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July 15, 1974

Iron Fortification of Wheat Flour

Author Affiliations

Scripps Clinic and Research Foundation La Jolla, Calif

JAMA. 1974;229(3):265-266. doi:10.1001/jama.1974.03230410011003

To the Editor.—  Dr. Butterworth is aware that iron-deficiency anemia is not diagnosed by any measurement of hemoglobin. Many diseases can cause anemia. Serum iron is a better index of iron deficiency than hemoglobin is. Using figures from the Ten-State Survey1 and from the Health and Nutrition Examination Survey (HANES),2 one can demonstrate that these women with anemia and low serum iron values comprise only 1% of those tested. It is obvious that this calculation errs by understating the amount of iron deficiency. Both exaggerations, the 23% and the 1%, indicate that the standards and conclusions of the two surveys were not scientifically derived nor wisely interpreted. It is equally unwise and unscientific to employ such information as a data base from which to mandate increases of iron in the American diet.Dr. Butterworth chides me for implying that this program would increase the iron in diets to