pots on Hb concentrations. In the iron pots group,
there was a non-significant increase in mean Hb concentration
(0.04g/dL); however, there was a greater reduction in anemia
prevalence (from 12.2 to 8.5%) than in the aluminum pots
group. Furthermore, when only anemic preschoolers were
analyzed there was a significant mean increase in mean Hb
concentration, 1.69g/ dL (<0.0001).
A pilot study to develop iron rich snacks using iron pots
compared to Teflon coated non-stick pots was conducted by
Kulkarni et al. . In this randomized trial, the efficacy of the
snack was examined according to the Hb status of preschool
children during a 3-month intervention. After intervention
there was a significant increase (7.9 %) in mean hemoglobin,
(from 10.1±1.6 to 10.9±1.7), serum iron and transferrin
saturation. Moreover, anemia prevalence reduced from 73%
at baseline to 54% at end-line. Another innovative trial by
Rappaport et al.  assessed the use of a reusable fish-shaped
iron ingot designed for home cooking and shaped like a fish.
This randomized controlled trial in rural Cambodian anemic
women (aged 18-49 y) was to explore the effect of cooking who
with the iron ingot compared with a daily iron supplement or
control after 1 year; however, no significant difference was
observed in mean hemoglobin concentrations between the
iron-ingot group, the iron-supplement group or the control
group at the end of the intervention.
Since iron pots may provide an innovative method to
address IDA, other studies have been carried out to assess
the acceptability of these for cooking. In one randomized trial
study, by Prinsen Geerligs et al. , to evaluate acceptability,
compliance and attitude towards the use of iron pots versus
aluminum pots for cooking in two rural Malawian villages,
the authors concluded that iron pots did not constitute an
appropriate a strategy to reduce IDA in rural Malawian
households due to their low acceptability when aluminum
pots were available. The researchers added that to increase
the acceptability of the iron pots a number of actions could be
considered such as the absence of aluminum pots in order to
reduce selection preference, and their introduction with clear
instructions on best practice for pot use.
Another intervention trial was conducted by Tripp et al.
 to assess the acceptability of iron pots for cooking in three
refugee camps in western Tanzania. It was identified that iron
pots were unpopular since they were heavier, more prone to
rusting and more difficult to wash than stainless steel pots.
The researchers alerted that the low usage of iron-alloy pots
may lead to selling in poor populations, especially those with
access to other pots.
IDA is a global public health problem, which is associated
with an increased risk of morbidity and mortality, especially
in pregnant women and children under five years of age.
Consequently, there is an urgent need for innovative, lowcost
interventions to treat and prevent anemia in these at-risk
populations. From this review, the authors witnessed that
cooking food in iron pots was beneficial to Hb concentrations
in young children up to the age of 5 years. In communities
with high prevalence rates of anemia, where other iron
supplementation or fortification programs may be impractical,
cooking in iron pots may provide a simple, useful and costeffective
strategy to tackle IDA. However, educational
programs would be necessary to elicit the importance and
relevance of cooking in iron pots. Nevertheless, large scale
interventions in different populations are necessary to
confirm the effectiveness of this intervention on hemoglobin
concentrations in at-risk populations.