5.1.6 Safety issuesConcern has been raised about increased iron intakes, particularly in terms ofthe potential effects on infection rates and on the risk of cardiovascular diseaseand cancer. Much of this concern, however, relates to the use of pharmaceutical iron supplements and not to fortified foods.A recent review of intervention studies with iron-fortified milk or cereals, concluded that iron fortification did not increase infectious morbidity in childrenunder 18 months of age (251). Studies in Chile (252), Hungary (253) and SouthAfrica (254) reported that iron added to milk formula had no influence on infectious outcome. Only one study, conducted in a poor community in Chile,reported an increase in episodes of diarrhoea in young infants fed iron-fortifiedformula (255). On balance, studies have indicated that iron fortification of milkformula is safe (251).It has been suggested that higher levels of iron intake and elevated body storesare potential risk factors for both coronary heart disease (CHD) and cancer.Results from studies carried out over the last 10 years to test this hypothesis are,however, inconclusive. The association between serum ferritin and risk of CHDhas been examined in at least 12 studies, but a meta-analysis of such evidencefailed to establish a strong relationship between the two (256). Inflammatoryresponse is an important risk factor for CHD and also increases serum ferritin,which might explain why an association between the risk of CHD and increased
serum ferritin is sometimes observed.
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