Abstract
To model the potential impact and equity impact of fortifying rice on nutritional adequacy of different subpopulations in Nepal. Using 24-h dietary recall data and a household consumption survey, we estimated: rice intakes; probability of adequacy (PA) of eight micronutrients commonly fortified in rice (vitamin A, niacin (B3), pyridoxine (B6), cobalamin (B12), thiamin (B1), folate (B9), Fe and Zn) plus riboflavin (B2), vitamin C and Ca and mean probability of adequacy (MPA) of these micronutrients. We modelled: no fortification; fortification of purchased rice, averaged across all households and in rice-buying households only. We compared adequacy increases between population subgroups. (i) Dhanusha and Mahottari districts of Nepal (24-h recall) and (ii) all agro-ecological zones of Nepal (consumption data). (i) Pregnant women (n 128), mothers-in-law and male household heads; (ii) households (n 4360). Unfortified diets were especially inadequate in vitamins B12, A, B9, Zn and Fe. Fortification of purchased rice in rice-purchasing households increased PA > 0·9 for thiamin, niacin, B6, folate and Zn, but B12 and Fe remained inadequate even after fortification (PA range 0·3-0·9). Pregnant women's increases exceeded men's for thiamin, niacin, B6, folate and MPA; men had larger gains in vitamin A, B12 and Zn. Adequacy improved more in the hills (coefficient 0·08 (95 % CI 0·05, 0·10)) and mountains (coefficient 0·07 (95 % CI 0·01, 0·14)) but less in rural areas (coefficient -0·05 (95 % CI -0·09, -0·01)). Consumption of purchased fortified rice improves adequacy and gender equity of nutrient intake, especially in non-rice-growing areas.
Highlights
Response rate and respondent characteristics The Low Birth Weight South Asia Trial (LBWSAT) sample included 150 households out of 199 eligible households visited, and we modelled potential effects of rice fortification on 128 households (1230 dietary recalls from 384 individuals) because twenty-two households had missing information on rice purchase
Incorporation of self-reported activity levels to adjust adult male equivalents (AME) does not appear to increase agreement between observed and predicted intakes. This is the first study to model the potential effects of rice fortification on probability of micronutrient adequacy and to examine its equity implications
We find that Nepalese unfortified diets are inadequate, and rice is consumed in high quantities, making rice suitable for fortification
Summary
Between June and September 2015, we collected individual 24-h dietary recalls of pregnant women, their mothers-in-law and male household heads, in Dhanusha and Mahottari districts in province 2(35–39), as part of the Low Birth Weight South Asia Trial (LBWSAT)(40,41). 19 September 2014 and 16 July 2015, the third Nepal Annual Household Survey (AHS III) estimated 7-d household food consumption for a nationally representative sample of households[42] These two studies provide rich data to estimate the potentially differential benefits of rice fortification in different population subgroups. For AHS III, daily usual intakes were 1/7 of weekly intakes For both datasets, we calculated PA by comparing intakes (apart from Fe for non-pregnant women) with known nutrient requirement means (estimated average requirements (EAR)) and SD[57,58,59,60]. Since the AHS III analyses rely on AME to estimate individual intakes, we used LBWSAT data to measure the agreement between observed and predicted intakes for pregnant women, their mothers-in-laws and male household heads with and without adjustments for pregnancy, physical activity levels and body weight.
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